Upload
others
View
6
Download
0
Embed Size (px)
Citation preview
Acute leukemia
Kanchana Chansung M.D.
Department of Medicine, Faculty of Medicine,
Khon-Kaen University
Normal Blood smear vs Acute leukemia
Leukemia = White blood
Acute leukemia = Blast count in BM > 20%
ALL
AML
ALL
Investigation for Diagnosis
• CBC
• Bone marrow aspiration
– Wright stained for morphology
– Cytochemistry– Cytochemistry
– Flow cytometry
– Cytogenetics (Chromosome study)
– Molecular study
Cytochemistry
• MPO
• Sudan Black B
• PAS
• NSE
Cytogenetic study
AML
FAB Classification
M0 Undifferentiated acute myeloblastic leukemia
M1 Acute myeloblastic anemia with minimal maturation
M2 Acute myeloblastic leukemia with maturation
M3 Acute promyelocytic leukemia (APL)M3 Acute promyelocytic leukemia (APL)
M4 Acute myelomonocytic leukemia
M4Eo Acute myelomonocytic leukemia with eosinophilia
M5 Acute monocytic leukemia
M6 Acute erythroid leukemia
M7 Acute megakaryoblastic leukemia
AML(M1)
AML (M2) M3 M4
M5a M5b M6 M7
Risk category of AML
(APL,M3)
CD33+, CD13+
Neg/low: CD34, CD11b, CD117, HLA-DR
T(15;17)(q22:q11-12)
expression of CD13, CD19, CD33, CD34, CD117, and HLA-DR .
Acute myeloid leukemia with
the t(8;21)(q22;22).
Acute Megakaryoblastic Leukemia (AML , M7)
48,XY,del(9)(p13),add(11)(q24),+19[1]/50,idem+19,+22[5] and 46,XY[16].
Acute Erythroid Leukemia (M6)
Positive :
Myeloperoxidase,
CD13, CD33, CD36,
CD71, CD117, HLA-DRglycophorin A
Complex chromosome abnormality
Treatment of AML (non M3)
Induction chemo ( IDA3+Ara-C7)1-2 cycles
CR No
CR
Allogeneic -HSCT HiDAC 2-4 cycles Palliative
care
Relapse
Treatment of APL
Induction chemo ( ATRA + IDA) 4-8 weeks
CR No
CRATO
Palliative
care
Relapse
Consolidation
IDA x 3 cycles
Maintenance (chemo + ATRA)
2 years
Outcomes of AML in EUs
Po-Han Lin, et.al., Cancer Medicine, 2017
Outcome of AML in Thailand (N=679)
ALL
ALL(L1)
FAB Classification
ALL(L3)ALL(L2)
T-cell lymphoblastic leukemia
• Young male
• HTLV-1 associated
• Poor prognosis
• Treatment as aggressive lymphoma
Philadelphia chromosome +ve ALL
• 1/3 of adult ALL
• Poor prognosis
• Upfront transplant
• Combination of chemo / TKI maintenance
Burkitt’s leukemia (ALL,L3)• 5% of ALL , EBV associated
• Aggressive , rapid progression
• High risk of tumor lysis syndrome
• Treatment with aggressive short course
chemotherapychemotherapy
Survival of Adult ALL in Thailand
(N=172)
0.50
0.75
1.00 Overall Survival by Type of ALL
0.00
0.25
0.50
0 180 360 540 720analysis time
Ty pe =T-ALL Ty pe =B-ALL
Ty pe = Biphenoty pe Ty pe = Undiff
Survival according to treatments