FAB Classification of ALLThe FAB Classification relies on morphology, dividing blasts into L1, L2 and L3 by their appearance.    These are derived from immunophenotypically distinct mature B cells.  

L1 L2 L3

Small Larger & Small Large

Almost no cytoplasm

About 20% cytoplasm

Basophilic Cytoplasm Cytoplasmic vacuolization

Round to cleaved nucleoli Perinuclear chromatin

More prominent nucleoli

 

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The leukemia may Relapse in the

Blood and bone marrow, Brain, Spinal cord, Testiclesor in other parts of the body.

Complications of acute leukemia (ALL):

-Tumor lysis syndrome-Renal failure-Sepsis-Bleeding-Thrombosis-Typhlitis-Neuropathy-Neuropathy-Encephalopathy ( CNS Involvment )-Encephalopathy ( CNS Involvment )-Seizures -Seizures -Secondary malignancy -Short stature (if craniospinal radiation) -Growth hormone deficiency

Prior to the introductionof total therapy for ALL, about 70% of children, without CNS prophelaxies, developed symptomatic involvement.

Lumbar puncture with cytospin Lumbar puncture with cytospin morphologic analysis:morphologic analysis:

This is performed before systemic chemotherapy is administered to assess the presence of CNS involvement and to administer intrathecal chemotherapy.

Central nervous system (CNS) therapy is usually given during each phase of therapy. Because chemotherapy that is given by mouth or injected into a vein may not reach leukemia cells in the CNS (brain and spinal cord) - Intrathecal chemotherapy and- Radiation therapy are able to reach leukemia cells in the CNS and are given to kill the leukemia cells and prevent the cancer from recurring ( CNS prophylaxis ).

Cerebrospinal sign in CNS Involvment with ALLCerebrospinal sign in CNS Involvment with ALL

1-Increased CSF pressure.

2-Elevated level of CSF protein.

3-Decreased glucose value.

4-Pleocytosis ( 5 or moe cellr/ul of CSF).

This incidence has been reducedto under 12% with appropriate CNS prophelaxy . approximately 5% of patients present with an initial diagnosis of meningeal leukemia.

Cranial irradiation effectively prevents overt CNS relapse. Complication: -Neurotoxicity -Brain tumors

Cranial irradiation is necessary for patients with very high-risk.

Intrathecal and systemic chemotherapy for most patients has produced excellent results,

(with CNS relapse rates of 10 - 2% in most studies.)

If CNS disease is present,Cranial irradiation and

intrathecal chemotherapy may be given.

 sign and Symptome: -Headach-Lethargy,-anorexia,and Vomating -EEG changes, -CNS pleocytosis, -Fever.-Bradicardy.  

CNS prophylaxis:

Radiation therapy may be used to treat childhood ALL that may spread, to the brain and spinal cord.

بيماران ALL بود . كل مورد 173تعداد

مغزي گرفتاري يا عود موارد تعدادمورد 24نخاعي .

و 18تا 3 بين بيماران سن سالسال 12ميانگين .

بيماران پسر 13جنس نفر 11 و نفر

بود دختر .

( 14 %)

نتائج و بيماران مشخصاات

نتائج مطالعه

كل 18-13 جمع 7-12 كمتر سال6از

مشخصات

173 81 70 22 كل تعدادبيماران

24 12 11 1 CNS-Relaps

14% 17% 5/16% 5/4% درصد

عود دچار بيماران درصد و تعدادبر نخاعي سني مغزي گروه 6حسب

سال 18و 12و

مطالعه نتائج

42تا ماه

36تا ماه

30تا ماه

24تا ماه

18تا ماه

12تا ماه

ماه 6 اول

زمان ماه

------ ------- 1 مورد

3 مورد

6 مورد

7 مورد

7 مورد

تعداد موار

عود د

بر نخاعي مغزي عود دچار بيماران تعداددرمان آغاز از زماني فاصله حسب نگهدارنده

نتائج

آمد بدست ذيل نتائج آماري بررسي :در

حاد -1 لنفوبالستيك لوسمي در نخاعي مغزي در عودبيشتر مؤنث از جنس (p=0.0001) مذكراستجنس

از -2 باالتر سني گروه در نخاعي مغزي سال 6عوداست .بيشتر

3- ( در ( لنفوبالستها لكوسيتها تعداد بيمارانيكه درباالتري بيماري بروز (P=0.0001) شروع اين داشتند

ب بيشتر ودعارضه . در -4 استخوان مغز نارسائي عالئم بيمارانيكه در

است بيشتر نخاعي مغزي عود داشتند درمان .شروعلوسمي -5 نخاعي مغزي عود عالمت شايعترين

حاد درمانهاي سردرد لنفوبالستيك به مقاوم) است %)100معمولي

بيشتر -6 حاد لنفوبالستيك لوسمي نخاعي مغري عودنگهدارنده 5/1در درمان آغاز اول آيد سال مي بوجود .

(Type II7- لو در نخاعي مغزي عود عارضه مي سبروزنوع نسبت P=0.0001 )لنفوبالستيك 6به 82با

است نوع (Type I) ) درصد از بيشتر