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AML
ALL
ALL
nave
B-lymphocytes
Plasma
Lymphoid cells
progenitor T-lymphocytes
AML
Hematopoietic Myeloid Neutrophils
stem cell progenitor
Eosinophils
Basophils
Monocytes
Platelets
Red cells
What Is Leukemia?
Cancer of the white blood cells
Acute or Chronic
Bone marrow makes abnormally large
number of immature white blood cells
called blasts
produksi normal blood cells
Demographics of Leukemia
Patients (2001 Data)
CLL=Chronic
Lymphocytic
ALL=Acute ALL
others
Lymphocytic 11%
17%
CML=Chronic
Mylogenous
AML=Acute
Mylogenous CML CLL
15% 26%
AML
31%
Acute Chronic
Mani, A, Lee, DA. Leukemic Gingival Infiltration. N Engl J Med 2008; 358(3): 274. Copyright 2008 Massachusetts Medical Society
Tests For Diagnosis
Blood sample
Blood dye
Bone marrow sample
Spinal Tap/Lumbar Puncture
Laboratory features
WBC usually elevated, but can be normal
or low
blasts in peripheral blood
normocytic anemia
thrombocytopenia
neutropenia
DIC
CML
Ph +ve
BCR-abl +ve
Coagulation is always
the initial event Thrombosis of
small and Bleeding
midsize vessels
Reduced Platelet
Activation Fibrin
Blood flow formation
Plt Study
Morphology
Stable Hemostatic Plug Function
Antibody
Screening Tests of Blood Coagulation
Mekanisme DIC
Systemic activation
of coagulation
Malignancy Pulmonary
Leukemia ARDS/RDS
Metastatic disease Pulmonary
Cardiovascular embolism
Post cardiac arrest Severe acidosis
Acute MI
Severe anoxia
Prosthetic devices
Hypothermia/Hyperth Collagen vascular
ermia disease
Anaphylaxis
Conditions Associated With DIC
Cyclophosphamide
Vincristine
Prednisone
Chronic Leukemia Treatment:
CHOP Regimen:
Cyclophosphamide
Doxorubicin
Vincristine
Prednisone
PENATALAKSANAAN TERAPI
Terapi non farmakologi :
Pembedahan (splenektomi)
untuk pasien dengan splenomegali masif yang
menunjukkan gejala, ataupun refractory cytopenia
(karena autoimun atau hipersplenism).
Respon : pengurangan gejala karena spenomegali,
dan perbaikan cytopenia.
The Future
Clinical trials
New drug treatments
Vaccines
Immunotherapy
Cord blood and planceta
Gene therapy
Block encoding instructions of an oncogene
Target the oncoprotein
Blood and marrow stem cell transplantation
Bone marrow transplantation provides long-
term, disease-free survival among patients in
remission
Prognosis for AML
Major Criteria
total RBC vol
Men > or = to 36 mL/kg
Women > or = to 32 mL/kg
arterial 02 saturation > or = to 92%
Splenomegaly
Minor Criteria
Thrombocytosis with platelet count > 400,000/mL
Leukocytosis with WBC > 12,000/mL
Increased leukocyte alkaline phosphatase LAP > 100U/L
(no infection)
Serum B12 > 900 pg/mL or binding capacity UB12 BC >
2200 pg/mL
Komplikasi
Examples of thrombotic events include
arterial and venous thrombosis,
cerebrovascular accident, deep venous
thrombosis, myocardial infarction,
peripheral arterial occlusion, and
pulmonary infarct
P vera - Treatment
Phlebotomy
Myelosuppressive agents
Hydroxyurea
Alkylating agents such as busulfan
32P
Interferon alpha
P vera - phlebotomy
Generally, the best initial treatment for P vera
No increase in progression to AML
Rapid onset
No BM suppression
Remove 500 cc blood 1-2x/wk to target Hct
45%, then maintain
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