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LeukemiaLeukemia
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LeukemiaLeukemia
A group of malignant disorders affectingthe blood and blood-forming tissues ofA group of malignant disorders affectingthe blood and blood-forming tissues of
–Bone marrow–Bone marrow
–Lymph system–Lymph system
–Spleen–Spleen
Occurs in all age groupsOccurs in all age groups
A group of malignant disorders affectingthe blood and blood-forming tissues ofA group of malignant disorders affectingthe blood and blood-forming tissues of
–Bone marrow–Bone marrow
–Lymph system–Lymph system
–Spleen–Spleen
Occurs in all age groupsOccurs in all age groups
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LeukemiaLeukemia
Results in an accumulation ofdysfunctional cells because of a loss ofregulation in cell divisionResults in an accumulation ofdysfunctional cells because of a loss ofregulation in cell division
Fatal if untreatedFatal if untreated
–Progressive–Progressive
Results in an accumulation ofdysfunctional cells because of a loss ofregulation in cell divisionResults in an accumulation ofdysfunctional cells because of a loss ofregulation in cell division
Fatal if untreatedFatal if untreated
–Progressive–Progressive
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LeukemiaLeukemia
Often thought of as a childhood diseaseOften thought of as a childhood disease
The number of adults affected withleukemia is 10 times that of childrenThe number of adults affected withleukemia is 10 times that of children
Often thought of as a childhood diseaseOften thought of as a childhood disease
The number of adults affected withleukemia is 10 times that of childrenThe number of adults affected withleukemia is 10 times that of children
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LeukemiaEtiology and PathophysiologyLeukemiaEtiology and Pathophysiology
No single causative agentNo single causative agent
Most from a combination of factorsMost from a combination of factors
–Genetic and environmental influences–Genetic and environmental influences
No single causative agentNo single causative agent
Most from a combination of factorsMost from a combination of factors
–Genetic and environmental influences–Genetic and environmental influences
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LeukemiaEtiology and PathophysiologyLeukemiaEtiology and Pathophysiology
Associated with the development ofleukemiaAssociated with the development ofleukemia
–Chemical agents–Chemical agents
–Chemotherapeutic agents–Chemotherapeutic agents
–Viruses–Viruses
–Radiation–Radiation
–Immunologic deficiencies–Immunologic deficiencies
Associated with the development ofleukemiaAssociated with the development ofleukemia
–Chemical agents–Chemical agents
–Chemotherapeutic agents–Chemotherapeutic agents
–Viruses–Viruses
–Radiation–Radiation
–Immunologic deficiencies–Immunologic deficiencies
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LeukemiaClassificationLeukemiaClassification
Acute versus chronicAcute versus chronic
–Cell maturity–Cell maturity
•Acute: clonal proliferation of immaturehematopoietic cells (the formation ofblood or blood cells )•Acute: clonal proliferation of immaturehematopoietic cells (the formation ofblood or blood cells )
•Chronic: mature forms of WBC; onset ismore gradual•Chronic: mature forms of WBC; onset ismore gradual
–Nature of disease onset–Nature of disease onset
Acute versus chronicAcute versus chronic
–Cell maturity–Cell maturity
•Acute: clonal proliferation of immaturehematopoietic cells (the formation ofblood or blood cells )•Acute: clonal proliferation of immaturehematopoietic cells (the formation ofblood or blood cells )
•Chronic: mature forms of WBC; onset ismore gradual•Chronic: mature forms of WBC; onset ismore gradual
–Nature of disease onset–Nature of disease onset
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LeukemiaClassificationLeukemiaClassification
Type of white blood cell (WBC)Type of white blood cell (WBC)
–Acute lymphocytic leukemia (ALL)–Acute lymphocytic leukemia (ALL)
–Acute myelogenous leukemia (AML)–Acute myelogenous leukemia (AML)
•Also called acute nonlymphoblasticleukemia (ANLL)•Also called acute nonlymphoblasticleukemia (ANLL)
–Chronic myelogenous leukemia (CML)–Chronic myelogenous leukemia (CML)
–Chronic lymphocytic leukemia (CLL)–Chronic lymphocytic leukemia (CLL)
Type of white blood cell (WBC)Type of white blood cell (WBC)
–Acute lymphocytic leukemia (ALL)–Acute lymphocytic leukemia (ALL)
–Acute myelogenous leukemia (AML)–Acute myelogenous leukemia (AML)
•Also called acute nonlymphoblasticleukemia (ANLL)•Also called acute nonlymphoblasticleukemia (ANLL)
–Chronic myelogenous leukemia (CML)–Chronic myelogenous leukemia (CML)
–Chronic lymphocytic leukemia (CLL)–Chronic lymphocytic leukemia (CLL)
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Myelogenous LeukemiaMyelogenous Leukemia
Leukemia characterized by proliferationof myeloid tissue (as of the bone marrowand spleen) and an abnormal increase inthe number of granulocytes, myelocytes,and myeloblasts in the circulating bloodLeukemia characterized by proliferationof myeloid tissue (as of the bone marrowand spleen) and an abnormal increase inthe number of granulocytes, myelocytes,and myeloblasts in the circulating blood
Leukemia characterized by proliferationof myeloid tissue (as of the bone marrowand spleen) and an abnormal increase inthe number of granulocytes, myelocytes,and myeloblasts in the circulating bloodLeukemia characterized by proliferationof myeloid tissue (as of the bone marrowand spleen) and an abnormal increase inthe number of granulocytes, myelocytes,and myeloblasts in the circulating blood
Myeloid tissue is a biologic tissue with theability to perform hematopoiesis. It is mainlyfound as the red bone marrow in bones, and isoften synonymous with this. However, myeloidcan also be present in the liver and spleen .Myeloid tissue is a biologic tissue with theability to perform hematopoiesis. It is mainlyfound as the red bone marrow in bones, and isoften synonymous with this. However, myeloidcan also be present in the liver and spleen .
A myelocyte is a young cell of the granulocyticseries, occurring normally in bone marrow, butnot in circulating blood (except when caused bycertain diseases).A myelocyte is a young cell of the granulocyticseries, occurring normally in bone marrow, butnot in circulating blood (except when caused bycertain diseases).
Myeloid tissue is a biologic tissue with theability to perform hematopoiesis. It is mainlyfound as the red bone marrow in bones, and isoften synonymous with this. However, myeloidcan also be present in the liver and spleen .Myeloid tissue is a biologic tissue with theability to perform hematopoiesis. It is mainlyfound as the red bone marrow in bones, and isoften synonymous with this. However, myeloidcan also be present in the liver and spleen .
A myelocyte is a young cell of the granulocyticseries, occurring normally in bone marrow, butnot in circulating blood (except when caused bycertain diseases).A myelocyte is a young cell of the granulocyticseries, occurring normally in bone marrow, butnot in circulating blood (except when caused bycertain diseases).
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Granulocytes are a category of whiteblood cells characterized by the presenceof granules in their cytoplasm.[1] They arealso called polymorphonuclear leukocytes(PMN or PML) because of the varyingshapes of the nucleus, which is usuallylobed into three segments.Granulocytes are a category of whiteblood cells characterized by the presenceof granules in their cytoplasm.[1] They arealso called polymorphonuclear leukocytes(PMN or PML) because of the varyingshapes of the nucleus, which is usuallylobed into three segments.
Granulocytes are a category of whiteblood cells characterized by the presenceof granules in their cytoplasm.[1] They arealso called polymorphonuclear leukocytes(PMN or PML) because of the varyingshapes of the nucleus, which is usuallylobed into three segments.Granulocytes are a category of whiteblood cells characterized by the presenceof granules in their cytoplasm.[1] They arealso called polymorphonuclear leukocytes(PMN or PML) because of the varyingshapes of the nucleus, which is usuallylobed into three segments.
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Acute Myelogenous Leukemia(AML)Acute Myelogenous Leukemia(AML)
Leukemia characterized by proliferation of myeloidtissue (as of the bone marrow and spleen) and anabnormal increase in the number of granulocytes,myelocytes, and myeloblasts in the circulating bloodLeukemia characterized by proliferation of myeloidtissue (as of the bone marrow and spleen) and anabnormal increase in the number of granulocytes,myelocytes, and myeloblasts in the circulating blood
One fourth of all leukemiasOne fourth of all leukemias
–85% of the acute leukemias in adults–85% of the acute leukemias in adults
Abrupt, dramatic onsetAbrupt, dramatic onset
–Serious infections, abnormal bleeding–Serious infections, abnormal bleeding
Uncontrolled proliferation of myeloblastsUncontrolled proliferation of myeloblasts
–Hyperplasia of bone marrow and spleen–Hyperplasia of bone marrow and spleen
Leukemia characterized by proliferation of myeloidtissue (as of the bone marrow and spleen) and anabnormal increase in the number of granulocytes,myelocytes, and myeloblasts in the circulating bloodLeukemia characterized by proliferation of myeloidtissue (as of the bone marrow and spleen) and anabnormal increase in the number of granulocytes,myelocytes, and myeloblasts in the circulating blood
One fourth of all leukemiasOne fourth of all leukemias
–85% of the acute leukemias in adults–85% of the acute leukemias in adults
Abrupt, dramatic onsetAbrupt, dramatic onset
–Serious infections, abnormal bleeding–Serious infections, abnormal bleeding
Uncontrolled proliferation of myeloblastsUncontrolled proliferation of myeloblasts
–Hyperplasia of bone marrow and spleen–Hyperplasia of bone marrow and spleen
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Acute Lymphocytic Leukemia(ALL)Acute Lymphocytic Leukemia(ALL)
Most common type of leukemia inchildrenMost common type of leukemia inchildren
15% of acute leukemia in adults15% of acute leukemia in adults
Immature lymphocytes proliferate in thebone marrowImmature lymphocytes proliferate in thebone marrow
Most common type of leukemia inchildrenMost common type of leukemia inchildren
15% of acute leukemia in adults15% of acute leukemia in adults
Immature lymphocytes proliferate in thebone marrowImmature lymphocytes proliferate in thebone marrow
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Acute Lymphocytic LeukemiaAcute Lymphocytic Leukemia
Signs and symptoms may appearabruptlySigns and symptoms may appearabruptly
–Fever, bleeding–Fever, bleeding
Insidious with progressiveInsidious with progressive
–Weakness, fatigue–Weakness, fatigue
Central nervous system manifestationsCentral nervous system manifestations
Signs and symptoms may appearabruptlySigns and symptoms may appearabruptly
–Fever, bleeding–Fever, bleeding
Insidious with progressiveInsidious with progressive
–Weakness, fatigue–Weakness, fatigue
Central nervous system manifestationsCentral nervous system manifestations
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Chronic Myelogenous Leukemia(CML)Chronic Myelogenous Leukemia(CML)
Excessive development of matureneoplastic granulocytes in the bonemarrowExcessive development of matureneoplastic granulocytes in the bonemarrow
–Move into the peripheral blood inmassive numbers–Move into the peripheral blood inmassive numbers
–Ultimately infiltrate the liver andspleen–Ultimately infiltrate the liver andspleen
Excessive development of matureneoplastic granulocytes in the bonemarrowExcessive development of matureneoplastic granulocytes in the bonemarrow
–Move into the peripheral blood inmassive numbers–Move into the peripheral blood inmassive numbers
–Ultimately infiltrate the liver andspleen–Ultimately infiltrate the liver andspleen
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Chronic Myelogenous LeukemiaChronic Myelogenous Leukemia
Philadelphia chromosomePhiladelphia chromosome
–The chromosome abnormality thatcauses chronic myeloid leukemia(CML) (9 &22)–The chromosome abnormality thatcauses chronic myeloid leukemia(CML) (9 &22)
–Genetic marker–Genetic marker
Chronic, stable phase followed by acute,aggressive (blastic) phaseChronic, stable phase followed by acute,aggressive (blastic) phase
Philadelphia chromosomePhiladelphia chromosome
–The chromosome abnormality thatcauses chronic myeloid leukemia(CML) (9 &22)–The chromosome abnormality thatcauses chronic myeloid leukemia(CML) (9 &22)
–Genetic marker–Genetic marker
Chronic, stable phase followed by acute,aggressive (blastic) phaseChronic, stable phase followed by acute,aggressive (blastic) phase
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Chronic Lymphocytic Leukemia(CLL)Chronic Lymphocytic Leukemia(CLL)
Production and accumulation offunctionally inactive but long-lived,mature-appearing lymphocytesProduction and accumulation offunctionally inactive but long-lived,mature-appearing lymphocytes
B cell involvementB cell involvement
Lymph node enlargement is noticeablethroughout the bodyLymph node enlargement is noticeablethroughout the body
–↑ incidence of infection–↑ incidence of infection
Production and accumulation offunctionally inactive but long-lived,mature-appearing lymphocytesProduction and accumulation offunctionally inactive but long-lived,mature-appearing lymphocytes
B cell involvementB cell involvement
Lymph node enlargement is noticeablethroughout the bodyLymph node enlargement is noticeablethroughout the body
–↑ incidence of infection–↑ incidence of infection
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Chronic Lymphocytic LeukemiaChronic Lymphocytic Leukemia
Complications from early-stage CLL israreComplications from early-stage CLL israre
–May develop as the disease advances–May develop as the disease advances
–Pain, paralysis from enlarged lymphnodes causing pressure–Pain, paralysis from enlarged lymphnodes causing pressure
Complications from early-stage CLL israreComplications from early-stage CLL israre
–May develop as the disease advances–May develop as the disease advances
–Pain, paralysis from enlarged lymphnodes causing pressure–Pain, paralysis from enlarged lymphnodes causing pressure
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Hairy Cell LeukemiaHairy Cell Leukemia
2% of all adult leukemias2% of all adult leukemias
Usually in males > 40 years oldUsually in males > 40 years old
Chronic disease of lymphoproliferationChronic disease of lymphoproliferation
–B lymphocytes that infiltrate the bonemarrow and liver–B lymphocytes that infiltrate the bonemarrow and liver
2% of all adult leukemias2% of all adult leukemias
Usually in males > 40 years oldUsually in males > 40 years old
Chronic disease of lymphoproliferationChronic disease of lymphoproliferation
–B lymphocytes that infiltrate the bonemarrow and liver–B lymphocytes that infiltrate the bonemarrow and liver
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Hairy Cell LeukemiaHairy Cell Leukemia
Cells have a “hairy” appearanceCells have a “hairy” appearance
Symptoms fromSymptoms from
–Splenomegaly, pancytopenia, infection,vasculitis–Splenomegaly, pancytopenia, infection,vasculitis
TreatmentTreatment
–alpha-interferon, pentostatin,cladribine–alpha-interferon, pentostatin,cladribine
Cells have a “hairy” appearanceCells have a “hairy” appearance
Symptoms fromSymptoms from
–Splenomegaly, pancytopenia, infection,vasculitis–Splenomegaly, pancytopenia, infection,vasculitis
TreatmentTreatment
–alpha-interferon, pentostatin,cladribine–alpha-interferon, pentostatin,cladribine
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Unclassified LeukemiasUnclassified Leukemias
Subtype cannot be identifiedSubtype cannot be identified
Malignant leukemic cells may haveMalignant leukemic cells may have
–Lymphoid, myeloid, or mixedcharacteristics–Lymphoid, myeloid, or mixedcharacteristics
Frequently these patients do not respondwell to treatmentFrequently these patients do not respondwell to treatment
–Poor prognosis–Poor prognosis
Subtype cannot be identifiedSubtype cannot be identified
Malignant leukemic cells may haveMalignant leukemic cells may have
–Lymphoid, myeloid, or mixedcharacteristics–Lymphoid, myeloid, or mixedcharacteristics
Frequently these patients do not respondwell to treatmentFrequently these patients do not respondwell to treatment
–Poor prognosis–Poor prognosis
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LeukemiaClinical ManifestationsLeukemiaClinical Manifestations
Relate to problems caused byRelate to problems caused by
–Bone marrow failure–Bone marrow failure
•Overcrowding by abnormal cells•Overcrowding by abnormal cells
•Inadequate production of normal marrowelements•Inadequate production of normal marrowelements
•Anemia, thrombocytopenia, ↓ numberand function of WBCs•Anemia, thrombocytopenia, ↓ numberand function of WBCs
Relate to problems caused byRelate to problems caused by
–Bone marrow failure–Bone marrow failure
•Overcrowding by abnormal cells•Overcrowding by abnormal cells
•Inadequate production of normal marrowelements•Inadequate production of normal marrowelements
•Anemia, thrombocytopenia, ↓ numberand function of WBCs•Anemia, thrombocytopenia, ↓ numberand function of WBCs
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LeukemiaClinical ManifestationsLeukemiaClinical Manifestations
Relate to problems caused byRelate to problems caused by
–Leukemic cells infiltrate patient’sorgans–Leukemic cells infiltrate patient’sorgans
•Splenomegaly•Splenomegaly
•Hepatomegaly•Hepatomegaly
•Lymphadenopathy•Lymphadenopathy
•Bone pain, meningeal irritation, orallesions (chloromas)•Bone pain, meningeal irritation, orallesions (chloromas)
Relate to problems caused byRelate to problems caused by
–Leukemic cells infiltrate patient’sorgans–Leukemic cells infiltrate patient’sorgans
•Splenomegaly•Splenomegaly
•Hepatomegaly•Hepatomegaly
•Lymphadenopathy•Lymphadenopathy
•Bone pain, meningeal irritation, orallesions (chloromas)•Bone pain, meningeal irritation, orallesions (chloromas)
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LeukemiaDiagnostic StudiesLeukemiaDiagnostic Studies
To diagnose and classifyTo diagnose and classify
–Peripheral blood evaluation (CBC andblood smear)–Peripheral blood evaluation (CBC andblood smear)
–Bone marrow evaluation–Bone marrow evaluation
To identify cell subtype and stageTo identify cell subtype and stage
–Morphologic, histochemical,immunologic, and cytogenic methods–Morphologic, histochemical,immunologic, and cytogenic methods
To diagnose and classifyTo diagnose and classify
–Peripheral blood evaluation (CBC andblood smear)–Peripheral blood evaluation (CBC andblood smear)
–Bone marrow evaluation–Bone marrow evaluation
To identify cell subtype and stageTo identify cell subtype and stage
–Morphologic, histochemical,immunologic, and cytogenic methods–Morphologic, histochemical,immunologic, and cytogenic methods
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LeukemiaCollaborative CareLeukemiaCollaborative Care
Goal is to attain remission (when there isno longer evidence of cancer cells in thebody)Goal is to attain remission (when there isno longer evidence of cancer cells in thebody)
Chemotherapeutic treatmentChemotherapeutic treatment
–Induction therapy–Induction therapy
•Attempt to induce or bring remission•Attempt to induce or bring remission
•Seeks to destroy leukemic cells in thetissues, peripheral blood, bone marrow•Seeks to destroy leukemic cells in thetissues, peripheral blood, bone marrow
•Patient may become critically ill•Patient may become critically ill
–Provide psychological support as well–Provide psychological support as well
Goal is to attain remission (when there isno longer evidence of cancer cells in thebody)Goal is to attain remission (when there isno longer evidence of cancer cells in thebody)
Chemotherapeutic treatmentChemotherapeutic treatment
–Induction therapy–Induction therapy
•Attempt to induce or bring remission•Attempt to induce or bring remission
•Seeks to destroy leukemic cells in thetissues, peripheral blood, bone marrow•Seeks to destroy leukemic cells in thetissues, peripheral blood, bone marrow
•Patient may become critically ill•Patient may become critically ill
–Provide psychological support as well–Provide psychological support as well
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LeukemiaCollaborative CareLeukemiaCollaborative Care
Chemotherapeutic treatment (cont.)Chemotherapeutic treatment (cont.)
–Intensification therapy–Intensification therapy
•High-dose therapy•High-dose therapy
•May be given after induction therapy•May be given after induction therapy
•Same drugs at higher doses and/or otherdrugs•Same drugs at higher doses and/or otherdrugs
Chemotherapeutic treatment (cont.)Chemotherapeutic treatment (cont.)
–Intensification therapy–Intensification therapy
•High-dose therapy•High-dose therapy
•May be given after induction therapy•May be given after induction therapy
•Same drugs at higher doses and/or otherdrugs•Same drugs at higher doses and/or otherdrugs
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LeukemiaCollaborative CareLeukemiaCollaborative Care
Chemotherapeutic treatment (cont.)Chemotherapeutic treatment (cont.)
–Consolidation therapy–Consolidation therapy
•Started after remission is achieved•Started after remission is achieved
•Purpose is to eliminate remainingleukemic cells that may not be evident•Purpose is to eliminate remainingleukemic cells that may not be evident
–Maintenance therapy–Maintenance therapy
•Lower doses of the same drug•Lower doses of the same drug
Chemotherapeutic treatment (cont.)Chemotherapeutic treatment (cont.)
–Consolidation therapy–Consolidation therapy
•Started after remission is achieved•Started after remission is achieved
•Purpose is to eliminate remainingleukemic cells that may not be evident•Purpose is to eliminate remainingleukemic cells that may not be evident
–Maintenance therapy–Maintenance therapy
•Lower doses of the same drug•Lower doses of the same drug
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LeukemiaChemotherapy RegimensLeukemiaChemotherapy Regimens
Combination chemotherapyCombination chemotherapy
–Mainstay treatment–Mainstay treatment
–3 purposes–3 purposes
•↓ drug resistance•↓ drug resistance
•↓ drug toxicity to the patient by usingmultiple drugs with varying toxicities•↓ drug toxicity to the patient by usingmultiple drugs with varying toxicities
•Interrupt cell growth at multiple points inthe cell cycle•Interrupt cell growth at multiple points inthe cell cycle
Combination chemotherapyCombination chemotherapy
–Mainstay treatment–Mainstay treatment
–3 purposes–3 purposes
•↓ drug resistance•↓ drug resistance
•↓ drug toxicity to the patient by usingmultiple drugs with varying toxicities•↓ drug toxicity to the patient by usingmultiple drugs with varying toxicities
•Interrupt cell growth at multiple points inthe cell cycle•Interrupt cell growth at multiple points inthe cell cycle
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Leukemia - Bone Marrow and StemCell TransplantationLeukemia - Bone Marrow and StemCell Transplantation
GoalGoal
–Totally eliminate leukemic cells fromthe body using combinations ofchemotherapy with or without totalbody irradiation–Totally eliminate leukemic cells fromthe body using combinations ofchemotherapy with or without totalbody irradiation
GoalGoal
–Totally eliminate leukemic cells fromthe body using combinations ofchemotherapy with or without totalbody irradiation–Totally eliminate leukemic cells fromthe body using combinations ofchemotherapy with or without totalbody irradiation
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Leukemia - Bone Marrow and StemCell TransplantationLeukemia - Bone Marrow and StemCell Transplantation
Eradicates patient’s hematopoietic stem cellsEradicates patient’s hematopoietic stem cells
Replaced with those of an HLA-matched(Human Leukocyte Antigen)Replaced with those of an HLA-matched(Human Leukocyte Antigen)
•Sibling (is a brother or a sister; that is, anyperson who shares at least one of the sameparents )•Sibling (is a brother or a sister; that is, anyperson who shares at least one of the sameparents )
•Volunteer•Volunteer
•Identical twin•Identical twin
•Patient’s own stem cells removed before•Patient’s own stem cells removed before
Eradicates patient’s hematopoietic stem cellsEradicates patient’s hematopoietic stem cells
Replaced with those of an HLA-matched(Human Leukocyte Antigen)Replaced with those of an HLA-matched(Human Leukocyte Antigen)
•Sibling (is a brother or a sister; that is, anyperson who shares at least one of the sameparents )•Sibling (is a brother or a sister; that is, anyperson who shares at least one of the sameparents )
•Volunteer•Volunteer
•Identical twin•Identical twin
•Patient’s own stem cells removed before•Patient’s own stem cells removed before