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Пульмонология, гематология (англ,рус)

Acute leukemia. Stages

nBeginning

nDevelopping

nRemission

full – the level of blasts in the bone marrow les than 5 %, in the blood – absence,

not full – clinical & hematology recovery but blasts are present

nRecidiv

nTerminal

 

Acute leukemia. Clinics

nAnemic syndrome

nHemmoragic syndrome (due to decreasing of platelets)

nInfective & ulcer-necrotic complications (due to decreasing of leukocytes)

nExtra-bone marrow localisation (lymphadenopathia, splenomegalia, leucemic infiltrationsin the skin, CNS, mammory glands, testis)

 

Acute leukemia. Laboratory findings

nPancytopenia with circulating blasts (in 10 % blasts may be absent – aleukemic leukemia)

nThe level of leucocytes may be sometimes little increase

nThe bone marrow is hypercellular & dominated by blasts

 

Acute lymphoblastic leukemia (ALL) - is a cancer of the white blood cells, characterised by the overproduction and continuous multiplication of malignant and immature white blood cells (referred to as lymphoblasts) in the bone marrow. It is a hematological malignancy.

It is fatal if left untreated as ALL spreads into the bloodstream and other vital organs quickly (hence "acute"). It mainly affects young children and adults over 50.

 

This picture shows the darkly-stained lymph cells (lymphoblasts) seen in acute lymphocytic leukemia (ALL), the most common type of childhood leukemia.

 

ALL. Classification

Subtyping of the various forms of ALL is done according to the FAB (French-American-British) classification, which is used for all acute leukemias (including acute myelogenous leukemia, AML).

The FAB classification is:

•ALL-L1: small uniform cells

•ALL-L2: large varied cells

•ALL-L3: large varied cells with vacuoles (bubble-like features)

 

ALL. Treatment

nThe earlier acute lymphocytic leukemia is detected, the more effective the treatment. The aim is to induce a lasting remission, defined as the absence of detectable cancer cells in the body (usually less than 5% blast cells on the bone marrow).

nTreatment for acute leukemia can include chemotherapy, steroids, radiation therapy, intensive combined treatments (including bone marrow or stem cell transplants), and growth factors.

 

ALL. Treatment

Stages:

nInduction

nConsolidation

nCNS prophilaxis

nMaintaince treatment

 

Prognosis

nAdvancements in medical technology and research over the past four decades in the treatment of ALL has improved the overall prognosis significantly from 0 to 20-75 % survival rate, largely due to the continuous development of clinical trials and improvements in bone marrow transplantation (BMT) and stem cell transplanation (SCT) technology.

 

The prognosis for ALL differs between individuals depending on a wide variety of factors:

•Sex: females tend to fare better than males.

•Ethnicity: Caucasians are more likely to develop acute leukemia than African-Americans, Asians and Hispanics and tend to have a better prognosis than non-Caucasians.

•Age at diagnosis: children between 1-10 years of age are most likely to be cured.

•White blood cell count at diagnosis of less than 50,000

•Whether the cancer has spread to the brain or spinal cord

•Morphological, immunological, and genetic subtypes

•Response of patient to initial treatment

•Genetic disorders such as Down's Syndrome

 

Acute myeloid leukemia (AML)

nis a cancer of the myeloid line of white blood cells, characterized by the rapid proliferation of abnormal cells which accumulate in the bone marrow and interfere with the production of normal blood cells.

nAML is the most common acute leukemia affecting adults, and its incidence increases with age. While AML is a relatively rare disease overall, accounting for approximately 1.2% of cancer deaths in the United States, its incidence is expected to increase as the population ages

 

Note multiple Auer rods which are found only in acute myeloid leukemias, either myeloblastic or monoblastic. These rods consist of clumps of azurophilic granule material.

 

 

AML. Classification

nThe two most commonly used classification schemata for AML, as of 2006, are the older French-American-British (FAB) system and the newer World Health Organization (WHO) system.

 

French-American-British classification

nThe French-American-British (FAB) classification system divided AML into 8 subtypes, M0 through to M7, based on the type of cell from which the leukemia developed and its degree of maturity. This is done by examining the appearance of the malignant cells under light microscopy and/or by using cytogenetics to characterize any underlying chromosomal abnormalities. The subtypes have varying prognoses and responses to therapy.

 

nThe eight FAB subtypes are:

•M0 (undifferentiated AML)

•M1 (myeloblastic, without maturation)

•M2 (myeloblastic, with maturation)

•M3 (promyelocytic), or acute promyelocytic leukemia (APL)

•M4 (myelomonocytic)

•M4eo (myelomonocytic together with bone marrow eosinophilia)

•M5 monoblastic leukemia (M5a) or monocytic leukemia (M5b)

•M6 (erythrocytic), or erythroleukemia

•M7 (megakaryoblastic)

 

Acute monocytic leukemia. These lesions are rarely found in chronic leukemia but are a common finding in acute forms. They appear as erythematous infiltrations of the skin, forming papules, macules, and plaques. Pruritus may be present.

World Health Organization classification

nThe World Health Organization (WHO) classification of acute myeloid leukemia attempts to be more clinically useful and to produce more meaningful prognostic information than the FAB criteria.

The WHO subtypes of AML are:

AML with characteristic genetic abnormalities, which includes AML with translocations between chromosome 8 and 21 [t(8;21)], inversions in chromosome 16 [inv(16)], or translocations between chromosome 15 and 17 [t(15;17)]. Patients with AML in this category generally have a high rate of remission and a better prognosis compared to other types of AML.

 

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