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Peds18 Leukemia

Peds18 Leukemia

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Published by DrSheika Bawazir

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Published by: DrSheika Bawazir on Oct 05, 2012
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Mahmoud Al-Sheyyab
Fathi Balbisi & Jameel Al-Farah
08 / 12 / 2009
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1 of 600 children will develop cancer in their childhood. Almost 1/3 of these casesis leukemia (i.e. 30% of child malignancy is leukemia) and it is the commonesttype of childhood malignancy.The 2
common cause of childhood malignancy: Brain tumors.The 3
: Neuroblastoma.The 4
: Wilm’s tumor.
 And lastly the 5
Definition:Leukemia is the most common child malignancy clonal expansion .It is blast cellclonal expansion and arrest at a specific stage of lymphoid or myeloidhematopoiesis & differentiation. So, there will be no further differentiation of theseblasts but accumulation of these cells according to the underlying clone. Leukemicexpansion starts in the bone marrow it is inflected first in the peripheral bonema
rrow, which causes leukocytosis, and may cause leucopenia in some cases…
 Any abnormal cell could be a clone for a leukemic transformation. Because of that,there are different types of leukemia, for example: ALL, Pre B, Mature T,Myeloid, promyelocytic, etc.During the process of maturation, there is what we call ((cluster differentiation)),which means that we have CD markers which are antigenic features that appear onthe cell surface during a stage of maturation & disappear during the others
Depending on these antigens, we can differentiate between different cell types &stages of development by using antibodies which are specific to these antigens. Forinstance if the cells had the stem cell markers that would be a leukemia arisingfrom an early stem cell, more over, if it had a B-cell Marker then it is a B-cellleukemia. Hence, each line of cell differentiation can be a site for leukemic clonalexpansion.
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In the above diagram we can see a blast cell (stem cell) which is precursor for theT-cells, B-cells and myeloid cells. We can also notice that each of these cells havespecific antigenic markers that differentiate it from other cells. Antigens arepresent early during the maturation process some of which will disappear othersremain on the surface and others will appear later.You should know that:- Blast cell (stem cell) are CD 34+ e.g. if the leukemic cell are CD 34+ then theclone is very close to the stem cell, hence, very mature.- B-cells are CD 19, 22 and 79a positive (mature B-cells have cell surfaceimmunoglobins).- T-cells are CD 2,3,4,5 and 7 positive (hint; any number less than 8)- Monocytes are CD 14 and 15 positive- DR is a pan cell marker which we use as a marker for blasts.Antigens are important to determine & classify the clone we have and which typeof cells we are dealing with.In the normal bone marrow we can see normal cellularity with no predominance of one cell lineage, with variety of all cells. It is abnormal to see predominance of onespecific type of cell in the bone marrow, hence, there is clonal expansion and therewould be no other cell lineages, other than the leukemic lineage, because therewould be no space (this is called arrest of differentiation). Clonal expansion can

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