《急性白血病》课件
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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。