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Acute Lymphoblastic Leukemia ALL презентация
Содержание
- 1. Acute Lymphoblastic Leukemia ALL
- 2. ACUTE LYMPHOBLASTIC LEUKEMIA (ALL) Clonal proliferation
- 3. Acute leukemias - clinical features 1. Bleeding
- 4. Acute leukemias - laboratory findings (1) 1.
- 5. Acute leukemias - Laboratory findings (2) 3.
- 7. Immunologic classification of acute lymphoblastic leukemias B-
- 8. Chromosomal/molecular abnormalities with prognostic significance in ALL
- 9. Risk classification in ALL 1. Standard risk 2. High risk 3. Very high risk
- 10. High-risk ALL 1. Pre - T 2.
- 11. VERY HIGH-RISK ALL Philadelphia Chromosome t(9;22)+ or BCR/ABL +
- 12. TREATMENT STRATEGY IN ALL
- 13. In ALL the choice of treatment-strategy depends
- 14. Remission induction therapy in ALL 1. Antineoplastic
- 15. Post-remission therapy in standard-risk ALL 1.
- 16. Post-remission therapy in very high-risk ALL Allogeneic Stem Cell Transplantation
- 17. Treatment results in ALL Adults
- 18. AlloHSCT in ALL Sibling donor CR1
- 19. THE END
ACUTE LYMPHOBLASTIC LEUKEMIA (ALL) Clonal proliferation and accumulation of blast cells in blood, bone marrow and other organs Disorder originates in single B or T lymphocyte progenitor Heterogenous disease
Слайд 2ACUTE LYMPHOBLASTIC LEUKEMIA (ALL)
Clonal proliferation and accumulation of blast cells
in blood, bone marrow and other organs
Disorder originates in single B or T lymphocyte progenitor
Heterogenous disease with different biological subtypes
Incidence in adults : 20% of acute leukemias
Etiology - unknown
Disorder originates in single B or T lymphocyte progenitor
Heterogenous disease with different biological subtypes
Incidence in adults : 20% of acute leukemias
Etiology - unknown
Слайд 3Acute leukemias - clinical features
1. Bleeding
2. Fever/infection
3. Bone/joint pain
4. Hepatomegaly
5. Splenomegaly
6.
Lymphadenopathy
7. CNS involvement
7. CNS involvement
Слайд 4Acute leukemias - laboratory findings (1)
1. Blood examination
- anemia,
- thrombocytopenia,
- variable
leukocyte count, usually increased,
- blood morphology: presence of blast cells
2. Bone marrow morphology
- presence of blast cells,
- suppression of normal hematopoiesis
- blood morphology: presence of blast cells
2. Bone marrow morphology
- presence of blast cells,
- suppression of normal hematopoiesis
Слайд 5Acute leukemias - Laboratory findings (2)
3. Cytochemical stains
4. Immunophenotyping
5. Cytogenetics
6. Molecular
studies
Слайд 7Immunologic classification of acute lymphoblastic leukemias
B- lineage (80%) Markers
Pro-B CD19(+),Tdt(+),CD10(-),CyIg(-),
Common CD19(+),Tdt(+),CD10(+),CyIg(-),
Pre-B CD19(+),Tdt(+),CD10(+),CyIg(+),SmIg(-)
Mature-B CD19(+),Tdt(+),CD10(±),CyIg(±),SmIg(+)
T-lineage (20%)
Pre-T CD7(+), CD2(-),
Tdt(+),
Mature-T CD7(+), CD2(+), Tdt(+),
Mature-T CD7(+), CD2(+), Tdt(+),
Слайд 8Chromosomal/molecular abnormalities with prognostic significance in ALL
Better prognosis
- normal koryotype
- hyperdiploidy
Poor
prognosis
- t (8; 14)
- t (4; 11)
Very poor prognosis
- t (9; 22); BCR/ABL (+)
- t (8; 14)
- t (4; 11)
Very poor prognosis
- t (9; 22); BCR/ABL (+)
Слайд 10High-risk ALL
1. Pre - T
2. Pro - B
3. Age > 35
years,
4. WBC > 30 G/L in B-ALL
> 100 G/L in T-ALL
5. No remission after 4 weeks of induction
therapy
4. WBC > 30 G/L in B-ALL
> 100 G/L in T-ALL
5. No remission after 4 weeks of induction
therapy
Слайд 13In ALL the choice of treatment-strategy depends on:
1. Risk qualification
2. Immunophenotype
of leukemic cells
- T lineage,
- early B lineage,
- mature B lineage,
3.Age and biological condition
4. Goal of treatment
- T lineage,
- early B lineage,
- mature B lineage,
3.Age and biological condition
4. Goal of treatment
Слайд 14Remission induction therapy in ALL
1. Antineoplastic treatment
a.Drugs: prednisone, vincristine, asparginase, cyclophosphamide,
6MP
daunorubicin/adriamycin/epirubicin,
cytosine arabinoside,
b.Treatment duration: 4-8 weeks
c. No of courses: 1- 2
2. CNS prophylaxis
3. Supportive care
4. Treatment of complications
daunorubicin/adriamycin/epirubicin,
cytosine arabinoside,
b.Treatment duration: 4-8 weeks
c. No of courses: 1- 2
2. CNS prophylaxis
3. Supportive care
4. Treatment of complications
Слайд 15Post-remission therapy in
standard-risk ALL
1. Chemotherapy
a. Maintenance therapy: 6- mercaptopurine,
methotrexate
- for 2-3 years.
b. Intensification treatment periodically
repeated: daunorubicin/adriamycin,
prednisone, vincristine, cyclophosphamide.
2. CNS prophylaxis
b. Intensification treatment periodically
repeated: daunorubicin/adriamycin,
prednisone, vincristine, cyclophosphamide.
2. CNS prophylaxis
Слайд 17Treatment results in ALL
Adults
Complete remission (CR) 80-85%
Leukemia-free survival (LFS) 30-40%
Children
Complete remission (CR) 95-99%
Leukemia-free survival (LFS) 70-80%
Слайд 18AlloHSCT in ALL
Sibling donor
CR1
>CR2 relapse/refractory
LFS 51% (21-80) 34% (13-42) 20% (12-33)
RR 26% (9-50) 47% (40-69) 71% (59-76)
TRM 29% (12-42)
Matched unrelated donor
LFS 39% (38-42)
RR 22% (19-23)
TRM 48%
LFS 51% (21-80) 34% (13-42) 20% (12-33)
RR 26% (9-50) 47% (40-69) 71% (59-76)
TRM 29% (12-42)
Matched unrelated donor
LFS 39% (38-42)
RR 22% (19-23)
TRM 48%
