Содержание
- 2. What is an Acute Myeloid Leukemia ? Accumulation of early myeloid progenitors (blast cells) in bone
- 3. ETIOLOGY Environment: irradiation, chemotherapeutic agents, organic solvents – benzene etc. Genetic diseases: neurofibromatosis, Wiscott-Aldrich synd., defective
- 5. AML Aggressive disease with an acute onset Can occur De Novo or following a known leukomogemic
- 6. Leukemia Malignant Transformation Proliferation and Accumulation Peripheral blood Blasts in BM Visceral organs Cytopenias
- 7. BM - Acute Leukemia (low power)
- 8. Morphology AML
- 9. Pathophysiology Radiation chromosomal damage Chemotherapy Viruses protooncogen Inhibition/Enhancements of regulatory genes Inhibition of suppressor genes Enhancements
- 10. Epidemiology
- 11. Predisposing factors Environmental Benzen, herbicies Chemotherapy :AK ; NU;PRC Radiation Acquired diseases Meyloproliferative(CML;PV..) Aplastic anemia Genetic
- 12. Clinical symptoms of Acute Leukemia Bone marrow expansion Bone pain Bone marrow failure Leucopoenia infections Thrombopenia
- 13. Clinical symptoms Extramedullary (Chloroma) Skin CNS Gingiva Kidney
- 14. Extramedullary: Gingival hypertrophy
- 15. Clinical symptomes DIC Bleeding Thrombosis Metabolic Hyperuricemia Tumor lysis syndrome K, phosphor, Ca Uric Acid
- 16. Diagnosis >20% blasts in bone marrow/peripheral blood) AML ;blasts B M Normal bone marrow
- 17. Acute leukemia - AUER Rods ( FAB;AML M3 ) Auer Rods Aggregation of granules
- 18. Acute promyelocytic leukemia - AML M3
- 19. Myeloblasts - AML Auer rod
- 20. AML M2 blasts
- 21. French American British (FAB) classification -Based on morphology and staining (cytochemistry) -Divides patients into 7 AML
- 22. AML – WHO classification AML with recurrent cytogenetic translocations – M2 with t(8;21), M3 with t(15;17)
- 23. Cytochemistry Myeloblasts - myeloproxidase positive
- 24. Diagnosis Diagnosis :>20% blasts in BM Cytochemical stains : ALL TdT +, MPO - AML TdT
- 25. Diagnosis : Karyotype, cytogenetics chromosomal abnormalities: M3
- 26. AML M2
- 27. Chromosomal abnormalities (cytogenetics)
- 28. Prognosis Risk factors Cytogentics Flt-3 mutation Age White blood cell count at presentation FAB classification De-novo
- 29. Cytogenetic Classification Favorable Intermediate SWOG Unfavorable Unknown MRC ; As for SWOG, except:- t(15;17) Inv(16) t(8;21)-
- 30. 0 50 25 75 100 0 1 Overall Survival (%) Years 2 3 4 5 67%
- 31. Treatment 0 10 20 30 40 50 1970-74 1975-79 1980-84 1985-89 1990-94 1995-99 % Still Alive
- 32. Treatment of acute leukemia (I) Supportive care : Hydration Allopurinol to prevent hyperuricemia Cytopharesis Blood products
- 33. Treatment in the Younger AML Patient Course I of chemotherapy INDUCTION Intensive Chemotherapy Allogeneic Stem Cell
- 34. Outcome at 5 years Allo Chemotherapy Relapse 20-30% 40-60% Overall survival 50% 50% TRM 20-30% 5%
- 35. So how to choose which therapy to a specific patient? use the prognostic factors to estimate
- 36. 0 0% 20% 40% Unfavorable Cytogenetics Survival 80% 60% 100% 2 4 6 Slovak M., et
- 37. What is the best treatment? Who should have a matched related Allo SCT ? Who should
- 38. AML in Elderly patients(>60 years) The majority of the patients are older than 60 Lower remission
- 39. Future directions Identify new prognostic factors New therapies : Modulation of drug resistance Biological, specific treatments:
- 40. Summary The majority of patients still die of their disease (significantly poor outcome in elderly patients)
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