医学专题—-白血病课件

1、医学专题-白血病第六篇 血液(xuy)系统疾病 第九章第九章白血病白血病(Leukemia)周剑峰周剑峰学时学时(xush)(xush)数：数：3 3学学时时(xush)(xush)第一页，共七十二页。医学专题-白血病讲授目的(md)和要求1.掌握急、慢性白血病的临床表现，实验室检查及诊断标准，治疗原则。2.熟悉急性(jxng)白血病FAB分型，联合化疗的原则，完全缓解的概念。第二页，共七十二页。医学专题-白血病讲授(jingshu)主要内容概述(i sh)病因和发病机制临床表现实验室检查诊断标准鉴别诊断治疗第三页，共七十二页。医学专题-白血病概 述第四页，共七十二页。医学专题-白血病Neut

2、rophilBasophilEosinophilMonocytes/Macrophage第五页，共七十二页。医学专题-白血病第六页，共七十二页。医学专题-白血病Stem cell Progenitor cellImmature cellMature cell 第七页，共七十二页。医学专题-白血病Accumulation of mutations of DNA within a pluripotential stem cell or very early progenitor cell gives rise to leukemic stem cells.Normal stem cellLeuke

3、mic stem cell第八页，共七十二页。医学专题-白血病第九页，共七十二页。医学专题-白血病第十页，共七十二页。医学专题-白血病病因和发病(f bng)机制第十一页，共七十二页。医学专题-白血病Etiology&Pathogenesis Environmental factors Acquired diseasesLesions to the DNAClonal expansion第十二页，共七十二页。医学专题-白血病Environmental factorscause leukemia第十三页，共七十二页。医学专题-白血病第十四页，共七十二页。医学专题-白血病第十五页，共七十二

4、页。医学专题-白血病第十六页，共七十二页。医学专题-白血病第十七页，共七十二页。医学专题-白血病Acute: the blood cells of acute leukemia remain in an immature state, so they reproduce and accumulate very rapidly. Therefore, they need treatment immediately , otherwise the disease may be fatal within few months.Chronic: in Chronic leukemia, the blo

5、od cells eventually mature, or partially mature. But they are not “normal”. They remain in the blood much longer than normal blood cells and they can not act functional cells well. 第十八页，共七十二页。医学专题-白血病Myelogenous versus lymphocytic leukemiaIf the leukemic cells arise from myeloid pluripotential stem

6、cells:myeloid leukemia If the leukemic cells arise from lymphocytic pluripotential stem cells:lymphocytic leukemia 第十九页，共七十二页。医学专题-白血病临床表现第二十页，共七十二页。医学专题-白血病 Leukemic hematopoiesis Normal hematopoiesis第二十一页，共七十二页。医学专题-白血病第二十二页，共七十二页。医学专题-白血病第二十三页，共七十二页。医学专题-白血病第二十四页，共七十二页。医学专题-白血病实验室检查(jinch)第二十五页，共

7、七十二页。医学专题-白血病 Anemia is a constant feature.Nucleated red cells or immature red blood cell may be present. Thrombocytopenia is nearly always present at the time of diagnosis.The total leukocyte counts can be high, normal or low. Immature hematopoietic cells are almost present in the blood.第二十六页，共七十二页

8、。医学专题-白血病Marrow findingsNormal bone marrow AML marrow 第二十七页，共七十二页。医学专题-白血病Cytogenetic findings第二十八页，共七十二页。医学专题-白血病诊断(zhndun)标准第二十九页，共七十二页。医学专题-白血病Diagnosis & Classification 第三十页，共七十二页。医学专题-白血病Morphology : the bone marrow cells are evaluated according to their size,shape, and content of granules

9、and then they are classified with respected to maturity. Cytochemistry staining: identification of the chemical components of cells is conducted to distinguish different types of leukemia. Cytochemistry often use special colored dyes. 第三十一页，共七十二页。医学专题-白血病Acute leukemiaAMLALL第三十二页，共七十二页。医学专题-白血病第三十三页

10、，共七十二页。医学专题-白血病P142 (CD tables)A lot of CD provides clues for the diagnosis第三十四页，共七十二页。医学专题-白血病第三十五页，共七十二页。医学专题-白血病 CD13 CD33 CD19 CytoCD79a CD7 CytoCD3 AML - - - -B-ALL - - - -T-ALL - - - -By using this method of analysis, one can make a firm diagnosis in 99% of cases.第三十六页，共七十二页。医学专题-白血病免疫(miny)表型

11、分型方案T 细胞(xbo)B 细胞(xbo)（4%）B 细胞前体 CD7（敏感），cCD3 （特异） CD19 (敏感), cCD79a (特异)成熟T 细胞 （18%）前 T 细胞（6%）前 B-细胞 （9%）早期前-B 细胞 （52%）前-前- B 细胞 （11%）sIg, sIg第三十七页，共七十二页。医学专题-白血病第三十八页，共七十二页。医学专题-白血病Insert table 90% of the cases with leukemia have non-randomized translocation.第三十九页，共七十二页。医学专题-白血病P118 types of trans

12、locationsCML AML-M2AML-M3AML-M4AMLAML-M4E0第四十页，共七十二页。医学专题-白血病第四十一页，共七十二页。医学专题-白血病第四十二页，共七十二页。医学专题-白血病第四十三页，共七十二页。医学专题-白血病第四十四页，共七十二页。医学专题-白血病鉴别(jinbi)诊断第四十五页，共七十二页。医学专题-白血病Pseudoleukemia Myelodysplastic syndrome Nonleukemic pancytopenia 第四十六页，共七十二页。医学专题-白血病治 疗第四十七页，共七十二页。医学专题-白血病 Supportive cares an

13、d preparation of the patients. Antileukemic therapy. Therapy of the central nervous system. Stem cell transplantation.第四十八页，共七十二页。医学专题-白血病Anemia Hemorrhage Infection第四十九页，共七十二页。医学专题-白血病第五十页，共七十二页。医学专题-白血病第五十一页，共七十二页。医学专题-白血病Chemotherapy to kill leukemia cells using strong anti-cancer drugs第五十二页，共七十二

14、页。医学专题-白血病第五十三页，共七十二页。医学专题-白血病Acute promyelocytic Leukemia (APL): because of the small particles (procoagulants) inside the APL cell, DIC are commonly seen in this type of AML.第五十四页，共七十二页。医学专题-白血病Normal APL第五十五页，共七十二页。医学专题-白血病Differentiation agents (all-trans retinoic acid, arsenic trioxide)第五十六页，共七

15、十二页。医学专题-白血病Hyperleukecytosis: cause a batch of complications and should be treated using leukapheresis ( exchanging transfusion) or preinduction treatment prior to intensive chemotherapy. 第五十七页，共七十二页。医学专题-白血病 Acute leukemia over 60 years of age is less responsive to chemotherapy. Standard two-drugs

16、 therapy can be used. CR 30%Intolerant to standard therapy. Low-dose of Ara-C can be used for 1428 days.第五十八页，共七十二页。医学专题-白血病The CNS is a frequent sanctuary site for leukemic cells because most of the chemotherapy drugs are not able to reach the CNS. Some types of acute leukemia have tendency to be w

17、ith CNS leukemia such as AML (M4, M5), ALL. 第五十九页，共七十二页。医学专题-白血病第六十页，共七十二页。医学专题-白血病The main purpose of BMT and PBSCT in cancer treatment is to make it possible for patients to receive very high doses of chemotherapy and/or radiation therapy. In addition, re-established normal hematopoiesis and immun

18、e system by the healthy stem cells fight against leukemia effectively. So it change the vision in the medical history that leukemia is incurable malignancies. 第六十一页，共七十二页。医学专题-白血病第六十二页，共七十二页。医学专题-白血病0%10%20%30%40%50%60%70%80%90%123AML ALL CMLTransplantationChemotherapy第六十三页，共七十二页。医学专题-白血病 Chronic myelogenous leukemia (CML)第六十四页，共七十二页。医学专题-白血病第六十五页，共七十二页。医学专题-白血病第六十六页，共七十二页。医学专题-白血病第六十七页，共七十二页。医学专题-白血病第六十八页，共七十二