Acute Leukemia.pptx

Acute Leukemia PPT

1. 1 Acute Leukemia Presented By: Pooja Rimal Pharmacotherapeutics -II M.Pharm , 3 rd Sem

2. 2 The  word leukemia  comes from the Greek  words   leukos , "white" and haima , “blood” Leukemia  means a blood condition of the white blood cells. Leukemia is an amalgam of cancers and arises due to the malignancy of the any elements of blood and bone marrow. In other terms, they are abnormal white blood cells, which are not fully developed and are called blasts or leukemia cells. Source: Ugandhar Chapalamadugu et al. Source: https://www.saintlukeskc.org/health-library/what-leukemia

3. 3 Classification of Leukemia: Acute leukemia Chronic leukemia 1. Acute leukemia is divided into two parts: Acute Lymphocytic Leukemia (ALL) Acute Myelocytic Leukemia (AML) 2. Chronic leukemia is divided into two parts: Chronic Lymphocytic Leukemia (CLL) Chronic Myelocytic Leukemia (CML)

4. 4 Acute Leukemia It is a heterogenous group of malignant disorders characterised by uncontrolled clonal and accumulation of blasts cells in the bone marrow and body tissues.

5. 5 Epidemiology The more common form of the disease is AML, which accounts for 75% of cases. In contrast, ALL is predominantly a childhood disease, with the peak incidence in the 3–5 year age group, and is the most common childhood cancer.

6. 6 Aetiology The exact cause of the acute leukemias is unknown. A multifactorial process involving genetics, environmental and socioeconomic factors, toxins, immunologic status, and viral exposures is likely. Causes of Leukemia

7. 7 1. General: Gender: Men are more likely to develop CML, CLL and AML then women. Age: With the exception of ALL, risk typically increases with age. 2. Genetics: Genetic factors: – A high incidence of acute leukemias & chronic lymphocytic leukemias is reported in certain families. Hereditary abnormalities associated with an increased incidence of leukemia are Down’s syndrome, Fanconi’s aplastic anemia, Trisomy -13 ( Patau’s syndrome), etc Identical twins, fraternal twins, and siblings of children with leukemia are also at increased risk.

8. 8 3. Over-exposure to ionizing radiations: Ionizing radiations are the only environmental risk factors strongly associated with ALL or AML. 4.Working with certain chemicals: Exposure to high levels of benzene in the workplace can cause leukemia. Benzene is used widely in the chemical industry. Formaldehyde is also used by the chemical industry. Workers exposed to formaldehyde also may be at greater risk of leukemia.

9. 9 5. Drugs: Alkylating agents and epidophyllotoxins used to treat other cancers, especially in combination with radiation therapy, increase a person’s risk of leukemia. 6. Viruses: Human T-cell lymphotrophic virus, an RNA retrovirus endemic in Japan and the West Indies, has been linked to a rare T-cell leukaemia /lymphoma.

10. 10 7. Congenital abnormalities: – Down’s syndrome, Haematological disorders. Many patients with other haematological disorders have a greatly increased risk of developing leukaemia , particularly AML. These disorders include the myelodysplastic syndromes, the non- leukaemic myeloproliferative disorders, aplastic anaemia and paroxysmal nocturnal haemoglobinuria .

11. 11 8. Social Habits: Smoking: Tobacco products are the single, major avoidable cause of cancer. Smoking is also causally associated with cancers of the pancreas, kidney, bladder, stomach, an d cervix and with myeloid leukemia. Maternal alcohol consumption, maternal marijuana use are also associated with childhood AML

12. 12 Pathophysiology In leukaemia , the normal process of haemopoiesis is altered Transformation to malignancy appears usually at the pluripotential stem cell level But it may occur in a committed stem cell with capacity for more limited differentiation Accumulation of malignant cells occur Leads to progressive impairment of the normal bone marrow function.

13. 13 Pathophysiology of Leukemia

14. 14 Pathophysiology In acute leukaemia , the normal bone marrow is replaced by a malignant clone of immature blast cells derived from the myeloid (in AML) or lymphoid (in ALL) series. More than 20% of the cellular elements of the bone marrow are replaced with blasts. This is usually associated with the appearance of blasts in the peripheral circulation accompanied by worsening pancytopenia as a result of the marrow's reduced ability to produce normal blood cells as the proportion of malignant cells increases. In ALL, the blasts may infiltrate lymph nodes and other tissues such as liver, spleen, testis and the meninges , in particular. In AML, blasts tend to infiltrate skin, gums, liver and spleen

15. 15 Types of Acute leukemia 1. Acute Myeloblastic Leukemia AML is a life-threatening disease in which the cells normally develop into neutrophils , basophils , eosinophils and monocytes become concerous and rapidly replace normal cells in the bone marrow.  characterized by the rapid growth of abnormal white blood cells that accumulate in the bone marrow and interfere with the production of normal blood cells.

16. 16 Source: Roger Walker and Cate Whittlesea , Clinical Pharmacy and Therapeutics 5 th Edition. Classification of Acute Myeloblastic Leukemia

17. 17 Source: Joseph T. Dipiro , Pharmacotherapy, A Pathophysiology Approach, 7 TH Edition.

18. 18 Pathophysiology : Firstly, the production of normal blood cells markedly decreases Which results in varying degrees of anemia, thrombocytopenia, and  neutropenia . Secondly, the rapid proliferation of these cells occurs With a reduction in their ability to undergo programmed cell death (apoptosis) Results in their accumulation in the bone marrow, blood, and, frequently, the spleen and liver

19. 19 Symptoms Abnormal menstrual periods Bleeding from the nose Bleeding gums Bruising Bone pain or tenderness Fatigue Fever Paleness Shortness of breath  Skin rash or lesion Swollen gums (rare) Weight loss

20. 20 Treatment The first course of drug treatment (induction chemotherapy) generally includes Cytarabine for 7 days by a continuous infusion and  Daunorubicin or idarubicin or  mitoxantrone  for 3 days A bone marrow or cord blood transplant. All- trans  retinoic acid (ATRA) if he or she has the subtype of AML known as promyelocytic leukemia. Treatment of AML is divided into two phases: induction:   postremission  (or  consolidation ) therapy:

21. 21 Treatment Patient diagnosed with AML ADE 10+3+5 ADE 8+3+5 Bone marrow assessment Complete remission No remission MACE Salvage chemotherapy Mid AC Consolidation chemotherapy

22. 22 Source: Roger walker and Cate Whittlesea clinical Pharmacy and therapeutics

23. 23 Acute lymphoblastic leukemia (ALL): ALL is a fast-growing cancer of the white blood cells. Lymphocytes are a type of WBC that the body uses to fight infections. In ALL, the bone marrow makes lots of blasts. However, the blasts are abnormal. They do not develop and cannot fight infections. The number of abnormal cells (or leukemia cells) grows quickly. They crowd out the normal red blood cells, white blood cells and platelets the body need

24. 24 Classification of ALL Source: Roger walker and Cate Whittlesea clinical Pharmacy and therapeutics

25. 25 Symptoms Bone and joint pain or tenderness Easy bruising and bleeding (gums, skin bleeding, nosebleeds. Feeling weak or tired, Fever Loss of appetite and weight loss Paleness Pain or feeling of fullness below the ribs Pinpoint red spots on the skin ( petechiae ) lymphadenopathy in the neck, under arms Night sweats

26. 26 Diagnosis A physical exam includes: Bruising Enlarged liver, lymph nodes, and spleen Signs of bleeding ( petechiae ,  purpura ) Blood tests may show the following: Abnormal  white blood cell (WBC) count Low red blood cell count ( anemia ) Low platelet count ( thrombocytopenea ) A bone marrow biapsy is almost always performed to confirm the diagnosis .

27. 27 Treatment: Pharmacolgical Treatment The most commonly used chemotherapy drugs are Vincristine , L- asparaginase , Anthracyclines (doxorubicin, daunorubicin ) Cyclophosphamide , Cytarabine ( ara -C), and Epipodophyllotoxins ( etoposide , teniposide ). The child will also receive a steroid (prednisone or dexamethasone ). Intrathecal chemotherapy will also be given.

28. 28 The goal of treatment: Is to get the blood counts and the bone marrow back to normal. If this occurs and the bone marrow looks healthy under the microscope, the cancer is said to be in remission. The main treatment for (ALL) is chemotherapy, which is usually divided into 3 phases: Induction: Consolidation (also called intensification): Maintenance

29. 29 1. Induction: The goal of induction chemotherapy is to achieve a  remission . This means that leukemia cells are no longer found in bone marrow samples, the normal marrow cells return, and the blood counts become normal. 2. Consolidation : The next, and usually more intensive, phase of chemotherapy typically lasts about 4 to 8 weeks. The consolidation phase reduces the number of leukemia cells still in the body. Several drugs are used in combination to prevent the remaining leukemia cells from developing resistance

30. 30 3. Maintenance: If the leukemia remains in remission after induction and consolidation, maintenance therapy can begin. Most treatment plans use methotrexate and 6-mercaptopurine, given as pills, often along with vincristine , which is given intravenously, and a steroid (prednisone or dexamethasone ). These latter 2 drugs are given for brief periods every 4 to 8 weeks. During the first few months of maintenance, most treatments include 1 or 2 repeat intensified treatments similar to the initial induction. These 4-week intensifications are called re-induction.

31. 31 Occasionally, leukemia patients at higher risk may receive more intensive maintenance chemotherapy and intrathecal therapy. The total duration of therapy (induction, consolidation, and maintenance) for most ALL treatment plans is 2 to 3 years. Because boys are at higher risk for relapse than girls, many doctors favor giving them several more months of treatment.

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