Leukemia

Leukemia is a cancer of blood-forming tissues, including bone marrow. Many types exist such as acute lymphoblastic leukemia, acute myeloid leukemia, and chronic lymphocytic leukaemia. Many patients with slow-growing types of leukaemia don't have symptoms. Rapidly growing types of leukaemia may cause symptoms that include fatigue, weight loss, frequent infections, and easy bleeding or bruising.Treatment is highly variable. For slow-growing leukemias, treatment may include monitoring. For aggressive leukemias, treatment includes chemotherapy that's sometimes followed by radiation and stem-cell transplant.

1. LEUKEMIA PRESENTED BY R.PRIYA

2. INTRODUCTION Cancer starts when cells in the body change (mutate) and grow out of control. body is made up of tiny building blocks called cells. Normal cells grow when body needs them. They die when body doesn't need them anymore. Cancer is made up of abnormal cells that grow even though body doesn’t need them. In most types of cancers, the abnormal cells grow to form a lump or mass called a tumor. Leukemia is different from most other cancers. Leukemia cells don't always form a tumor. This cancer starts in the bone marrow. The bone marrow is the thick, spongy liquid inside bones. It's where new blood cells are made. Leukemia starts in early forms of blood cells, often white blood cells, which help fight infections. When have leukemia, body makes too many "bad" blood cells that don’t work like they should. Instead of forming tumors, leukemia cells travel in the blood and go all over the body. This means they can reach almost any organ. Leukemia can cause problems and be found in many different ways, depending on which organs are affected.

3. DEFINITION Leukemia is a cancer of the blood cells. There are several broad categories of blood cells, including  red blood cells  (RBCs),  white blood cells  (WBCs), and platelets. Generally, leukemia refers to cancers of the WBCs. WBCs are a vital part of   immune system . They protect body from invasion by bacteria, viruses, and fungi, as well as from abnormal cells and other foreign substances. In leukemia, the WBCs don’t function like normal WBCs. They can also divide too quickly and eventually crowd out normal cells. WBCs  are mostly produced in the bone marrow, but certain types of WBCs are also made in the  lymph nodes ,  spleen , and  thymus gland . Once formed, WBCs circulate throughout body in blood and lymph (fluid that circulates through the  lymphatic system ), concentrating in the lymph nodes and spleen.

4. KNOW ABOUT HEMATOPOIETIC STEM CELL

5. BONE MARROW FUNCTION The bones of the  skeletal system  serve many important functions for the body, from giving body support to allowing to move. They also play an important role in blood cell production and fat storage. Bone marrow is the spongy or viscous tissue that fills the inside of bones. There are actually two types of bone marrow: Red bone marrow  helps produce blood cells Yellow bone marrow  helps store fat. Read on to learn more about different functions of red and yellow bone marrow as well as the conditions that affect bone marrow. Red bone marrow is involved in  hematopoiesis . This is another name for blood cell production. Hematopoietic stem cells that are found in red bone marrow can develop into a variety of different blood cells, including: Red blood cells.  These are the cells that work to carry oxygen-rich blood to the cells of the body. Old red blood cells can also be broken down in red bone marrow, but this task is mostly performed in the  liver  and  spleen . Platelets.  Platelets help blood clot. This prevents uncontrolled bleeding. White blood cells.  There are several types of white blood cells. They all work to help body fight off infections.

6. BONE MARROW FUNCTION Yellow bone marrow is involved in the storage of fats. The fats in yellow bone marrow are stored in cells called adipocytes. This fat can be used as an energy source as needed. Yellow bone marrow also contains mesenchymal stem cells. These are cells that can develop into bone, fat, cartilage, or muscle cells. Remember, over time, yellow bone marrow starts to replace red bone marrow. So, most bones in an adult body contain yellow bone marrow.

7. LEUKEMIA TYPES IN FLOW CHART

8. TYPES General classification Clinically and pathologically, leukemia is subdivided into a variety of large groups. The first division is between its  acute  and  chronic  forms: [ citation needed ] Acute leukemia  is characterized by a rapid increase in the number of immature blood cells. The crowding that results from such cells makes the bone marrow unable to produce healthy blood cells resulting in low  hemoglobin  and low  platelets . Immediate treatment is required in acute leukemia because of the rapid progression and accumulation of the  malignant cells , which then spill over into the bloodstream and spread to other organs of the body. Acute forms of leukemia are the most common forms of  leukemia in children . Chronic leukemia  is characterized by the excessive buildup of relatively mature, but still abnormal, white blood cells. Typically taking months or years to progress, the cells are produced at a much higher rate than normal, resulting in many abnormal white blood cells. Whereas acute leukemia must be treated immediately, chronic forms are sometimes monitored for some time before treatment to ensure maximum effectiveness of therapy. Chronic leukemia mostly occurs in older people, but can occur in any age group.

9. SPECIFIC TYPES Specific types Acute lymphoblastic leukemia  (ALL) is the most common type of leukemia in ng children. It also affects adults, especially those 65 and older. Standard treatments involve  chemotherapy  and  radiotherapy . Subtypes include  precursor B acute lymphoblastic leukemia ,  precursor T acute lymphoblastic leukemia ,  Burkitt's leukemia , and  acute biphenotypic leukemia . While most cases of ALL occur in children, 80% of deaths from ALL occur in adults. [15] Chronic lymphocytic leukemia  (CLL) most often affects adults over the age of 55. It sometimes occurs in nger adults, but it almost never affects children. Two-thirds of affected people are men. The five-year survival rate is 85%. It is incurable, but there are many effective treatments. One subtype is  B-cell prolymphocytic leukemia , a more aggressive disease. Acute myelogenous leukemia  (AML) occurs far more commonly in adults than in children, and more commonly in men than women. It is treated with chemotherapy. The five-year survival rate is 20%. Subtypes of AML include  acute promyelocytic leukemia ,  acute myeloblastic leukemia , and  acute megakaryoblastic leukemia . Chronic myelogenous leukemia  (CML) occurs mainly in adults; a very small number of children also develop this disease. It is treated with  imatinib  (Gleevec in United States, Glivec in Europe) or other drugs. The five-year survival rate is 90%. One subtype is  chronic myelomonocytic leukemia . Hairy cell leukemia  (HCL) is sometimes considered a subset of chronic lymphocytic leukemia, but does not fit neatly into this category. About 80% of affected people are adult men. No cases in children have been reported. HCL is incurable but easily treatable. Survival is 96% to 100% at ten years.

10. SPECIFIC TYPES T-cell prolymphocytic leukemia  (T-PLL) is a very rare and aggressive leukemia affecting adults; somewhat more men than women are diagnosed with this disease. [22]  Despite its overall rarity, it is the most common type of mature  T cell  leukemia; [23]  nearly all other leukemias involve  B cells . It is difficult to treat, and the median survival is measured in months. Large granular lymphocytic leukemia  may involve either T-cells or  NK cells ; like hairy cell leukemia, which involves solely B cells, it is a rare and  indolent  (not aggressive) leukemia. [24] Adult T-cell leukemia  is caused by  human T-lymphotropic virus  (HTLV), a virus similar to  HIV . Like HIV, HTLV infects CD4+ T-cells and replicates within them; however, unlike HIV, it does not destroy them. Instead, HTLV "immortalizes" the infected T-cells, giving them the ability to proliferate abnormally. Human T-cell lymphotropic virus types I and II (HTLV-I/II) are endemic in certain areas of the world. [ citation needed ] Clonal eosinophilias  (also called  clonal hypereosinophilias ) are a group of blood disorders characterized by the growth of  eosinophils  in the  bone marrow , blood, and/or other tissues. They may be  pre-cancerous  or  cancerous . Clonal eosinophilias involve a  "clone"  of eosinophils, i.e., a group of genetically identical eosinophils that all grew from the same  mutated  ancestor cell. [25]  These disorders may evolve into  chronic eosinophilic leukemia  or may be associated with various forms of  myeloid  neoplasms,  lymphoid  neoplasms,  myelofibrosis , or the  myelodysplastic syndrome

11. RISK FACTOR The causes of leukemia aren’t known. However, several factors have been identified which may increase risk. These include: a family history of leukemia smoking , which increases risk of developing  acute myeloid leukemia (AML) genetic disorders  such as  Down syndrome blood disorders , such as  myelodysplastic syndrome , which is sometimes called “ preleukemia ” previous treatment for cancer with  chemotherapy  or  radiation exposure to high levels of  radiation exposure to chemicals such as benzene

12. PATHOPHYSIOGY

13. SIGNS AND SYMPTOMS fatigue a general feeling of discomfort or illness (called malaise) loss of appetite weight loss fever shortness of breath paleness rapid heartbeat (called palpitations) weakness dizziness easy bruising frequent or severe nose bleeds bleeding gums bleeding in the middle of a menstrual cycle or heavy menstrual flow tiny, flat, red spots caused by bleeding just under the surface of the skin (called petechiae) frequent infections in the lungs, urinary tract or gums or around the anus frequent cold sores

14. SIGNS AND SYMPTOMS vomiting headache sore throat night sweats bone or joint pain enlarged lymph nodes in the neck, underarm, groin or above the collarbone abdominal discomfort or feeling of fullness vision problems sores in the eyes swelling of the testicles chloroma  – a collection of leukemia cells, or blasts, under the skin or in other parts of the body leukemia cutis – appears as sores or as patches of any size that are usually pink or tan in colour leukocytoclastic vasculitis – a condition that looks like an allergic reaction on the skin and usually causes sores on the hands and feet Sweet’s syndrome, or acute febrile neutrophilic dermatosis – causes fever and painful sores that may appear anywhere on the body

15. DIAGNOSTIC EVALUATION Physical exam.   doctor will look for physical signs of leukemia, such as pale skin from anemia, swelling of lymph nodes, and enlargement of liver and spleen Laboratory tests Blood film – likely to show the  presence of blast cells Imaging or invasive tests All children suspected to have a new diagnosis of leukemia should also undergo  chest X ray  to exclude mediastinal mass Lumbar puncture  is required to check for CNS involvement .CT, MRI,UTRASOUND Blood tests.  By looking at a sample of blood, doctor can determine if have abnormal levels of red or white blood cells or platelets — which may suggest leukemia. A blood test may also show the presence of leukemia cells, though not all types of leukemia cause the leukemia cells to circulate in the blood. Sometimes the leukemia cells stay in the bone marrow. Bone marrow test.   doctor may recommend a procedure to remove a sample of bone marrow from hipbone. The bone marrow is removed using a long, thin needle. The sample is sent to a laboratory to look for leukemia cells. Specialized tests of leukemia cells may reveal certain characteristics that are used to determine treatment options. Bone marrow  aspirate / trephine  is required to confirm the diagnosis

16. MANAGEMENT Chemotherapy.  Chemotherapy is the major form of treatment for leukemia. This drug treatment uses chemicals to kill leukemia cells.  standard induction plans include  prednisone ,  vincristine , and an  anthracycline  drug; other drug plans may include  L-asparaginase  or  cyclophosphamide Depending on the type of leukemia have, may receive a single drug or a combination of drugs. These drugs may come in a pill form, or they may be injected directly into a vein. Targeted therapy.  Targeted drug treatments focus on specific abnormalities present within cancer cells. By blocking these abnormalities, targeted drug treatments can cause cancer cells to die.eg.imatinub Radiation therapy.  Radiation therapy uses X-rays or other high-energy beams to damage leukemia cells and stop their growth. During radiation therapy, lie on a table while a large machine moves around . may receive radiation in one specific area of body where there is a collection of leukemia cells, or may receive radiation over whole body. Radiation therapy may be used to prepare for a bone marrow transplant. may receive stem cells from a donor or may be able to use own stem cells.

17. MANAGEMENT Bone marrow transplant.  A bone marrow transplant, also called a stem cell transplant, helps reestablish healthy stem cells by replacing unhealthy bone marrow with leukemia-free stem cells that will regenerate healthy bone marrow. Prior to a bone marrow transplant, receive very high doses of chemotherapy or radiation therapy to destroy leukemia-producing bone marrow. Then receive an infusion of blood-forming stem cells that help rebuild bone marrow.

18. MANAGEMENT Many different treatments have been attempted, with limited success in certain people:  purine analogues  ( pentostatin , fludarabine, cladribine),  chlorambucil , and various forms of combination chemotherapy (cyclophosphamide, doxorubicin, vincristine, prednisone  CHOP , cyclophosphamide, vincristine, prednisone [COP], vincristine, doxorubicin, prednisone, etoposide, cyclophosphamide, bleomycin  VAPEC-B ).  Alemtuzumab  ( Campath ), a  monoclonal antibody  that attacks white blood cells, has been used in treatment with greater success than previous options. Engineering immune cells to fight leukemia.  A specialized treatment called chimeric antigen receptor (CAR)-T cell therapy takes body's germ-fighting T cells, engineers them to fight cancer and infuses them back into body. CAR-T cell therapy might be an option for certain types of leu Immunotherapy .  Immunotherapy uses immune system to fight cancer. body's disease-fighting immune system may not attack cancer because the cancer cells produce proteins that help them hide from the immune system cells. Immunotherapy works by interfering with that process..

19. PREVENTION Be a non-smoker. Not smoking is the best way to lower risk of leukemia. ... Maintain a healthy body weight. ... Avoid breathing in benzene and formaldehyde. ... More information about preventing cancer.

20. THANK YOU