白血病

(Leukemia)第六章

血液系統(tǒng)疾病

講授目的和要求1.掌握急、慢性白血病的臨床表現(xiàn)，實(shí)驗(yàn)室檢查及診斷標(biāo)準(zhǔn)，治療原則2.熟悉急性白血病FAB分型，聯(lián)合化療的原則，完全緩解的概念PluripotentialstemcellsMyeloidstemcellsLymphoidstemcellsUnipotentialprogenitorcellsImmaturehematopoieticcellsmaturehematopoieticcellsStemcellProgenitorcellImmaturecellMaturecellEtiology&PathogenesisEnvironmentalfactors

AcquireddiseasesLesionstotheDNAClonalexpansionCytogeneticfindingsDiagnosis&ClassificationOthernewlydevelopedmethodsFlowCytometryImmunohistochemistry免疫表型分型方案T細(xì)胞B細(xì)胞（4%）B細(xì)胞前體

CD7（敏感），cCD3（特異）

CD19(敏感),cCD79a(特異)成熟T細(xì)胞（18%）前T細(xì)胞（6%）前B-細(xì)胞（9%）早期前-B細(xì)胞（52%）前-前-B細(xì)胞（11%）sIg,sIg

P118typesoftranslocationsCMLAML-M2AML-M3AML-M4AMLAML-M4E0OthernewdevelopedmethodsDifferentialDiagnosisPseudoleukemiaMyelodysplasticsyndromeNonleukemicpancytopeniaTreatmentSupportivecaresandpreparationofthepatientsAntileukemictherapyTherapyofthecentralnervoussystemStemcelltransplantationAnemiaHemorrhageInfection

HematologicalsupportTransfusionofPlateletsTransfusionofpackedredcellsTransfusionsofgranulocytesTransfusionsofIgG

InfectioncontrolSpecialprecautions:protectiveisolationEliminationofcontaminatedfoodsOralanddigestivesystemcareBroadspectrumantibioticsGM-CSFadministrationAntileukemictherapyChemotherapytokillleukemiacellsusingstronganti-cancerdrugsTreatmentphasesInductiontherapy:theaimistobringaboutremission,thatisleukemiccellsarenolongerfoundinthebonemarrowandtherecoveryofnormalhematopoiesisPost-remissiontherapy:toeliminateanyleukemiacellspotentialhidinginthebodySpecialsubtypesAcutepromyelocyticLeukemia(APL):becauseofthesmallparticles(procoagulants)insidetheAPLcell,DICarecommonlyseeninthistypeofAMLNormalAPLGenesessentialfordifferentiationareshutdownbythefusionproteinsPML-RARalphaDifferentiationagents(all-transretinoicacid,arsenictrioxide)IntrathecalchemotherapyCranialirradiation復(fù)習(xí)思考題1.慢性粒細(xì)胞白