LEUKEMIA

NYOTO WIDYO ASTORO

HEMATOLOGI ONKOLOGI MEDIK
RSGS
 LEUKEMIA
Accumulation of neoplastic WBCs in :
– Bone marrow
– Peripheral blood
– Organ
This may present :
– Bone marrow failure(anemia,
thrombocytopenia, leukopenia)
– Elevated WBC count
– Organ dysfunction
 Acute Leukemia
Result from the clonal proliferation of an
abnormal progenitor stem cell
Fail to further differentiate
Rapid division
The hematopoetic progenitor usually
– Lymphocyte precusor
– Myelocyte precusor
Patophysiology
Acute Myelogenous Leukemia
80% of adult leukemia
Median age 50-60 yo
Annual incidence of 2.4/100.000 increase
to 12.6/100.000 in those≥65 yo
Risk factor : Radiation, previous
chemotherapy with ankylating agent or
topoisomerase inhibitor, MDS, MP, AA,
exposure to benzene, Down’s syndrome,
Klinefelter syndrome, Turner’s syndrome
 Clinical presentation
Cytopenias
Infiltrate leukemic cell
Tumor lysis syndrome
DIC
Leukostasis : Pulmonary infiltrate and
cerebrovascular even if L>100.000
DIC
AUER RODS
 Lab Evaluation
CBC
Coagulation test
Electrolyte
Possible an LP if CNS involvement
AML is defined by>30% leukemic blast in
BMP
 Treatment
Goal to achieve remission and recovery
peripheral blood count
chemotherapy
 Prognosis
Good prognostic
– T15;17(M3), t8;21, inv 16 associated M4 with
eosinophilia
Poor prognostic
– Age>60 yo, AML secodary MDS, atendence
hematologic disorder, del 5q, 7q or trisomy 8,
lack favorable cytogenetic (eg. t(6;9), t(9;22)
Acute Lymphoblastic Leukemia
Abnormal proliferation lymphoid
hematopoietic progenitor cell
80% childhood and 20% adult leukemia
Adult ALL ---worse prognosis than
childhood ALL
 Clinical Presentation
Sign marrow failure
Leukemic infiltration : headached and or
cranial nerve palsies
Leukostasis : athralgias, dyspnea, hypoxia
Hepatosplenomegaly and
lymphadenophaty
Anterior mediastinal mass (T), Large
abdominal lymph nodes
 Lab evaluation
Same AML
Circulating blast in Peripheral Blood
Absent cytoplasmic granules and Auer
rods
 Clasification
L1 (Smal Lymphoblastic/childhood)
L2 (Large Lymphoblastic )
L3 (Undifferentiated, Large vacuolated /
Burkitt-like)
 Management
TX consists 3 phase :
– Induction to induce a complete remission
– CNS prophylaxis
– Maintenace
 Prognosis
60-90% complete remission but majority will
relapse
Younger and good prognostic indicator have
cure rate 50-70%
Older and poor prognostic indicator have cure
rate 10-30%
Poor indicator : male, age>9 yo, prolonged time
to remission, L3 Burkitt’s morphology, B cell
immunotype, Translocation 8;14,9;22 and 4;1