Huy t h c
101
Map 6.4 Leukaemia
Causes
Neoplasm
Cause
ALL
Possibly a genetic susceptibility
coupled with an environmental
trigger
Exact cause unknown
Comment
Commonest cancer in children
Often spreads to central nervous system
Associations – DIP:
•
Down’s syndrome
•
Ionising radiation
•
Pregnancy
Usually affects adults over 60 years old
Affects B lymphocytes
Positive ZAP-70 marker is associated with
a worse prognosis
CLL
AML
Exact cause unknown
Risk factors include:
•
Myeloproliferative disease
•
Alkylating agents
•
Ionising radiation exposure
•
Down’s syndrome
Commonest leukaemia in adults
Rapidly progressing
Auer rods on microscopy are
diagnostic
CML
Exact cause unknown
Risk factor: ionising radiation
exposure
Usually affects males 40–60 years old
80% associated with the Philadelphia
chromosome t[9;22], forming
bcr-abl fusion gene
AML
Suy tủy xương
Khó chịu
Sụt cân
Đổ mồ hôi đêm
CML
Suy tủy xương
Gan lách lớn
Khó chịu
Sụt cân
Đổ mồ hôi đêm
Signs and symptoms
Neoplasm
Clinical features
ALL
Bone marrow failure
Bruising
Shortness of breath
Purpura
Malaise
Weight loss
Night sweats
Asymptomatic
Bone marrow failure
Nontender lymphadenopathy
Hepatosplenomegaly
Malaise
Weight loss
Night sweats
CLL
What is leukaemia?
This is a rare neoplasm of the blood or bone marrow.
It is classified into lymphoid and myeloid neoplasms
that may present chronically or acutely. These 4
classifications are:
1 Acute lymphoblastic leukaemia (ALL).
2 Chronic lymphocytic leukaemia (CLL).
3 Acute myeloid leukaemia (AML).
4 Chronic myeloid leukaemia (CML).
Đi u tr
Đi u tr
ALL
B o t n
CLL
Chlorambucil
Fludarabine
Rituximab
Prednisolone
Cyclophosphamide
Gi i thích, d n dò BN, d a theo l i khuyên c a y tá chăm sóc gi m nh tri u ch ng (Macmillan nurse).
Thu c
Làm thuyên gi m và duy trì:
Đ làm thuyên gi m:
•
Dexamethasone
•
Vincristine
•
Kháng sinh lo i anthracycline
•
Cyclophosphamide
Duy trì:
•
Methotrexate
•
Mercaptopurine
•
Cytarabine
•
Hydrocortisone
AML
B nh nhân <60 tu i:
Hóa tr k t h p v i anthracycline và
cytarabine ho c methotrexate.
B nh nhân >60 tu i:
Gi m nh b ng anthracycline,
cytarabine ho c mitoxantrone.
N u là AML type M3, như lơ xê mi c p
th ti n t y bào (APML), thêm all-trans
retinoic acid vào li u pháp đi u tr .
CML
Imatinib
B nh nhân <60 tu i có th
xem xét ghép t bào g c đ ng
lo i.
Phương pháp khác:
g m alpha-interferon,
vincristine, prednisolone,
cytarabine and daunorubicin.
C n lâm sàng
•
Máu:CT máu,BC, ti u c u, XN nư c ti u và đi n gi i đ , ch c
năng gan, máu l ng, CRP.
•
Sinh thi t t y xương, h ch lympho.
•
Hình nh: X-Quang, siêu âm, CT scan, MRI.
•
AML và ALL đư c phân lo i theo x p lo i French–
American–British (FAB).
Bi n ch ng
•
T vong.
•
D nhi m trùng.
•
Xu t huy t:
ph i, n i s .
•
Tr m c m.
•
Các bi n ch ng
c a hóa tr .
MAP 6.4 Lơ xê mi
Chapter_06.indd 101
08/12/14 6:16 PM
