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A Glimpse into the World of Leukemia

A Glimpse into the World of Leukemia. Jeffrey Bryan, Pharm.D. Clinical Pharmacy Specialist, Leukemia MD Anderson Cancer Center. Objectives. Describe the epidemiology, etiology and pathophysiology of acute and chronic leukemia

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A Glimpse into the World of Leukemia

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  1. A Glimpse into the World of Leukemia Jeffrey Bryan, Pharm.D. Clinical Pharmacy Specialist, Leukemia MD Anderson Cancer Center

  2. Objectives • Describe the epidemiology, etiology and pathophysiology of acute and chronic leukemia • Discuss the presenting signs and symptoms of adult patients with acute and chronic leukemia • Summarize approaches to the diagnosis of leukemia • Compare the general approaches to the treatment of acute and chronic leukemia patients • Discuss the supportive care issues associated with acute and chronic leukemia patients

  3. Leukemia: Epidemiology http://seer.cancer.gov/statfacts/html/leuks.html

  4. Leukemia: Etiology • Chromosomal abnormalities/changes • Congenital disorders • Environmental factors • Family history • Chemical agents • Chemotherapeutic agents • Viruses

  5. Leukemia: Pathophysiology • The pathophysiology of leukemia involves: Abnormal proliferation of leukocytes Failure of leukocytes to mature Metabolic complications • Abnormal leukocytes cannot perform the primary function • Abnormal cells crowd the bone marrow, lymph nodes, and spleen • Infection and bleeding are two common perils

  6. Leukemia: Clinical Presentation

  7. Leukemia: Clinical Problems

  8. Leukemia: Approach to Diagnosis • Medical history and physical • CBC with differential • Chemistry panel • Bone marrow biopsy and aspiration • Immunophenotyping • Cytogenetics

  9. Leukemia: Major Types • Acute Lymphocytic Leukemia (ALL) • Acute Myelogenous Leukemia (AML) • Chronic Lymphocytic Leukemia (CLL) • Chronic Myelogenous Leukemia (CML)

  10. Leukemia: Diagnostic Categories FAB: French-American-British

  11. Leukemia: Diagnostic Categories FAB: French-American-British

  12. Acute Leukemias

  13. Acute Leukemia: Blast Cells • Immature precursors of either lymphocytes (lymphoblasts), or granulocytes (myeloblasts) • Not normally appear in peripheral blood • Large size and primitive nuclei (i.e. the nuclei contain nucleoli) • Presence of Auer Rods • Special stains and surface marker techniques are needed to identify the lineage of the cells

  14. ALL: Treatment Phases CNS Therapy (intrathecal chemotherapy)

  15. AML: Treatment Phases

  16. Acute Leukemia: Treatment Goals • Induction therapy Rapidly achieve complete response (CR) • Consolidation therapy Maintain CR Eliminate clinically undetectable leukemia Prevent/delay relapse • Maintenance therapy Eliminate residual leukemia Prolong remission • CNS therapy Prevent relapse

  17. Acute Leukemia: Remission Criteria • Disappearance of all evidence of leukemia • Bone marrow: > 20% cellularity • Bone marrow: < 5% blasts • Absolute neutrophil count: > 1000 • Platelets: > 100x109/L

  18. Acute Leukemia: Frontline Agents

  19. Chronic Leukemias

  20. CLL: Clinical Features of Staging

  21. CLL: Treatment Phases

  22. CLL: Response Criteria National Cancer Institute Working Group Criteria for complete remission in CLL

  23. Chronic Leukemia: Frontline Agents

  24. Chronic Myelogenous Leukemia

  25. CML: Pathophysiology • CML arises from abnormal hematopoietic stem cells that give rise to progeny that have the Philadelphia chromosome (Ph) • Ph is created from the reciprocal translocation between chromosome 9 and 22 forming a BCR-Abl gene on a shortened chromosome 22 • Translocation is termed t(9;22)(q34.1;q11.2)

  26. CML: Three Clinical Phases Disease Progression

  27. CML: Clinical Presentation

  28. CML: Treatment

  29. CML: Response Criteria

  30. CML: Tyrosine Kinase Inhibitors

  31. Leukemia: Supportive Care Common Occasional Rare

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