Acute leukemia

Prepared by:
Student of 7307 group
5th year
3 medical faculty
NMU named after O. Bogomolets
Tanya Marchenko
 What is acute leukemia?

• Acute lymphocytic leukemia

(ALL) is a type of cancer of
the blood and bone
marrow — the spongy tissue
inside bones where blood cells
are made.
• The word "acute" in acute
lymphocytic leukemia comes
from the fact that the disease
progresses rapidly and creates
immature blood cells, rather
than mature ones.
 EPIDEMIOLOGY
• Estimated new cases in the United States in
2016 are 19,950 for AML (1.2% of all new cancer
cases) and 6,590 for ALL (0.4% of all new
cancer cases).
• AML accounts for 10,430 deaths and ALL
accounts for 1,430 deaths annually in the United
States.
• The risk of developing AML increases with
advanced age, the median age being 67 years.
• Seventy-five percent of newly diagnosed patients
with AML are older than 60 years.
• ALL is more common in children; 60% to 70%
are diagnosed in patients younger than 20 years.
 Risk Factors for Acute Leukemia

1. Exposure 2.Acquired
disorders
Ionizing radiation, Myelodysplastic
syndrome, paroxysmal
benzene, cytotoxic
nocturnal
drugs, alkylating hemoglobinuria,
agents, cigarette polycythemia vera,
smoking, ethanol chronic myelogenous
leukemia,
use by the mother
myeloproliferative
disorders, idiopathic
myelofibrosis, aplastic
anemia, eosinophilic
fasciitis, myeloma.
Risk Factors for Acute Leukemia

Genetic Familial Infection

predisposition
Down syndrome, Nonidentical Human T-
Fanconi anemia, sibling (1:800), cell
Diamond- monozygotic leukemia
Blackfan anemia, twin (1:5), first- virus and
Kostmann degree relative T-cell ALL
syndrome, (three times
Klinefelter increased risk)
syndrome,
chromosome 21q
disorder, ataxia-
telangiectasia,
Shwachman
syndrom.
 Acute myeloid leukemia (AML):

• This is the most common

type of acute leukemia. It
is more common in older
adults (those over 65
years of age) and in men
compared with women.
About 4.3 per 100,000
men and women or
21,400 new cases of AML
per year are diagnosed in
the United States.
Acute lymphocytic leukemia (ALL):

• This is the most common type

of leukemia in children, teens,
young adults and those up to 39
years of age. About 54% of new
cases occur in those under the
age of 20. It is more common in
persons of Hispanic and White
origin. About 1.7 per 100,000
men and women or 5,900 new
cases of ALL per year are
diagnosed in the United States.
 How does leukemia develop? How does
leukemia affect the body?

• Leukemia begins in the

developing blood cells
in the bone marrow. All
blood cells start out as
hematopoietic (hemo =
blood; poiesis = make)
stem cells. The stem
cells undergo multiple
stages of development
until they reach their
adult form.
• First, blood stem cells develop
into either myeloid cells or
lymphoid cells. If blood cells
were to continue to develop
completely normally, the adult
forms of these cells are as
follows:
• Myeloid cells develop into red
blood cells, platelets, and
certain types of white blood
cells (basophils, eosinophils
and neutrophils).
• Lymphoid cells develop into
certain types of white blood
cells (lymphocytes and natural
killer cells).
 CLINICAL SIGNS AND
SYMPTOMS
• Thrombocytopenia:
• Ineffective
Epistaxis, petechiae, and
hematopoiesis: Results
easy bruising
from marrow infiltration by
the malignant cells and a • Neutropenia: Fever and
block in differentiation pyogenic infection
• Infiltration of other organs
• Anemia: Pallor,
• Skin: Leukemia cutis in
fatigue, and shortness
10%
of breath, rarely
• Gum hypertrophy:
myocardial infarction
Especially in monocytic
or stroke leukemias
CLINICAL SIGNS AND SYMPTOMS
DIAGNOSTIC EVALUATION

A complete history and physical examination are an essential part of

diagnosis of acute leukemia, including a detailed family history and history
of previous chemotherapy or radiation therapy, or of environmental
exposures.

Complete blood count (CBC), differential and manual examination of

peripheral smear, and peripheral blood flow cytometry are considered
when circulating blasts are sufficiently abundant to rapidly establish a
diagnosis.

• Coagulation tests include prothrombin time (PT), partial thromboplastin

time (PTT), d-dimer, and fibrinogen .
 Complete metabolic panel with calcium, magnesium, phosphorus, and
uric acid. Pseudohyperkalemia, as well as a spuriously low glucose and
PO2 (partial pressure of oxygen) can occur with a high blast count .

Human leukocyte antigen (HLA) testing of patients who are transplant

candidates—the test is performed before the patient becomes cytopenic.
Specimen requirements are minimal when DNA-based HLA typing is
performed

Hepatitis B and C, and human immunodeficiency virus antibody titers

are obtained.

Pregnancy test (β-human chorionic gonadotropin), if applicable

Electrocardiogram (ECG) and analysis of cardiac ejection fraction should be done

prior to the treatment with anthracyclines only if a patient has symptoms or a history
of heart disease.
DIAGNOSTIC

• Bone marrow biopsy and

aspirate (with analysis for
morphology),
cytogenetics, flow
cytometry, and
cytochemical stains
(Sudan black,
myeloperoxidase, acid
phosphatase, and
specific and nonspecific
esterase) are used for
diagnosis.
 DIAGNOSTIC
• Performed when signs and
symptoms of neurologic
involvement are present.
Thrombocytopenia and
fibrinogen should be corrected
prior to the procedure, which
should be performed after
reduction of peripheral blast
count to avoid theoretical
inoculation of blasts into
uninvolved CSF. Obtain cell
count, opening pressure, protein
level, and submit cytocentrifuge
specimen for cytology or flow
cytometry.
• Cytogenetic
(metaphase
karyotype) and gene
mutation analysis of
blasts are essential
for risk-stratification
and are needed to
determine
subsequent
management.
 How is leukemia treated?
Treatments for leukemia depend on the type of leukemia you have, your
age and overall health, and if the leukemia has spread to other organs
or tissues. There are five common treatment categories. They include:
• Chemotherapy: Chemoth
erapy are chemicals
(medications) given in pill
form, administered
through an IV into a vein
or a central line or given in
shots under the skin
(subcutaneously). The
chemicals kill leukemia
cells or stop them from
dividing.
Radiation therapy:
• This treatment uses
strong beams of energy
to kill leukemia cells or
stop them from growing.
Radiation is directed to
exact sites in your body
where there is a
collection of cancer cells
or can be given over your
whole body as part of a
hematopoietic cell
transplant (see below).
Immunotherapy:
•
Targeted therapy:
 Examples of targeted therapy include:

• monoclonal antibodies (such as inotuzumab

[Besponsa®], gemtuzumab, [Mylotarg®], rituximab
[Rituxan®], ofatumumab [Arzerra®], obinatuzumab
[Gazyva®, Gazyvaro®], alemtuzumab [Campath®,
MabCampath®]) and tyrosine kinase inhibitors (such as
imatinib [Gleevec®], dasatinib [Sprycel®], nilotinib
[Tasigna®], ponatinib [Iclusig®]), ruxolitinib [Jakafi®],
fedratinib [Inrebic®], gilteritinib [Xospata®], midostaurin
[Rydapt®], ivositinib [Tibsovo®], ibrutinib [Imbruvica®],
venetoclax [Venclexta®]).
Hematopoietic cell transplant (also known as
stem cell or bone marrow transplant):
Thank you for attention!