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LEUKEMI S

Normal human blood

White Cell Red Cell

Platelet

Blood with leukemia

BlastsRed Cell

Platelet

White Cell

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DEVELOPMENT OF LEUKEMIA

IN THE BLOODSTREAM

Stage 1- Normal Stage 2- Symptoms Stage 3- Diagnosis

Stage 4- Worsening

Stage 5a- Anemia

Stage 5b- Infection

Legend

White Cell

Red Cell

PlateletBlast

Germ Sources from  Leukemia, by D. Newton and D. Siegel

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1. ACUTE MYELOID LEUKEMIA

(AML)

It results from a defect inthe hematopoetic stem

cell that differentiatesinto all myeloid cells  – monocytes, granulocytes( neutrophils, basophils,

eosinophils )erythrocytes andplatelets.

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Cont…. 

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CLINICAL MANIFESTATION

Fever and infectionfrom neutropenia

Bleeding tendencies

from thrombocytopenia Weakness and fatigue

from anemia

Pain from enlarged liver

or spleen Hyperplasia of gums

Bone pain fromexpansion of marrow

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MEDICAL MANAGEMENT

INDUCTION THERAPY:Involves high doses of

Cytarabine ( cytosar) and Daunarubicin(cerubidin) or Idarubicin (idamycin) to eradicate

the leukemic cells.

CONSOLIDATION THERAPY (post remission) :

For this, multiple

treatment cycles of various agents are used ,usually containing some form of cytarabine ( eg.Cytosar, ara-c) frequently, patient receives onecycle of treatment at a lower dosage resulting inless toxicity.

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Supportive careincludes  – 

 Administering

blood products(PRBCs and platelets)and promptly treating

infections.

BMT

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2. CHRONIC MYELOID

LEUKEMIA 

 CML originate in thepluripotent stem cell or it arisesfrom a mutation in the myeloidstem cell.

 Normal myeloid cells continueto be produced , but then ispathologic increase in theproduction of forms of blastcells. Therefore a widespectrum of cell types existswithin the blood, from blastforms through mature

neutrophils.

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CLINICAL MANIFESTATIONS

CBC  –Leukocyte count greaterthan 100,000/mm

Short of breath or slightly confuseddue to decrease capillaryperfusion to the lungs and brainfrom leukostasis.

Enlarged tender spleen

Sometimes malaise, anorexia ,weight loss.

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MANAGEMENT 

Treatment is usually divided into 4 areas:

1. Stem cell transplantation

2. Interferon alpha therapy with or without

chemotherapy

3. Single agent chemotherapy ( hydroxyurea)

4. The use of specific Tyrosine kinase

inhibitors

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Cont….. 

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The goal of therapy in the chronic phase is tocontrol leukocytosis and thrombocytosis.

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APHERESIS

LEUKAPHERESISSPLENECTOMY 

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Most widely used medicationsare interferon alphaadministered IV or SC andhydroxyurea administeredorally.

Clients with blast crisis requireintensive chemotherapy withsame agent as in acuteleukemia

Targeted therapy: Imatinibmesylate ( Gleevec) inhibitsproliferation

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Thank you