LEUKEMIA

Courtney Chaney

LEUKEMIA
Cancer of blood-forming tissues, including

bone marrow, hindering the body's ability to

fight infection
Bone marrow is harbored in the spongy part

of bones such as the femur and humerus

Bones have spongy and compact areas
Red or Yellow marrow
Bone marrow creates blood cells
Blood cells help fight infections and move

nutrients and oxygen throughout the body

4 types of leukemia: Acute, Chronic,

Myelogenous, lymphocytic which pair up to

make ALL, AML, CLL, CML

EPIDEMIOLOGY
44,240 cases a year
Higher prevalence in men - 32% more
Higher risk for whites than blacks
Most common children cancer
most off those are ALL
50% of all leukemia cases are Acute

ETIOLOGY
No exact cause
High Risk factors do include:
smoking
previous radiation exposure
handling the chemical benzene
previous chemotherapy
having down syndrome or other genetic conditions
having myelodysplastic syndrome or other blood disorders
smoking (AML)
family history

PRESENTING SYMPTOMS
fatigue
fever
bleeding (nose bleeds, from gums, excessive period, etc.)
easy bruising
pallor
malaise
joint pain (ALL)
enlarged spleen or liver (AML)

 No lymph drainage because it is

already systemic and moves

through the blood

LYMPH DRAINAGE

METS
Blood is throughout the body so it is
already "everywhere" but it can cross
over into the CSF

STAGING

AML staging: M1-M7

CML staging: chronic,

accelerated, or acute
ALL staging (FAB

system): L1-L3

CLL staging: Stage 0-4 & A-C

Stage 0 - low risk
Stage 1-2: intermediate risk
Stage 3-4: high risk
Stage A: no cytopenia and

involvement of up to 2 sites
Stage B: 3 or more sites
Stage C: anemia, thrombopenia,

or both

For ALL
4 types of chemo drugs given:
remission induction:

-given immediately when diagnosed to kill all

detectable leukemia
- prednisone or dexamethodrone, vincristine,
and L-asparginase
-high risk patients get anthracycline and
daunorubicin added
consolidation: high dose IV methotrexate and L-

asparaginase
maintenance: IV mercaptopurine and systemic

methotrexate
prophylaxis or CNS involvement: methotrexate

either systemically or intrathecally

MOST COMMON
TREATMENT
Chemotherapy - exact
regime depends on type

 Bone marrow from the posterior iliac and iliac

crests is taken from a donor or the patient's

own bone marrow is harvested and cleaned or
leukemia
Donor and patient must have matching HLAs
Marrow is infused intravenously to patient

after the patients previously marrow has been

destroyed by chemotherapy or total body
irradiation
heparin is administered to prevent clotting
cyclophosphamide and total body irradiation

is given before transplant to prevent rejection

of the transplant or just the chemo drugs
busulfan and cyclophosphamide
normal blood cells will begin to regenerate 2-4

weeks after transplant

ALTERNATE
TREATMENT
Bone Marrow Transplant good for ALL, AML, and CML
patients only

 Take T-cells (White blood cells)

from patient and genetically

modify them in a lab so that they
recognize the cell receptor CD19
which cancer cells have
The white blood cells block

growth signal and kill the cancer

cells

IMMUNE CELL
THERAPY
-car-t

cell therapy

Chemothera
py S.E.
depends on drugs

administered
hair loss
nausea
vomiting
malaise
loss of appetite
fatigue
fluid retention
muscle weakness

IMMUNE CELL
THERAPY S.E
- FEVER
- LOW BLOOD PRESSURE
- MUSCLE PAIN
- CYTOKINE RELEASE SYNDROME
(DIFFICULTLY BREATHING)

Bone Marrow
Transplant S.E.
chemo side effects
recurrence

(autologous)
graft-versus-host

disease
external total body

irradiation side
effects

Overall Prognosis
PROGNOSIS
& Survival of
Disease
ALL- 71% overall,

92% for children

AML- 60-70% for

children, 25%
overall
CLL - 84%
CML- 60%

Immune Cell
Therapy Survival
Rate
88%

BEST TREATMENT
combination of chemotherapy and bone marrow

transplant

full body attacking with chemo and clearing out a lot

of disease with bone marrow transplant

immune cell therapy is new so it isn't as backed up

with tons of evidence so I would rather stick with what

we know works

REFERENCES
Medical News. "New Leukemia Immune Cell therapy

Shows Promise." 2015. MedicalNewToday.com 2015.

Purple Book
Notes
Cancer Institution. "Leukemia." 2012. Cancer.gov 2015.
Cancer Center. "Immune Cell Therapy" 2015.

Cancercenter.com 2015.

Cancer Researchers. "Leukemia Treatments". 2013.

Cancerresearch.org 2015.