1.

Classification of AML by World Health Organization and

French American Britain Classification
FABC- The eight acute myelogenous leukemia stages are classified as follows:

Undifferentiated AML - M0: In this stage of acute myelogenous leukemia,

the bone marrow cells show no significant signs of differentiation.
Myeloblastic leukemia - M1: Bone marrow cells show some signs of
granulocytic differentiation with or without minimal cell maturation.
Myeloblastic leukemia - M2: Maturation of the bone marrow cells is beyond
the promyelocyte (early granulocyte) stage. Varying amounts of granulocyte
maturation may be observed.
Promyelocytic leukemia - M3: Most of the abnormal cells are early
granulocytes, between myeloblasts and myelocytes in their stage of
development. The cells contain many small particles and have nucleuses of
varying size and shape.
Myelomonocytic leukemia - M4: In this stage of acute myelogenous
leukemia, the bone marrow and circulating blood have variable amounts of
monocytes and differentiated granulocytes in them. The percentage of
monocytes and promonocytes in the bone marrow is greater than 20 percent.
There may also be an increased number of granular leukocytes called
eosinophils, a type of granulocyte that often has a two-lobed nucleus.
Monocytic leukemia - M5: This subset is further divided into two different
categories. The first is characterized by poorly differentiated monoblasts with
lacy-appearing genetic material. The second subset is characterized by a
large number of monoblasts, promonocytes and monocytes. The proportion of
monocytes in the bloodstream may be higher than that in the bone marrow.
Erythroleukemia - M6: This form of leukemia is characterized by abnormal
red blood cell-forming cells, which make up over half of the nucleated cells in
the bone marrow.
Megakaryoblastic leukemia - M7: The blast cells in this form of leukemia
look like immature megakaryocytes (giant cells of the bone marrow) or
lymphoblasts (lymphocyte-forming cells). M7 leukemia may be distinguished
by extensive fibrous tissue deposits (fibrosis) in the bone marrow.

WHO- Acute myelogenous leukemia with certain genetic abnormalities: Cellular

testing is capable of identifying specific genetic abnormalities:
AML with a translocation between chromosomes 8 and 21
AML with a translocation or inversion in chromosome 16
AML with changes in chromosome 11
APL (M3), which usually has translocation between chromosomes 15 and 17
AML with multi-lineage dysplasia: More than one type of abnormal myeloid cell is
involved.
AML from previous chemotherapy/radiation
AML not otherwise specified: This includes AML cases that don't fall into any of the
above groups, such as:
Undifferentiated AML - M0
AML with Minimal Maturation - M1
AML with Maturation - M2
Acute Myelomonocytic Leukemia - M4
Acute Monocytic Leukemia - M5
Acute Erythroid Leukemia - M6
Acute Megakaryoblastic Leukemia - M7
Acute Basophilic Leukemia

Acute Panmyelosis with Fibrosi

Myeloid Sarcoma - Also called Granulocytic Sarcoma or Chloroma
Undifferentiated/biphenotypic acute leukemias: This type of leukemia may exhibit
features of both lymphocytic and myelogenous leukemia. This may also be referred
to as ALL with myeloid markers, AML with lymphoid markers or mixed lineage
leukemia.

2. Induction & Consolidation

InductionThis first part of treatment is aimed at getting rid of as many leukemia cells as possible.
How intense the treatment is can depend on a persons age and health. Doctors often
give the most intensive chemo to people under the age of 60. Some older patients in
good health may benefit from similar or slightly less intensive treatment.
People who are much older or are in poor health might not do well with intensive
chemo. Treatment of these patients is discussed below in Treating frail, older adults.
Age, health, and other factors clearly need to be taken into account when considering
treatment options. Doctors are also trying to determine whether people with certain
gene or chromosome changes are more likely to benefit from more intensive treatment.
In younger patients, such as those under 60, induction often involves treatment with 2
chemo drugs, cytarabine (ara-C) and an anthracycline drug such as daunorubicin
(daunomycin) or idarubicin. Sometimes a third drug, cladribine (Leustatin, 2-CdA), is
given as well. The chemo is usually given in the hospital and lasts about a week.
Patients with poor heart function cant be treated with anthracyclines, so they may be
treated with another chemo drug, such as fludarabine (Fludara) or topotecan.
In rare cases where the leukemia has spread to the brain or spinal cord, chemo may
also be given into the cerebrospinal fluid (CSF). Radiation therapy might be used as
well.
Induction destroys most of the normal bone marrow cells as well as the leukemia cells.
Most patients develop dangerously low blood counts at this time, and may be very ill.
Most patients need antibiotics and blood product transfusions. Drugs to raise white
blood cell counts may also be used. Blood counts tend to stay low for a few weeks.
Usually, the patient stays in the hospital during this time.
About 1 or 2 weeks after chemo is done, the doctor will check a bone marrow biopsy. It
should show few bone marrow cells (hypocellular bone marrow) and only a small portion
of blasts. If the biopsy shows that there are still leukemia cells in the bone marrow,
more chemo may be given. Sometimes a stem cell transplant is recommended at this
point. If it isnt clear on the bone marrow biopsy whether the leukemia is still there,
another bone marrow biopsy may be done again in about a week.
Over the next few weeks, normal bone marrow cells will return and start making new
blood cells. The doctor may check other bone marrow biopsies during this time. When
the blood cell counts recover, the doctor will again check cells in a bone marrow sample
to see if the leukemia is in remission (blasts make up no more than 5% of the bone
marrow).
Remission induction usually does not destroy all the leukemia cells and a small number
often remain. Without consolidation treatment, the leukemia is likely to return within
several months.

ConsolidationInduction is considered successful if remission is achieved. Further treatment is then

given to try to destroy any remaining leukemia cells and help prevent a relapse. This is
called consolidation.
For younger patients, the main options for consolidation therapy are:
Several cycles of high-dose cytarabine (ara-C) chemo (sometimes known as HiDAC)
Allogeneic (donor) stem cell transplant
Autologous stem cell transplant
Consolidation chemo differs from induction therapy in that usually only cytarabine is
used. The drug is given at very high doses, typically over 5 days. This is repeated about
every 4 weeks, usually for a total of 3 or 4 cycles. Another approach after successful
induction therapy is to give very high doses of chemo followed by either an allogeneic

(from a donor) or autologous (patients own) stem cell transplant. Stem cell transplants
have been found to reduce the risk of leukemia coming back more than standard
chemo, but they are also more likely to have serious complications, including an
increased risk of death from treatment.
Older patients or those in poor health may not be able to tolerate such intensive
consolidation treatment. Often, giving them more intensive therapy raises the risk of
serious side effects (including treatment-related death) without providing much more of
a benefit. These patients may be treated with:
1 or 2 cycles of higher dose cytarabine (usually not quite as high as in younger
patients)
1 or 2 cycles of standard dose cytarabine, possibly along with idarubicin,
daunorubicin, or mitoxantrone
Non-myeloablative stem cell transplant (mini-transplant)
It is not always clear which treatment option is best for consolidation. Each has pros and
cons. Doctors look at several different factors when recommending what type of therapy
a patient should get. These include:
How many courses (cycles) of chemo it took to bring about a remission. If it
took more than one course, some doctors recommend that the patient get a more
intensive program, which might include a stem cell transplant.
The availability of a brother, sister, or an unrelated donor who matches the
patients tissue type. If a close enough tissue match is found, an allogeneic
(donor) stem cell transplant may be an option, especially for younger patients.
The potential of collecting leukemia-free bone marrow cells from the
patient. If lab tests show that a patient is in remission, collecting stem cells from the
patients bone marrow or blood for an autologous stem cell transplant may be an
option. Stem cells collected from the patient would be purged (treated in the lab to
try to remove or kill any remaining leukemia cells) to lower the chances of relapse.
The presence of one or more adverseprognostic factors, such as certain gene or
chromosome changes, a very high initial white blood cell count, AML that develops
from a previous blood disorder or after treatment for an earlier cancer, or spread to
the central nervous system. These factors might lead doctors to recommend more
aggressive therapy, such as a stem cell transplant. On the other hand, for people
with good prognostic factors, such as favorable gene or chromosome changes, many
doctors might advise holding off on a stem cell transplant unless the disease recurs.
The patients age. Older patients may not be able to tolerate some of the severe
side effects that can occur with high-dose chemo or stem cell transplants.
The patients wishes. There are many issues that revolve around quality of life that
must be discussed. An important issue is the higher chance of early death from highdose chemo or a stem cell transplant. This and other issues must be discussed
between the patient and the doctor.
Stem cell transplants are intensive treatments with real risks of serious complications,
including death, and their exact role in treating AML is not always clear. Some doctors
feel that if the patient is healthy enough to withstand the procedure and a compatible
donor is available, an allogeneic transplant offers the best chance for long-term
survival. Others feel that studies have not yet shown this conclusively, and that in some
cases a transplant should be reserved in case the leukemia comes back after standard
treatment. Still others feel that stem cell transplants should be given if the leukemia is
likely to come back based on certain gene or chromosome changes. Research in this
area continues to see which AML patients get the most benefit from stem cell transplant
and what is the best transplant procedure.

Treating frail, older adults

Treatment of AML in people under 60 is fairly standard. It involves cycles of intensive
chemo, sometimes along with a stem cell transplant (as discussed above). Many
patients older than 60 are healthy enough to be treated in the same way, although
sometimes the chemo may be less intense. People who are much older or are in poor
health may not be able to tolerate this intense treatment. In fact, intense chemo could
actually shorten their lives.
In some cases, doctors may recommend low-intensity chemo with a low dose of
cytarabine given in cycles. Sometimes, these patients may be treated with other chemo
drugs like azacitidine (Vidaza) or decitabine (Dacogen). These drugs arent approved to
treat AML, but still may be helpful. In some cases, this may induce remission. In others,
it may control the leukemia for a time.

3. Research
-Complementary - Complementary therapies are used in addition to your hospital treatment, not
instead. They aim to improve mental and physical wellbeing. Many people find the experience of having the
complementary therapy itself pleasant.
Complementary therapies cannot cure your lymphoma be suspicious of promises that they can or might.
Many people do find they help them to relax and cope with their feelings and emotions though.
Some research suggests that complementary therapies may also help to:

control symptoms such as nausea (feeling sick)

reduce your sense of pain

reduce fatigue

lessen feelings of anxiety

Improve your overall psychological wellbeing.

Massage therapy
Massage is a popular complementary therapy that uses touch and pressure to work the muscles and soft
tissues. It can also give your blood circulation a boost. It can help your lymphatic system get rid of waste,
but does not treat or cure your lymphoma.
In general, doctors advise you to:

limit your massages to 20-30 minutes

avoid areas of the body that are the focus of any active treatment (e.g. radiotherapy)

ask the therapist to keep the pressure light avoid heavy massage techniques such as Swedish

massage and Turkish massage

Remember that your skin might be sensitive. For example, if you have had radiotherapy,
massage could irritate your skin, especially if oils are used. If your blood platelet count is low (a
common side effects of chemotherapy treatment), you might bruise easily.

Acupuncture
Acupuncture uses fine needles, which are inserted into parts of your body. There is some evidence that
acupuncture can help with nausea and vomiting as side effects of chemotherapy. It may also provide some
pain relief. Sometimes, acupuncture is offered by the NHS but mostly you will have to pay for it. As with all
complementary therapies, speak to a member of your medical team before you decide whether to have
acupuncture if you have a low platelet or white blood cell count, you could be at greater risk of bleeding
or infection.

Aromatherapy
Aromatherapy uses essential oils (that come from plants and flowers) to improve your wellbeing.
Aromatherapy can be used alongside other complementary therapies such as massage and acupuncture.
More research is needed to look specifically at the effects of aromatherapy on improving quality of life for
cancer patients. There is, however, some evidence that it may help to bring down anxiety and pain levels in
the short-term.

Art therapy
Art therapy helps people to express their thoughts and feelings through art forms such as painting, sculpture,
drama, poetry and dance. There is little research into how art therapy helps people affected by cancer but
some studies show it reduces tiredness. Also, people do often say that it helps to improve their
emotional wellbeing.

Music therapy
He idea behind music therapy is that we all respond to music. Music therapists help people to connect
with music as a way of expressing themselves. Although more research is needed, there is some evidence that
music therapy may help people living with cancer by lowering pain levels and anxiety. It may also help to lift
your mood and improve your quality of life.

Hypnotherapy
During hypnotherapy, your body is very relaxed but your mind is still active. Although you go into a trance-like
state, you remain fully in control a bit like when you are in a daydream. Research shows that hypnotherapy
may help with nausea and vomiting as a side effect of chemotherapy. It may also help to reduce your sense
of pain.

Meditation
Meditation helps to calm the mind and body. There are lots of different types of meditation many of
them involve movement and all of them encourage relaxation.

-Alternative medicine
Ginger- is a traditional treatment used for nausea. It has been used for pregnancy-associated nausea. It

may also help relieve nausea associated with chemotherapy.

Ginger may be taken in a variety of ways. Some people like eating candied ginger or chewing ginger gum.
Others prefer taking the powered, dried rhizome in pill form. Ginger may also be consumed as a beverage
its possible that ginger might interfere with other cancer treatment. If youre consuming ginger frequently,
be sure to tell your doctor.
The national cancer institute recommends different medicine system such as:

Ayurvedic medicine, from India, which focuses on balancing the mind, body, and
spirit

Chinese medicine, which is based on the opposing forces yin and yang

Homeopathy, which uses small doses of medicines to help the body heal itself

Naturopathic medicine, which allows the body to heal itself without the use of
substances

-whats new in Hodgkins lymphoma

Scanning- Scans May Spare Some Hodgkin Lymphoma Patients from
Chemo
A certain type of medical scan can be used to help spare some
Hodgkin lymphoma patients from the severe side effects of
chemotherapy, a new study suggests.
Researchers found that PET imaging can identify patients whose
Hodgkin lymphoma will likely respond better to treatment, and
therefore require less intensive chemotherapy.
"The good news is that the majority of people diagnosed with Hodgkin
lymphoma can be cured -- in this trial more than 95 percent of patients
are alive after three years. But we worry about the long-term side
effects from the treatments we use," study leader Peter Johnson, a
professor of medical oncology at the University of Southampton in
England, said in a university news release.
"As we've done in this trial, personalizing treatment based on how well
it works is a major development for patients with Hodgkin lymphoma,
and sets a new standard of care," he noted.
PET scans were given to more than 1,200 patients with advanced
Hodgkin lymphoma who had undergone two cycles of standard
chemotherapy. Those with a clear scan continued chemotherapy
without the drug bleomycin. Those who didn't have a clear scan -suggesting a more resistant form of the blood cancer -- continued
chemotherapy with bleomycin.
Bleomycin has been used to treat Hodgkin lymphoma for 30 years,
researchers said. But, the drug can lead to scarring of the lungs that
can cause serious breathing problems.
Patients with clear PET scans who stopped receiving bleomycin had the
same survival rate as those who continued receiving the drug,
according to the study.

"Knowing which patients have a more difficult-to-treat form of the

disease means we can select those who need stronger chemotherapy,
while sparing everyone else the severe side effects such as infertility,"
Johnson said.
"This approach, along with a reduction in the need for radiotherapy,
should substantially reduce damage to healthy tissues and the risk of
second cancers caused by treatments," he added.

Chemotherapy--Update in Chemotherapy (Cancer.org)

Why is this medication prescribed?
Bendamustine injection is used to treat chronic lymphocytic leukemia
(CLL; a type of cancer of the white blood cells). Bendamustine injection
is also used to treat a type of non-Hodgkins lymphoma (NHL: cancer
that begins in a type of white blood cell that normally fights infection)
that is slow spreading, but has continued to worsen during or after
treatment with another medication. Bendamustine is in a class of
medications called alkylating agents. It works by killing existing cancer
cells and limiting the growth of new cancer cells.

Bendamustine injection may cause side effects. Tell your doctor if any of these
symptoms are severe or do not go away:

nausea
vomiting
diarrhea
heartburn
constipation
stomach pain or swelling
sores or white patches in the mouth
dry mouth
bad taste in the mouth or difficulty tasting food
loss of appetite
weight loss
headache
anxiety
depression
difficulty falling asleep or staying asleep
back, bone, joint, arm or leg pain
dry skin
sweating
night sweats

Why this medication is prescribed?

Pralatrexate injection is used to treat peripheral T-cell lymphoma

(PTCL; a form of cancer that begins in a certain type of cells in the
immune system) that has not improved or that has come back after
treatment with other medications. Pralatrexate injection has not been
shown to help people who have lymphoma live longer. Pralatrexate
injection is in a class of medications called folate analogue metabolic
inhibitors. It works by killing cancer cells.

What side effects can this medication cause?

Pralatrexate injection may cause side effects. Tell your doctor if any of
these symptoms are severe or do not go away:
nausea
vomiting
diarrhea
constipation
decreased appetite
tiredness
weakness

rash
itching
night sweats
stomach, back, arm, or leg pain
swelling of the hands, feet, ankles, or lower legs

Targeted therapy
What types of targeted therapies might be available in the future?
Drug development is a long process. New drugs have to undergo
rigorous tests to demonstrate that their potential benefits outweigh
their potential risks before they can be approved. As scientists learn
more about how lymphoma develops and the changes in lymphoma
cells that make them grow out of control, new ways to kill lymphoma
cells will be developed. Several targeted drugs (described in this
information) are already beginning to be used in people with
lymphoma. Many more are in development and the number of
treatment options available to people with lymphoma will increase in
the future.
As their effectiveness has not yet been determined, in this information
we havent included drugs that are not yet approved for use in people
with lymphoma. Many of the drugs in clinical trials do not show enough
benefit to undergo further testing. Some of the new ways to target
lymphoma cells that are being tested in clinical trials are described in
the section on other targets for new lymphoma drugs. The other
targets section also includes drugs that have been approved for use in
people with lymphoma in the US but not yet in Europe.

Antibodies against CD20

Antibodies bind to proteins on the surface of cells. Different proteins

are found on the surface of different types of cells, eg CD20 is found on
the surface of B cells. There are newer antibodies that, like rituximab,
target the CD20 antigen. They might bind to different parts of CD20 or
bind more tightly than does rituximab. Because CD20 is found only on
B cells, these are used to treat B-cell lymphomas.

Ofatumumab (Arzerra) targeted drugs

Ofatumumab is an antibody that binds to a slightly different part of

CD20 than does rituximab. It also binds to CD20 for longer than does
rituximab.

It is given intravenously (into a vein) and slowly to begin with,

particularly at the first dose. The rate of infusion (how quickly it is
given into your vein) is increased gradually during each treatment.

For the first dose, a small amount of drug is given, starting at a lower
rate of infusion than normal and increasing gradually. If you tolerate
the drug well, you will get your first full dose a week later. For the next
doses:

When given as a first treatment, it is given monthly for 211 more

doses
when given to people who have previously received other treatments,
it is given weekly for 7 more weeks, followed by a 45 week gap, then
monthly for 4 more doses.

Approved uses of ofatumumab

Chronic lymphocytic leukaemia (CLL)

For people whose lymphoma has relapsed after having fludarabine or

alemtuzumab. It is given on its own.
For people having treatment for the first time and who cannot have
fludarabine. It is given with chlorambucil or bendamustine.
Ofatumumab is being tested in clinical trials to see if it can be used in
other ways for CLL. An application has been submitted for a European
licence for ofatumumab to be used as maintenance therapy after
successful initial treatment of CLL.

Ofatumumab is being tested in

Follicular lymphoma and other low-grade B-cell non-Hodgkin

lymphomas
Richters syndrome (transformation of B-cell CLL).

Possible side effects of ofatumumab

Infusion-related side effects (occur while the treatment is given or

shortly afterwards), such as shivers, fevers, headache and other flu-like
symptoms. Severe reactions can occur. They can make people feel
very ill and require prompt treatment. Infusion reactions are more
common at the first infusion. This is given more slowly and at a lower
dose than later infusions so that your reaction to ofatumumab can be
monitored carefully. Other drugs are given before and during the
ofatumumab infusion to reduce the risk of severe infusion reactions.
Other common side effects (occur in more than 1 in every 10 people):
increased risk of infection (including colds and pneumonia), a drop in
the number of your white blood cells, anaemia (shortage of red blood
cells), nausea, fever (high temperature), and rash.
Uncommon but serious complications: progressive multifocal
leukoencephalopathy (PML is a viral brain infection that is usually
fatal), tumour lysis syndrome (complications caused by the rapid
breakdown of lymphoma cells), reactivation of past infections
(including hepatitis B, which can lead to liver failure).

Antibodydrug conjugates (ADCs)

In antibody-drug conjugates (ADC), an antibody is joined to a

chemotherapy drug. The antibody delivers chemotherapy directly to
the lymphoma cells by binding to a protein found on the surface of the
lymphoma cells. The chemotherapy drug used is one that is good at
killing lymphoma cells but cannot be given into the bloodstream on its
own because of its potential side effects.

Brentuximab vedotin (Adcetris)

Brentuximab vedotin combines an antibody to the CD30 protein with a

drug called monomethyl auristatin E (MMAE). The antibody delivers
MMAE to the lymphoma cells reducing its effect on normal cells.
Brentuximab vedotin is given as an intravenous infusion over 30
minutes. The infusion is usually repeated every 3 weeks and may be
given for up to 1 year.

Approved uses of brentuximab vedotin

Classical Hodgkin lymphoma

For people whose lymphoma has relapsed after a stem cell transplant
or who are not able to have a stem cell transplant and have had at
least 2 other types of treatment?

As consolidation treatment (treatment to kill any cancer cells left in the

body) for people who have had autologous stem cell transplant and are
at high risk of relapse.
Brentuximab vedotin is being tested in clinical trials to see if it can be
used in other ways for classical Hodgkin lymphoma, eg as a first-line
treatment.
Systemic anaplastic large cell lymphoma
For people whose lymphoma has relapsed or has not responded to
first-line treatment.

Brentuximab vedotin is being tested in

CD30-positive T-cell lymphoma

CD30-positive skin lymphoma.

Possible side effects of brentuximab vedotin

Infusion-related reactions (occurring while the treatment is given or

shortly afterwards) such as shivers, fevers, and other flu-like
symptoms.
Other very common side effects (occurring in more than 1 in 10
people): nausea, diarrhea, vomiting, fatigue (tiredness), itching,
alopecia (hair loss), muscle pain, peripheral neuropathy (including pins
and needles), increased risk of infection, a drop in the number of white
blood cells.
Uncommon but serious side effects: progressive multifocal
leukoencephalopathy (PML is a viral brain infection that is usually
fatal), tumour lysis syndrome (complications caused by the rapid
breakdown of lymphoma cells), demyelinating polyneuropathy (a
neurological disorder characterized by slowly progressive weakness
and a loss of sensation in the legs and arms), Stevens-Johnson
syndrome (a life-threatening allergic reaction affecting the skin and
mucous membranes), pancreatitis (inflammation of the pancreas).

Cell signal blockers

Cells receive signals that keep them alive and make them divide.
These signals are sent along 1 or more pathways. Blocking either the
signal or a key part of the pathway can make cells die or stop them
from growing. Certain signalling pathways are more important in some
types of lymphoma than in others. Scientists dont yet fully understand
how all the various pathways are linked.

Ibrutinib (Imbruvica)

Ibrutinib targets Brutons tyrosine kinase (BTK), which is part of a

pathway that helps B cells to stay alive and divide. Ibrutinib is taken as
tablets once daily. Treatment usually continues until the lymphoma
stops responding unless side effects develop that make you stop it.

Approved uses of ibrutinib

Mantle cell lymphoma

For people whose lymphoma has relapsed (come back) after
treatment.
Chronic lymphocytic leukaemia (CLL)
For people whose CLL has relapsed after treatment.
For people with genetic changes (deletion 17p, where some genes are
missing) in their lymphoma cells that make their CLL harder to treat.
Waldenstrms macroglobulinaemia (WM)
For people whose WM has relapsed after treatment.

For people who have had chemo-immunotherapy as first-line

treatment.

Ibrutinib is being tested in

Follicular lymphoma and marginal zone lymphoma

Diffuse large B-cell lymphoma (particularly people with subtypes of
diffuse large B-cell lymphoma called non-GCB type).

Monoclonal therapy- One way the immune system attacks foreign substances in
the body is by making large numbers of antibodies. An antibody is a protein that
sticks to a specific protein called an antigen. Antibodies circulate throughout the
body until they find and attach to the antigen. Once attached, they can recruit other
parts of the immune system to destroy the cells containing the antigen.
Researchers can design antibodies that specifically target a certain antigen, such as
one found on cancer cells. They can then make many copies of that antibody in the
lab. These are known as monoclonal antibodies (mAbs).
Monoclonal antibodies are used to treat many diseases, including some types of
cancer. To make a monoclonal antibody, researchers first have to identify the right
antigen to attack. For cancer, this is not always easy, and so far mAbs have proven
to be more useful against some cancers than others.

Types of monoclonal antibodies

Naked monoclonal antibodies-

MEDICAL SURGICAL NURSING

#1 Requirement
In NCM 106
(Midterm)

Submitted by: Ylron John A. Tapar

Submitted to: Maria Veronica Doceo, RN, MAN