acute exacerbation of chronic myeloid leukemia

Ngày tải lên: 10/08/2014, 22:21

... (FDA) for marketing based on trials using the FAB criteria. Acute Myeloid Leukemia Incidence The incidence of acute myeloid leukemia (AML) is ~3.7 per 100,000 people per year, and the age-adjusted ... Survivors of the atomic bomb explosions in Japan had an increased incidence of myeloid leukemias that peaked 5–7 years after exposure. Therapeutic radiation alone seems to add little risk of AML ... factor (G-CSF) receptor and, often, neutrophil elastase that may evolve into AML. Myeloproliferative syndromes may also evolve into AML (Chap. 103). Germ-line mutations of CCAAT/enhancer-binding...

Ngày tải lên: 07/07/2014, 04:20

... Acute myelomonocytic leukemia Acute monoblastic and monocytic leukemia Acute erythroid leukemia Acute megakaryoblastic leukemia Acute basophilic leukemia Acute panmyelosis with myelofibrosis ... myelofibrosis Myeloid sarcoma French-American-British (FAB) Classification c Incidence M0: Minimally differentiated leukemia 5% M1: Myeloblastic leukemia without maturation 20% M2: Myeloblastic leukemia ... Myelomonocytic leukemia 20% M4Eo: Variant: Increase in abnormal marrow eosinophils M5: Monocytic leukemia 10% M6: Erythroleukemia (DiGuglielmo's disease) 4% M7: Megakaryoblastic leukemia...

Ngày tải lên: 07/07/2014, 04:20

... transducer and Chapter 104. Acute and Chronic Myeloid Leukemia (Part 3) Immunophenotype and Relevance to the WHO Classification The immunophenotype of human leukemia cells can be studied ... flow-cytometric demonstration of the myeloid- specific antigens cluster designation (CD) 13 or 33. Similarly, acute megakaryoblastic leukemia can often be diagnosed only by expression of the platelet-specific ... tyrosine kinase receptor important in the development of myeloid and lymphoid lineages. Activating mutations of the gene FLT3 are present in ~30% of adult AML patients due to internal tandem duplications...

Ngày tải lên: 07/07/2014, 04:20

... granulation. Figure 104-1 Chapter 104. Acute and Chronic Myeloid Leukemia (Part 4) Clinical Presentation Symptoms Patients with AML most often present with nonspecific symptoms that ... complain of fatigue or weakness at the time of diagnosis. Anorexia and weight loss are common. Fever with or without an identifiable infection is the initial symptom in ~10% of patients. Signs of ... considerably, irrespective of other hematologic findings, splenomegaly, or duration of symptoms. The anemia is usually normocytic normochromic. Decreased erythropoiesis often results in a reduced...

Ngày tải lên: 07/07/2014, 04:20

... Chapter 104. Acute and Chronic Myeloid Leukemia (Part 5) Morphology of AML cells. A. Uniform population of primitive myeloblasts with immature chromatin, ... Once the diagnosis of AML is suspected, a rapid evaluation and initiation of appropriate therapy should follow (Table 104-2). In addition to clarifying the subtype of leukemia, initial studies ... evaluated for infection. Table 104- 2 Initial Diagnostic Evaluation and Management of Adult Patients with Acute Myeloid Leukemia History Increasing fatigue or decreased exercise tolerance (anemia)...

Ngày tải lên: 07/07/2014, 04:20

... achievement of CR. In addition, patients who achieve Chapter 104. Acute and Chronic Myeloid Leukemia (Part 6) Most patients are anemic and thrombocytopenic at presentation. Replacement of the ... initial phases of therapy. Prognostic Factors Many factors influence the likelihood of entering CR, the length of CR, and the curability of AML. CR is defined after examination of both blood ... qualitative platelet dysfunction or the presence of an infection may increase the likelihood of bleeding, evidence of hemorrhage justifies the immediate use of platelet transfusion, even if the platelet...

Ngày tải lên: 07/07/2014, 04:20

... Chapter 104. Acute and Chronic Myeloid Leukemia (Part 7) Acute Myeloid Leukemia: Treatment Treatment of the newly diagnosed patient with AML is usually ... for the therapy of newly diagnosed acute myeloid leukemia. For all forms of AML except acute promyelocytic leukemia (APL), standard therapy includes a 7-day continuous infusion of cytarabine ... course of therapy, and one-third require two courses. About 50% of patients who do not achieve CR have a drug-resistant leukemia, and 50% do not achieve CR because of fatal complications of bone...

Ngày tải lên: 07/07/2014, 04:20

... Chapter 104. Acute and Chronic Myeloid Leukemia (Part 8) The hematologic toxicity of high-dose cytarabine-based induction regimens has typically ... in only half of febrile patients. Early initiation of empirical broad-spectrum antibacterial and antifungal antibiotics has significantly reduced the number of patients dying of infectious ... complications remain the major cause of morbidity and death during induction and postremission chemotherapy for AML. Prophylactic administration of antibiotics in the absence of fever is controversial....

Ngày tải lên: 07/07/2014, 04:20

... M195 Chapter 104. Acute and Chronic Myeloid Leukemia (Part 9) Treatment of Promyelocytic Leukemia Tretinoin is an oral drug that induces the differentiation of leukemic cells bearing ... standard-dose cytarabine. The Cancer and Leukemia Group B (CALGB), for example, compared the duration of CR in patients randomly assigned postremission to four cycles of high (3 g/m 2 , every 12 h on ... agents (Table 104-3). Table 104- 3 Selected New Agents under Study for Treatment of Adults with AML Class of Drugs Example Agent(s) MDR1 modulators Cyclosporine, LY335979 Demethylating...

Ngày tải lên: 07/07/2014, 04:20

... Chapter 104. Acute and Chronic Myeloid Leukemia (Part 11) Chronic Myelogenous Leukemia Incidence The incidence of chronic myelogenous leukemia (CML) is 1.5 per 100,000 ... Heterogeneous structural alterations of the p53 gene, as well as structural alterations and lack of protein production of the retinoblastoma gene and the catalytic component of telomerase, have been associated ... development of a CML cell mass of 10,000/àL took 6.3 years. No increase in CML incidence was found in the survivors of the Chernobyl accident, suggesting that only large doses of radiation...

Ngày tải lên: 07/07/2014, 04:20

... promyelocytes are noted with the majority of cells being myelocytes, metamyelocytes and band forms. Cycling of the counts may be Chapter 104. Acute and Chronic Myeloid Leukemia (Part 12) Clinical ... significant degrees of reticulin stain–measured fibrosis are noted in about half of the patients. Disease acceleration is defined by the development of increasing degrees of anemia unaccounted ... Chromosomal Findings The cytogenetic hallmark of CML, found in 90–95% of patients, is the t(9;22)(q34;q11.2). Originally, this was recognized by the presence of a shortened chromosome 22 (22q-), designated...

Ngày tải lên: 07/07/2014, 04:20

... posttransplantation treatment. Chapter 104. Acute and Chronic Myeloid Leukemia (Part 13) Chronic Myelogenous Leukemia: Treatment The therapy of CML is changing rapidly because we have a ... owing to the transplant procedure. Outcome of SCT depends on multiple factors including: (1) the patient (e.g., age and phase of disease); (2) the type of donor [e.g., syngeneic (monozygotic twins) ... Discussion of both treatment options with a patient is indicated. The decision should focus on the outcomes, risks, and toxicities of the various approaches. At present, the goal of therapy...

Ngày tải lên: 07/07/2014, 04:20

... and even syngeneic marrow may exhibit limited GVL activity in CML. Chapter 104. Acute and Chronic Myeloid Leukemia (Part 14) The Patient Patients should have acceptable end-organ function, ... accelerated and blastic phases of the disease is significantly diminished and is associated with high rates of relapse. Bone marrow transplantation (BMT) early in the chronic phase (1–2 years from ... transplantation is our recommendation. Development and Type of GVHD Development of grade I GVHD (Chap. 108) decreases the risk of relapse compared to no GVHD. An even lower relapse rate was...

Ngày tải lên: 07/07/2014, 04:20

... and should be offered other treatment approaches. Progression to accelerated/blastic phases of the disease was noted in 3% of patients treated with imatinib as compared to 8.5% of patients treated ... Myelosuppression, while rare, may require holding drug and/or growth Chapter 104. Acute and Chronic Myeloid Leukemia (Part 15) Posttransplantation Treatment BCR/ABL transcript levels have ... have been developed for chronic- phase CML patients (Table 104-4). For example, chronic- phase CML patients who do not achieve any cytogenetic remission following six months of imatinib are unlikely...

Ngày tải lên: 07/07/2014, 04:20

Ngày tải lên: 07/07/2014, 04:20

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