Kazan state medical university ACUTE LEUKEMIA 1 Acute

Kazan state medical university ACUTE LEUKEMIA 1. Acute lymphocytic leukemia ( ALL ) 2. Acute myelogenous leukemia ( AML ) STUDENT – Abhinav sumit kumar Group - 1428

Leukemia is a cancer of the blood cells. There are several broad categories of blood cells, including red blood cells (RBCs), white blood cells (WBCs), and platelets. Generally, leukemia refers to cancers of the WBCs are a vital part of immune system. They protect body from invasion by bacteria, viruses, and fungi, as well as from abnormal cells and other foreign substances. In leukemia, the WBCs don’t function like normal WBCs. They can also divide too quickly and eventually crowd out normal cells. WBCs are mostly produced in the bone marrow, but certain types of WBCs are also made in the lymph nodes, spleen, and thymus gland. Once formed, WBCs circulate throughout of the body in blood and lymph, concentrating in the lymph nodes and spleen.

The Types of Leukemia The onset of leukemia can be acute (sudden onset) or chronic (slow onset). In acute leukemia, cancer cells multiply quickly. In chronic leukemia, the disease progresses slowly and early symptoms may be very mild. Leukemia is also classified according to the type of cell. Leukemia involving myeloid cells is called myelogenous leukemia. Myeloid cells are immature blood cells that would normally become granulocytes or monocytes. Leukemia involving lymphocytes is called lymphocytic leukemia. There are four main types of leukemia: 1. Acute myelogenous leukemia (AML) - can occur in children and adults. This is the most common form of leukemia. 2. Acute Lymphocytic Leukemia (ALL) Acute lymphocytic leukemia (ALL) occurs mostly in children.

3. Chronic Myelogenous Leukemia (CML) 4. Chronic Lymphocytic Leukemia (CLL) Chronic lymphocytic leukemia (CLL) is most likely to affect people over the age of 55. It’s very rarely seen in children. Hairy cell leukemia is a very rare subtype of CLL. Its name comes from the appearance of the cancerous lymphocytes under a microscope. Risk Factors for Leukemia The causes of leukemia are not known. However, several factors have been identified which may increase the risk. These include: a family history of leukemia smoking, which increases the risk of developing AML genetic disorders such as Down syndrome blood disorders, such as myelodysplastic syndrome, which sometimes called “preleukemia” previous treatment for cancer with chemotherapy or radiation exposure to high levels of radiation exposure to chemicals such as benzene

Symptoms of Leukemia The symptoms of leukemia include: excessive sweating, especially at night (called “night sweats”) fatigue and weakness that don’t go away with rest unintentional weight loss, bone pain and tenderness painless, swollen lymph nodes (especially in the neck and armpits) enlargement of the liver or spleen red spots on the skin, called petechiae bleeding and bruising easily, fever or chills frequent infections Leukemia - can also cause symptoms in organs that have been infiltrated or affected by the cancer cells. For example, if the cancer spreads to the central nervous system, it can cause headaches, nausea and vomiting, confusion, loss of muscle control, and seizures. Leukemia can also spread to other parts of your body, including: the lungs, gastrointestinal tract, heart, kidneys & in testes.

Acute lymphocytic leukemia (ALL ) 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. The word "lymphocytic" in acute lymphocytic leukemia refers to the white blood cells called lymphocytes, which ALL affects. Acute lymphocytic leukemia is also known as acute lymphoblastic leukemia. Acute lymphocytic leukemia is the most common type of cancer in children, and treatments result in a good chance for a cure. Acute lymphocytic leukemia can also occur in adults, though the chance of a cure is greatly reduced.

Symptoms Acute lymphocytic leukemia Signs and symptoms of acute lymphocytic leukemia may include: Bleeding from the gums Bone pain Fever Frequent infections Frequent or severe nosebleeds Lumps caused by swollen lymph nodes in and around the neck, underarm, abdomen or groin Pale skin Shortness of breath Weakness, fatigue or a general decrease in energy

Causes of Acute lymphocytic leukemia - occurs when a bone marrow cell develops errors in its DNA. The errors tell the cell to continue growing and dividing, when a healthy cell would normally stop dividing and eventually die. When this happens, blood cell production becomes abnormal. The bone marrow produces immature cells that develop into leukemic white blood cells called lymphoblasts. These abnormal cells are unable to function properly, and they can build up and crowd out healthy cells. It's not clear what causes the DNA mutations that can lead to acute lymphocytic leukemia. But it has been found that most cases of acute lymphocytic leukemia aren't inherited.

Risk factors of Acute lymphocytic leukemia Factors that may increase the risk of acute lymphocytic leukemia include: Previous cancer treatment. Children and adults who've had certain types of chemotherapy and radiation therapy for other kinds of cancer may have an increased risk of developing acute lymphocytic leukemia. Exposure to radiation. People exposed to very high levels of radiation, such as survivors of a nuclear reactor accident, have an increased risk of developing acute lymphocytic leukemia. Genetic disorders. Certain genetic disorders, such as Down syndrome, are associated with an increased risk of acute lymphocytic leukemia. Having a brother or sister with ALL. People who have a sibling, including a twin, with acute lymphocytic leukemia have an increased risk of ALL.

Tests and diagnosis. Acute lymphocytic leukemia Tests and procedures used to diagnose acute lymphocytic leukemia include: Blood tests may reveal too many white blood cells, not enough red blood cells and not enough platelets. A blood test may also show the presence of blast cells — immature cells normally found in the bone marrow. Bone marrow test. During bone marrow aspiration, a needle is used to remove a sample of bone marrow from the hipbone. The sample is sent to a lab for testing to look for leukemia cells. Doctors in the lab will classify blood cells into specific types based on their size, shape and other features. They also look for certain changes in the cancer cells and determine whether the leukemia cells began from the B lymphocytes or T lymphocytes. Imaging tests such as an X-ray, computerized tomography (CT) scan or ultrasound scan may help determine whether cancer has spread to the brain and spinal cord or other parts of the body. Spinal fluid test. A lumbar puncture test, also called a spinal tap, may be used to collect a sample of spinal fluid — the fluid that surrounds the brain and spinal cord. The sample is tested to see whether cancer cells have spread to the spinal fluid.

Differential Diagnoses Acute Myelogenous Leukemia (AML) B-Cell Lymphoma High-Grade Malignant Immunoblastic Lymphoma Non-Hodgkin Lymphoma

Treatments and drugs. Acute lymphocytic leukemia In general, treatment for acute lymphocytic leukemia falls into separate phases: Induction therapy. The purpose of the first phase of treatment is to kill most of the leukemia cells in the blood and bone marrow and to restore normal blood cell production. Consolidation therapy. - Also called post-remission therapy, this phase of treatment is aimed at destroying any remaining leukemia in the body, such as in the brain or spinal cord. Maintenance therapy. The third phase of treatment prevents leukemia cells from regrowing. The treatments used in this stage are often given at much lower doses over a long period of time, often years. Preventive treatment to the spinal cord. During each phase of therapy, people with acute lymphocytic leukemia may receive additional treatment to kill leukemia cells located in the central nervous system. In this type of treatment, chemotherapy drugs are often injected directly into the fluid that covers the spinal cord.

Depending on the situation, the phases of treatment for acute lymphocytic leukemia can span two to three years. Treatments may include: Chemotherapy, which uses drugs to kill cancer cells, is typically used as an induction therapy for children and adults with acute lymphocytic leukemia. Chemotherapy drugs can also be used in the consolidation and maintenance phases. Targeted drug therapy. Targeted drugs attack specific abnormalities present in cancer cells that help them grow and thrive. Radiation therapy uses high-powered beams, such as X-rays, to kill cancer cells. If the cancer cells have spread to the central nervous system, Stem cell transplant. A stem cell transplant may be used as consolidation therapy in people at high risk of relapse or for treating relapse when it occurs. This procedure allows someone with leukemia to re-establish healthy stem cells by replacing leukemic bone marrow with leukemia-free marrow from a healthy person. A stem cell transplant begins with high doses of chemotherapy or radiation to destroy any leukemia-producing bone marrow. The marrow is then replaced by bone marrow from a compatible donor (allogeneic transplant).

ALL in older adults Older adults, such as those older than 60, tend to experience more complications from ALL treatments. And older adults generally have a worse prognosis than children who are treated for ALL. Medication Antineoplastic agents are used for induction, consolidation, and maintenance therapy and central nervous system (CNS) prophylaxis in patients with acute lymphoblastic leukemia (ALL). drug classes used in treatment of ALL include the following: Corticosteroids may be used during induction, consolidation, and/or maintenance therapy such as Prednlsone, Dexamethasone Antineoplastics drugs are used such as Vincristine, Tyrosine kinase inhibitors are used in treatment of Philadelphia chromosome – positive (Ph+) ALL Colony-stimulating factors are used to treat or prevent neutropenia and to mobilize autologous peripheral blood progenitor cells for bone marrow transplantation (BMT) and in management of chronic neutropenia Prophylactic antibiotics and antifungal drugs are given to prevent infection in patients receiving chemotherapy

2. Acute myelogenous leukemia (AML) is a cancer of the blood and bone marrow — the spongy tissue inside bones where blood cells are made. The word "acute" in acute myelogenous leukemia denotes the disease's rapid progression. It's called myelogenous leukemia because it affects a group of white blood cells called the myeloid cells, which normally develop into the various types of mature blood cells, such as red blood cells, white blood cells and platelets. Acute myelogenous leukemia is also known as acute myeloid leukemia, acute myeloblastic leukemia, acute granulocytic leukemia and acute nonlymphocytic leukemia. Symptoms of Acute myelogenous leukemia (AML) General signs and symptoms of the early stages of acute myelogenous leukemia may mimic those of the flu or other common diseases. Signs and symptoms may vary based on the type of blood cell affected. Signs and symptoms of acute myelogenous leukemia include: Fever Bone pain, Lethargy and fatigue Shortness of breath, Pale skin Frequent infections, Easy bruising Unusual bleeding, such as frequent nosebleeds and bleeding from the gums

Causes Acute myelogenous leukemia (AML) Acute myelogenous leukemia is caused by damage to the DNA of developing cells in the bone marrow. When this happens, blood cell production goes wrong. The bone marrow produces immature cells that develop into leukemic white blood cells called myeloblasts. These abnormal cells are unable to function properly, and they can build up and crowd out healthy cells. In most cases, it's not clear what causes the DNA mutations that lead to leukemia. Radiation, exposure to certain chemicals and some chemotherapy drugs are known risk factors for acute myelogenous leukemia. Risk factors Acute myelogenous leukemia (AML) Increasing age. Sex Previous cancer treatment. Exposure to radiation Dangerous chemical exposure Smoking Other blood disorders. Genetic disorders

Tests and diagnosis Acute myelogenous leukemia (AML) signs or symptoms of acute myelogenous leukemia, diagnostic tests, including: Blood tests. Most people with acute myelogenous leukemia have too many white blood cells, not enough red blood cells and not enough platelets. The presence of blast cells — immature cells normally found in bone marrow but not circulating in the blood — is another indicator of acute myelogenous leukemia. Bone marrow test. A blood test can suggest leukemia, but it usually takes a bone marrow test to confirm the diagnosis. During a bone marrow biopsy, a needle is used to remove a sample of the bone marrow. Usually, the sample is taken from the hipbone (posterior iliac crest). The sample is sent to a laboratory for testing. Lumbar puncture (spinal tap). In some cases, it may be necessary to remove some of the fluid around the spinal cord to check for leukemia cells. .

Determining your AML subtype a more specific AML subtype is based on how the cells appear when examined under a microscope. Special laboratory testing may also be used to identify the specific characteristics of the cells. AML subtype helps to determine which treatments may be best for the patient. . Differential Diagnoses Acute Lymphoblastic Leukemia (ALL) Anemia Aplastic Anemia B-Cell Lymphoma Bone Marrow Failure Lymphoblastic Lymphoma

Treatments and drugs Acute myelogenous leukemia (AML) Treatment of acute myelogenous leukemia depends on several factors, including the subtype of the disease, age, overall health and preferences. In general, treatment falls into two phases: Remission induction therapy. The purpose of the first phase of treatment is to kill the leukemia cells in the blood and bone marrow. However, remission induction usually doesn't wipe out all of the leukemia cells, so it need further treatment to prevent the disease from returning. Consolidation therapy. Also called post-remission therapy, maintenance therapy or intensification, this phase of treatment is aimed at destroying the remaining leukemia cells. It's considered crucial to decreasing the risk of relapse. Drugs are used for Acute Myeloid Leukemia (AML) Antineoplastic agents are used for induction or consolidation therapy. These agents inhibit cell growth and differentiation. These drugs are - cytarabine, daunorubicin, idarubicin, and mitoxantrone.

Therapies used in these phases include: Chemotherapy Other drug therapy. Arsenic trioxide (Trisenox) and all-trans retinoic acid (ATRA) are anti-cancer drugs that can be used alone or in combination with chemotherapy for remission induction of a certain subtype of AML called promyelocytic leukemia. These drugs cause leukemia cells with a specific gene mutation to mature and die, or to stop dividing. Stem cell transplant. A stem cell transplant, also called a bone marrow transplant, may be used for consolidation therapy. A stem cell transplant helps reestablish healthy stem cells by replacing unhealthy bone marrow with leukemia-free stem cells that will regenerate healthy bone marrow.

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