LEUKEMIAConcept ofleukemiaClassification of leukemia●Chronic leukemia (CL):Classification of leukemiaChronic leukemiaEpidemiology：incidenceEpidemiology:mortalityEtiologyRisk factors：ACUTE LEUKEIAoutlineThe classification11Acute leukemiaThe traditional classification of AMLTION(FAB)OFThe traditional classification of ALLWHO classification (2001)：AML 1AML with recurrent genetic abnormalities，•AML with t(8;21)(q22;q22),(AML1/ETO)•AML with t(15;17)(q22;q12),(PML/RAR )•AML with inv(16)(p13;q22) or t(16;16)(p13;q22)•AML with t(9;11)(p22;q23);•AML with t(6;9)(p23;q34);•AML with inv(3)(q21q26.2)] or t(3;3)(q21;q26.2)•Megakaryoblastic AML with t(1;22)(p13;q13)•AML with mutated NPM1•AML with mutated CEBPAWHO classification (2001)：AML2，AML with multilineage dysplasia•With prior myelodysplastic syndrome•Without prior myelodysplastic syndrome 3，AML and myelodysplastic syndrome,therapy related4，AML not otherwise categorized•AML minimally differentiation•AML without maturation•AML with maturation•Acute myelomonocytic leukemiaWHO classification (2001) ：AML （continued）4，AML not otherwise categorized •Acute monoblastic and monocytic leukemia•Acute erythroid leukemia•Acute megakaryoblastic leukemia•Acute basophilic leukemia•Acute panmyelosis with myelofibrosis•Myeloid sarcoma5，Acute leukemia of ambiguous lineageWHO classification (2008):ALL•B-lymphoblastic ALL (•Burkitt ALL (corresponds to ALL-L3)•T-cell ALL.ACUTE LEUKEMIA•CLINICAL FEATURESA amount of leukemic cells proliferateout of control.Normal blood cells are suppressed.Clinical features of ALAnemia Bleeding FeverinfiltrationClinical features of ALBleedingAnemiaInfiltrationACUTE LEUKEMIA•LABORATORY FINDINGSLABORATORY FINDINGS•Blood：complete blood countWBCPLT BLASTWBCWBCBLASTBLOODmorphologyBone marrow: morphologyBone marrow: morphologyleukemia cells ( show Auer’s rods )Bone marrow: morphologyBone marrow: morphologyleukemia cells ( show Auer’s rods )Cytochemical Reations in Acute leukemiaALL AML AMoL POX -+~+++ -or +PAS +~+++ -or + -or +NSE -or + +-NaF inhibited <50% NaF inhibited ≥50%NAP +-+++ +or -+ or ++The FAB classification of AMLTION(FAB)OFLABORATORY FINDINGSMICM typing diagnosis •M•I•C•MIMMUNO-PHENOTYPINGIMMUNO-PHENOTYPINGB cell: CD10+, CD19+, CD20+,CD22+, TdT+, HLA-DR+ T cell: CD3+, CD7+, TdT+,Granulocyte：CD13+, CD33+,HLA-DR+, MPO+ Monocyte: CD14+Megakaryocyte: CD41+, CD42+,PPO+Stem cell: CD34+/CD38-Chromosome and Molecular abnormalityin Acute leukemiaChromosome abnormality Affecting gene FABt(8;21)(q22;q22) AML/ETO M2t(15;17)(q22;q21) PML/RARa M3t(11;17)(q22;q21) PLZF/RARa M3inv/del(16)(q22) CBFB/MYH11 M4Eot(variable; 11q23) MLL M4/M5or other t(8;14)(q24;q32) MYC-IgH L3(B)t(9;22)(q34;q11) Bcr/abl CML, ALL,AMLMICM typing diagnosis•M I C MAML2 with t(8;21)(q22;q22),(AML1/ETO) andFL T3-ITD mutationB-lymphoblastic ALL with t(9;22)(q34;q11)Differential Diagnosis•Leukemoid reaction•CMLDifferential Diagnosis•Myelodysplastic syndrome(MDS)Aplastic Anemia：Idiopathic thrombocytopenic purpura（ITP）ACUTE LEUKEMIA•TREATMENT •PROGNOSISTREATMENTSupportive therapyAntileukemic treatmentcomplete remission(CR)✓there are not anemia, fever,hemorrhage and infiltration✓Pb: Hb>100g/L,WBC Induction therapy aim<10×10^9/L,PLT >100×10^9/L✓BM :blasts<5%Postremission therapyreduce the minimalresidual disease（MRD）aimReduce MRD step by step Keep the DFS for long timeLeukemic burden:1011～1012Leukemic burden:106～108Leukemic burden:104(MRD)Treatment for ALL•The 1st step:•the 2nd step:•the 3rd step:Chemotherapy protocols for ALLregimesRemission Induction VP(prednisolone or dexamethasone,vincristine)VDP VP+DNRVDLP VDP+L-aspRemission consolidation VDLPHD-MTX Maintenace therapy chose consolidation protocols,last for 2-3y。
