childhood acute lymphoblastic leukemia
TRANSCRIPT
Leukemias
Seyed Morteza MahmoodiMaryam BulooshiNadia choudhry
Acute Lymphoblastic Leukemia
Acute and Chronic Myelogenous Leukemia
Leukemia with Down syndrome
Contents
Acute Lymphoblastic Leukemia
Contents
INTRODUCTION
TREATMENT
CLASSIFICATION EITIOLOGY
DIAGNOSIS
CLINICAL PRESENTATION
Acute Lymphoblastic Leukemia
Contents
INTRODUCTION
TREATMENT
CLASSIFICATION EITIOLOGY
DIAGNOSIS
CLINICAL PRESENTATION
The most common malignant neoplasms of childhood are………………
INTRODUCTION
The most common malignant neoplasms of childhood are Leukemias.
INTRODUCTION
The most common malignant neoplasms of childhood are Leukemias.
Which one is the commonest type of childhood Leukemias?
AML
ALL
CML
JCML
INTRODUCTION
The most common malignant neoplasms of childhood are Leukemias
Which one is the commonest type of childhood Leukemias?
AML …………….%
ALL …………….%
CML .……………%
JCML …………….%
INTRODUCTION
The most common malignant neoplasms of childhood are Leukemias
Which one is the commonest type of childhood Leukemias?
AML …………….%
ALL 80%
CML .……………%
JCML …………….%
INTRODUCTION
The most common malignant neoplasms of childhood are Leukemias
Which one is the commonest type of childhood Leukemias?
AML 10%
ALL 80%
CML 2-3%
JCML 1-2%
INTRODUCTION
Acute Lymphoblastic Leukemia
Contents
INTRODUCTION
TREATMENT
CLASSIFICATION EITIOLOGY
DIAGNOSIS
CLINICAL PRESENTATION
CLASSIFICATION EITIOLOGY
FAB
WHO
Immunophenotypic
L1 L2
L3
1- Acute lymphoblastic leukemia/lymphoma Synonyms: Former Fab L1/L2
• Precursor B acute lymphoblastic leukemia/lymphoma. Cytogenetic subtypes:
t(12;21)(p12,q22) TEL/AML-1 t(1;19)(q23;p13) PBX/E2A t(9;22)(q34;q11) ABL/BCR T(V,11)(V;q23) V/MLL • Precursor T acute lymphoblastic
leukemia/lymphoma 2-Burkitt's leukemia/lymphoma Synonyms: Former
FAB L3 3-Biphenotypic acute leukemia
CLASSIFICATION EITIOLOGY
B-cell ALL • Early pre-B ALL (pro-B ALL) - 10%• common ALL - 50%• pre-B ALL - 10%• mature B-cell ALL (Burkitt leukemia) - 4% T-cell ALL • pre-T ALL - 5% to 10%• mature T-cell ALL - 15% to 20%
CLASSIFICATION EITIOLOGY
Acute Lymphoblastic Leukemia
Contents
INTRODUCTION
TREATMENT
CLASSIFICATION EITIOLOGY
DIAGNOSIS
CLINICAL PRESENTATION
CLINICAL PRESENTATION
CLINICAL PRESENTATION
Common presentations of all acute Leukemias?
1)2)3)
CLINICAL PRESENTATION
Common presentations of all acute Leukemias?
1) Fever2) Fatigue 3) Bleeding
Feature Percent of Total
Children
Fever 57
Fatigue 50
Bleeding 43
Bone or joint pain 25
Lymphadenopathy 70
Marked (>3 cm) 15
Hepatomegaly 66
Marked (below umbilicus) 17
Splenomegaly 60
Marked (below umbilicus) 17
Mediastinal mass 8
CNS leukemia 3
Testicular leukemia 1
An anterior mediastinal mass Superior vena cava syndrome • Cough, dyspnea, orthopnea, dysphagia, stridor,
cyanosis, facial edema, increased intracranial pressure, syncope
Ocular involvement Cranial nerve palsy Epidural spinal cord compression Enlarged salivary glands (Mikulicz syndrome) Subcutaneous nodules (leukemia cutis) Priapism Infiltration of tonsils, adenoids, appendix, or
mesenteric lymph nodes
CLINICAL PRESENTATION
Differential Diagnosis At early presentations Late presentation CBC picture Microscopic blood picture
Differential Diagnosis Aplastic anemia Idiopathic thrombocytopenic purpura Recent viral infection Infectious mononucleosis Pertussis or parapertussis Small round cell tumors involving the bone
marrow, including neuroblastoma, rhabdomyosarcoma, and retinoblastoma
Juvenile rheumatoid arthritis, rheumatic fever, other collagen diseases, or osteomyelitis
Acute Lymphoblastic Leukemia
Contents
INTRODUCTION
TREATMENT
CLASSIFICATION EITIOLOGY
DIAGNOSIS
CLINICAL PRESENTATION
DIAGNOSIS
DIAGNOSIS
ESR, CRP Bleeding profile Electrolytes LDH LFT RFT Serum Igs Urinalysis
DIAGNOSIS
What should we do if we found blasts?
F_ _ _ C _ _ _ _ _ _ _ _
DIAGNOSIS
FLOW CYTOMETRY
DIAGNOSIS
EGIL-Score for biphenotypic leukemias
Score B-lymphocytic T-lymphocytic Myeloid
2 CD79(cyt/membrane)
CD22(cyt/membrane)
cyt.IgM
CD3(cyt/membrane)
TCR-a/bTCR-g/d
Myelo-peroxidase
(cytopl.)
1 CD19CD10CD20
CD2CD5CD8
CD10
CD13CD33
CDw65
0.5 TdTCD24
CD14CD15CD64
CD117*
B Lineage T Lineage
CD19/CD79a/CD22 CD3 (surface/cytoplasmic)
Pre-pre-B ALL — Precursor T ALL CD1a, CD2, CD5, CD7, CD8, cCD3
Common ALL CD10 (CALLA) Mature T ALL Surface CD3 (plus any other T-cell markers)
Pre-B ALL Cytoplasmic IgM
Mature B-cell ALL
Cytoplasmic or surface Ig
ALLAML
Acute Lymphoblastic Leukemia
Contents
INTRODUCTION
TREATMENT
CLASSIFICATION EITIOLOGY
DIAGNOSIS
CLINICAL PRESENTATION
How much is the cure rate?????????
TREATMENT
Around 85%
TREATMENT
TREATMENT
Remission Induction
Intensification
Maintenance Therapy
Outcomes of treatment A remission (complete remission) Minimal residual disease Active disease
Prognosis Sex Ethnicity Age at diagnosis Whether the cancer has spread to the brain or
spinal cord Initial white blood cell count Response of patient to initial treatment Genetic disorders such as Down's Syndrome ALL subtype Cytogenetics Chromosome translocations
