Acute & Chronic Myeloid Leukemias neoplastic cells of the hemopoietic system

Acute & Chronic Myeloid Leukemias

• AcuteGlycogen Storage Diseases von Gierke disease, Andersen's disease, McArdle's disease. Read more ... » & ChronicChronic Hepatitis Classification viral hepatitis Clinical features and Treatment. Read more ... » Myeloid Leukemias neoplastic cells of the hemopoietic systemGlycogen Storage Diseases von Gierke disease, Andersen's disease, McArdle's disease. Read more ... »

Acute & Chronic Myeloid Leukemias ,The myeloid leukemias are a group of diseases with infiltration of blood, bone-marrow and other tissues by neoplastic cells of the hemopoietic system

 

 

Acute & Chronic Myeloid Leukemias

 

Acute & Chronic Myeloid Leukemias

• The myeloid leukemias are a group of diseases with infiltration of blood, bone-marrow and other tissues by neoplastic cells of the hemopoietic system.

ACUTE MYELOID LEUKEMIA

• Incidence is higher in men than in women. Incidence increases with age.

Etiolog

 

Acute & Chronic Myeloid Leukemias Etiology –

• Heredity, radiation, chemical and occupa­tional exposure, drugs, virus.
• Certain syndromes are associated with leukemias like Down’s syndromeMetabolic,Insulin Resistance Syndrome X Causes Symptoms. Read more ... », Klinefelter syndrome, Patau syn­drome, Fanconi anemia, Ataxia telangiectasia, Kostmann syndrome.

Acute & Chronic Myeloid Leukemias Classification –

• Acute leukemias are classified on basis of morphology, cytochemistry, cytogenetics and molecular techniques.

Clinical presentation Acute & Chronic Myeloid Leukemias

• Patients with AML(acute myeloid leukemia) present with non-specific symp­toms, gradually or abruptly.
• Presentation may be due to anaemia, leukocytosis, leukopenia, or thrombocytopenia.

Acute & Chronic Myeloid Leukemias Symptoms –

• are fatigueFatigue diagnosis medicine and treatment. Read more ... », weakness, anorexia, weight loss, feverThyrotoxic crisis or Thyroid storm. Read more ... », bleeding, easy bruising, bone pains, lym­phadenopathy, coughInfluenza SARS and Whooping Cough Signs and Symptoms with Diagnosis and Treatment. Read more ... », headacheHeadache. Read more ... », diaphoresis.

Acute & Chronic Myeloid Leukemias Physical findings –

• are fever, splenomegaly, hepatomegalyAlcoholic Liver Disease Diagnosis CAGE criteria and Treatment. Read more ... », lymphadenopathy, sternal tenderness, infection, haemorrhage, GI (gastrointestinal) bleed­ing, intracranial haemorrhage, retinal hemorrhages.
• There may be infiltration of gums, skin, soft tissues, meninges, granulocytic sarcoma in GITAmoebiasis infection Diagnosis Treatment protozoan Entamoeba histolytica Symptoms and Causes. Read more ... », lung, uterus, breast, prostate, mediastinum, and bone.
• Other systems
• which are involved are cardiovascu­lar, hepatic and renalDiabetic Nephropathy and Renal complications of DM (Diabetes Mellitus). Read more ... » systems.
• The most severe and fatal presentation is in acute promyelocytic leukemia (APL) or monocytic AML.

 

Hematological findings

 

Hematological findings

 

• Anaemia – usually normocytic, normochromic. Reduced reticulocyte count.
• Leukocyte count may be 15,000 to 100,000 or some­times more than even 100,000/1J1.
• 20 – 40 per cent of patients have leucocyte count less than 5000/1J1.

 

FAB (French-American-British) classification of AML

• MO M1 M2 M3 M4 M4Eo
• Minimally differentiated leukemia Myeloblastic leukemia without maturation Myeloblastic leukemia with maturation Hypergranular promyelocytic leukemia Myelomonocytic leukemia
• Variant: Increase in abnormal marrow eosinophils
• Monocytic leukemia
• Erythroleukemia (DiGuglielmo’s diseaseGlycogen Storage Diseases von Gierke disease, Andersen's disease, McArdle's disease. Read more ... ») Megakaryoblastic leukemia

Acute & Chronic Myeloid Leukemias Treatment

• The treatmentGlycogen Storage Diseases von Gierke disease, Andersen's disease, McArdle's disease. Read more ... » is divided into 2 phases:
• Induction phase
• Post remission managementChronic Renal Failure (CRF) Risk factors Causes Stage CRF Treatment. Read more ... »
• The goal is to quickly induce CR (complete remis­sion).

Complete remission (CR)

• CR is defined as absence of blast cells in circulation. Blood neutrophil count must be more than 1500/1J1. Platelet count must be more than 100,000/ IJI. Bone-marrow should contain less than 5% blast cells. Auer rods should be absent.
• Standard therapy is 7-day continuous infusion of Cytarabine 100 – 200 mg /sq m / day.
• Patients who achieve CR must be given consolidation therapy with sequential courses of Cytarabine in high doses and allogenic stem cell transplant.
• Patients with APL (acute promyeiocytic leukemia) should receive Tretinoin with anthracycline chemo­therapy (Daunorubicin), and then consolidation che­motherapy with Daunorubicin and Cytarabine, fol­lowed by maintenance with tretinoin.
• ClinicalGlycogen Storage Diseases von Gierke disease, Andersen's disease, McArdle's disease. Read more ... » trials with recombinant hemopoietic growth factors are going on.

Acute & Chronic Myeloid Leukemias Supportive care

• with blood transfusion, platelet transfusion, broad-spectrum antibacterials, and an­tifungals are given.

CHRONIC MYELOGENOUS I MYELOID LEUKEMIA

• The diagnosisGlycogen Storage Diseases von Gierke disease, Andersen's disease, McArdle's disease. Read more ... » ofCML(chronicmyeloid leukemia) is by presence of haematopoietic stem cell with recip­rocal translocation between chromosomes 9 and 22.
• The disease is characterized by elevated white blood cell counts with a majority of immature granu­locytes, which progresses to an accelerated phase and a blast crisis.
• The incidence of CML increases after the age of 40.

Etiology is same as AML

• Clinical presentation Onset is slow, with patients often asymptomatic at diagnosis.
• There is fatigue, malaise, weight loss, splenomegaly, infections, thrombosis, bleeding, cerebrovascular ac­cidents, MI, venous thrombosis, bone and joint pains, splenomegaly, hepatomegaly, lymphadenopathy.

Acute & Chronic Myeloid Leukemias Hematological findings

• White blood cells counts are grossly elevated, imma­ture granulocytes are seen in circulating blood, but small in number i.e. less than 5% blasts and less than 10% promyelocytes are seen in circulating blood.
• Platelet counts may be elevated
• There is increased bone marrow cellularity, of my­eloid and megakaryocytic types.
• Disease acceleration is defined as increasing anaemia, blood or marrow blasts between 10 and 20%, blood or marrow basophils >20%, platelet count less than 100,000/1-11.
• Blast crisis is defined as acute leukemia with blood or marrow blasts more than 20%.

Acute & Chronic Myeloid Leukemias Treatment

• Allogenic stem cell transplant or treatment with ImatinibInterferon
• Chemotherapy with hydroxyurea, 1-4 g/day, halved when leucocyte count reduces by 50%
• Busulphan : alkylating agent, with serious side­effects and therefore not used nowadays
• HHT — Homoharringtonine is a plant alkaloid from Cephalotaxus tree
• Leukapheresis and splenectomy