1、LEUKEMIADep. Hematology，Zhongshan HospitalJenny ZhaoConceptofleukemia Leukemias are a heterogeneous group of hematopoietic malignancies characterized by infiltration of the blood, bone marrow, and other tissues by leukemic cells which inhibited differentiation and apoptosis arrest in any lineage 201
2、5/11/18and in any stage of maturation.Classification of leukemiaAccording to maturation and natural disease stage:Acute leukemia (AL)：low grade differentiation with the most of blast /immature cells,disease develops very fast and prognosis is very bad, mean natural disease stage is about 3 months or
3、 so.Chronic leukemia (CL):2015/11/18high grade differentiation with the most near mature /mature cells,disease develops relatively slowly and prognosis is comparatively good, mean natural disease stage is several years .According to involved cell line:Classification of leukemiaAcute leukemiaAcute my
4、elocyticleukemia (AML): M1-M7Acute lymphoblast leukemia(ALL): L1-L32015/11/18Chronic leukemiaChronic myelocyticleukemia (CML)Chronic lymphocytic leukemia (CLL)Epidemiology： incidence Thesecond most common blood cancer after lymphoma. 3/105， increasewith years? acutechronic, AMLALL Sex ：male：female2：
5、1 Age ： ALL,adolescent 8020y2015/11/18 AML, adult CML,2050yearsold CLL,5070yearsoldEpidemiology:mortality Inorder of the mortality of malignant tumorsin114y，leukemia ismost highin1544y，leukemia isthird high(stomachCaliverCa)in allpersons, leukemia issixth oreighth high2015/11/18EtiologyRisk factors：
6、 Hereditary factors：family leukemia, chromosome changes Radiation：atomic bomb explosions, x-ray, r-ray, isotope，Chemicals and drugs: 2015/11/18 anti-cancer drugs, benzene Virus : RNA virus (RT-virus)， HTLV-1, “Preleukemic“blood disorders：MDS, MPD, PNH ACUTE LEUKEIAoutline Classification Clinical fea
7、tures Laboratory findings Differential diagnosis Treatment prognosis11The classificationAcute leukemia: hematopoietic malignancies with little evidence of differentiation.Acute myelogenous leukemia (AML)Acute lymphoblastc leukemia (ALL)The traditional classificationof AMLTION(FAB)OF The traditional
8、classificationof ALLWHOclassification (2001)： AML1，AML with recurrent genetic abnormalities AML with t(8;21)(q22;q22),(AML1/ETO) AML with t(15;17)(q22;q12),(PML/RAR) AML with inv(16)(p13;q22) or t(16;16)(p13;q22) AML with t(9;11)(p22;q23); AML with t(6;9)(p23;q34);2015/11/18 AML with inv(3)(q21q26.2
9、) or t(3;3)(q21;q26.2) MegakaryoblasticAML with t(1;22)(p13;q13) AML with mutated NPM1 AML with mutated CEBPA2，AML with multilineage dysplasiaWHOclassification (2001)： AML With prior myelodysplastic syndrome Without prior myelodysplastic syndrome3，AML and myelodysplastic syndrome,therapy related4，AM
10、L not otherwise categorized AML minimally differentiation2015/11/18 AML without maturation AML with maturation Acute myelomonocytic leukemiaWHOclassification (2001) ：AML4， AML not otherwise categorized（continued） Acute monoblastic and monocytic leukemia Acute erythroid leukemia Acute megakaryoblasti
11、c leukemia Acute basophilic leukemia2015/11/18 Acute panmyelosis with myelofibrosis Myeloid sarcoma5，Acute leukemia of ambiguous lineageWHOclassification (2008) :ALLThese are identified by immunophenotyping of surface markers of the abnormal lymphocytes: B-lymphoblastic ALL (this category can be sub
12、divided according to the correlation of the ALL cell immunophenotypewith the stages of normal B-cell development)2015/11/18 Burkitt ALL (corresponds to ALL-L3) T-cell ALL. We could use traditional typing diagnosis as what FAB asked. If the situation permit, we could use FCM, chromosome, PCR or FISH
13、in a WHO typing diagnosis way.ACUTE LEUKEMIA ClassificationCLINICAL FEATURES Laboratory findings Differential diagnosis Treatment prognosisA amount of leukemic cells proliferate out of control.Normal blood cells are suppressed.Clinical features of ALAnemia Bleeding FeverinfiltrationClinical features
14、 of ALFeverBleedingAnemia2015/11/18InfiltrationACUTE LEUKEMIA Classification Clinical featuresLABORATORY FINDINGS Differential diagnosis Treatment prognosisLABORATORY FINDINGSBlood：complete blood countBone marrowWBCHbPLTBLASTWBCHbPLTWBCBLASTHbPLTBLOODWBC: Elevated (most patients )Deceased or normalBlasts may be present in 10% of casesRBC: most patients had anemiaPLT: almost all the patients had thrombocytopenia.Bone marrow: morphology
