... AcuteMyeloidLeukemia Incidence The incidence of acutemyeloidleukemia (AML) is ~3.7 per 100,000 people per year, and the age-adjusted incidence is higher in men than in women (4.6 versus ... series Radiation 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 ... Alkylating agent–associated leukemias occur on average 4–6 years after exposure, and affected individuals have aberrations in chromosomes and Topoisomerase II inhibitor–associated leukemias occur 1–3...
... of specific recurrent genetic abnormalities For example, AML FAB M3 is now designated acute promyelocytic leukemia (APL), based on the presence of either the t(15;17)(q22;q12) cytogenetic rearrangement ... promyelocytic leukemia (Pml)/retinoic acid receptor α (Rarα), which is formed by the fusion of the retinoic acid receptor α (RARα) gene from chromosome 17 and the promyelocytic leukemia (PML) ... associated with improved treatment outcome In contrast, overexpression of genes such as brain and acute leukemia, cytoplasmic (BAALC) predicts for poor outcome Gene expression profiles to predict outcome...
... cells Abnormal rod-shaped granules called Auer rods are not uniformly present, but when they are, myeloid lineage is virtually certain (Fig 104-1) Poor neutrophil function may be noted by impaired...
... infection Table 104-2 Initial Diagnostic Evaluation and Management of Adult Patients with AcuteMyeloidLeukemia History Increasing fatigue or decreased exercise tolerance (anemia) Excess bleeding ... from IV sites (DIC, possible acute promyelocytic leukemia) Fever and tachycardia (signs of infection) Papilledema, retinal infiltrates, cranial nerve abnormalities (CNS leukemia) Poor dentition, ... hypertrophy (leukemic infiltration, most common in monocytic leukemia) Skin infiltration or nodules (leukemia infiltration, most common in monocytic leukemia) Lymphadenopathy, splenomegaly, hepatomegaly...
... greater proportion of patients have more resistant disease Chronic and intercurrent diseases impair tolerance to rigorous therapy; acute medical problems at diagnosis reduce the likelihood of ... maturation The bone marrow should contain
... Figure 104-2 Flow chart for the therapy of newly diagnosed acutemyeloidleukemia For all forms of AML except acute promyelocytic leukemia (APL), standard therapy includes a 7-day continuous ... improve the CR duration After induction chemotherapy, the bone marrow is examined to determine if the leukemia has been eliminated If ≥5% blasts exist with ≥20% cellularity, the patient is usually re-treated ... and one-third require two courses About 50% of patients who not achieve CR have a drug-resistant leukemia, and 50% not achieve CR because of fatal complications of bone marrow aplasia or impaired...
... febrile reactions Blood products should also be irradiated to prevent transfusion associated graft -versus- host disease (GVHD) Cytomegalovirus (CMV)-negative blood products should be used for CMVseronegative...
... underway to determine whether a critical threshold level of transcripts uniformly predicts for leukemia relapse Postremission Therapy Induction of a durable first CR is critical to long-term ... autologous SCT Highdose cytarabine is more effective than standard-dose cytarabine The Cancer and Leukemia Group B (CALGB), for example, compared the duration of CR in patients randomly assigned...
... ABL (named after the abelson murine leukemia virus) gene located on chromosome 9q34 Untreated, the disease is characterized by the inevitable transition from a chronic phase to an accelerated phase ... actin microfilaments is enhanced Disease Progression The events associated with transition to the acute phase, a common occurrence in the pre-imatinib era, were extensively studied Chromosomal instability...
... Blast crisis is defined as acute leukemia, with blood or marrow blasts ≥20% Hyposegmented neutrophils may appear (Pelger-Huet anomaly) Blast cells can be classified as myeloid, lymphoid, erythroid, ... are elevated Phagocytic functions are usually normal at diagnosis and remain normal during the chronic phase Histamine production secondary to basophilia is increased in later stages, causing ... pruritus, diarrhea, and flushing At diagnosis, bone marrow cellularity is increased, with an increased myeloid to erythroid ratio The marrow blast percentage is generally normal or slightly elevated...
... hematologic, cytogenetic, or molecular remission a Nutritional Comprehensive Cancer Network, Chronic myelogenous leukemia b Denotes that at the indicated milestones, patients should stay on the same...
... Syngeneic BMT in patients with chronic- phase CML results in 7-year disease-free survival in 55% of patients, with a 30% relapse rate BMT with an HLA-identical sibling in the chronic phase achieves 5-year ... groups, patients receiving BMT from unrelated donors have higher rates of graft failure and acute and chronic GVHD and prolonged convalescence after treatment, compared to those who receive allogeneic ... donors in chronic- phase CML, marrow stem cells led to a higher cumulative incidence of relapse at years, while peripheral blood stem cell recipients had a higher cumulative incidence of chronic...
... as a treatment goal in CML Specific milestones have been developed for chronicphase CML patients (Table 104-4) For example, chronic- phase CML patients who not achieve any cytogenetic remission...
... Monitoring of ChronicMyeloidLeukemia by Qualitative and Quantitative RT-PCR Methods in Molecular Medicine Vol 125, (2006), 69-92 APPLYING PCR TECHNIQUE IN THE DETECTION OF CHRONICMYELOIDLEUKEMIA ... Mechanisms of Leukemia induction to treatment of chronic myelogenous Leukemia. Oncogene 21 (56), (2002), 8547- 59 Sawyers, C.L Chronicmyeloidleukemia The New England Journal of Medicine 340(17), ... extraction Anal Biochem.Apr; 162(1), (1987), 156-9 Joanna Gora-Tybor Targeted drugs in ChronicMyeloidLeukemia Current medicinal Chemistry, 15, (2008), 3036-3051 Nowel, PC and D.A Hungerford...
... chronicmyeloidleukemia cells Hematology 2007, 12(6):497-503 Kim JG, Sohn SK, Kim DH, Baek JH, Lee NY, Suh JS: Clinical implications of angiogenic factors in patients with acute or chronic leukemia: ... with acutemyeloidleukemia Leuk Lymphoma 2005, 46(6):885-91 10 Kaneta Y, Kagami Y, Tsunoda T, Ohno R, Nakamura Y, Katagiri T: Genomewide analysis of gene-expression profiles in chronicmyeloidleukemia ... production by bone marrow mononuclear cells from normal individuals and patients with acute and chronicmyeloidleukemia or myelodysplastic syndromes Clin Cancer Res 1999, 5(5):1115-24 16 Kaneta...
... road to a cure for chronicmyeloidleukemia Blood 2007, 110:2242-2249 Cang S, Liu D: P-loop mutations and novel therapeutic approaches for imatinib failures in chronicmyeloidleukemia J Hematol ... mutations in chronicmyeloidleukemia resistant to imatinib Haematologica 2006, 91:659-662 27 Auewarakul CU, Huang S, Yimyam M, Boonmoh S: Natural history of Southeast Asian chronicmyeloidleukemia ... J: Chronicmyeloidleukemia and secondgeneration tyrosine kinase inhibitors: when, how, and which one? Semin Hematol 47:344-353 23 Wei G, Rafiyath S, Liu D: First-line treatment for chronic myeloid...