According
to statistics, Taiwan, about 500 new cases each year, about 2 cases per 100,000
persons per year of new cases, and the number is still rising year by year, in
Taiwan is all leukemia (leukemia) the highest annual incidence than the United
States each year about 3.6 cases
hundred thousand new cases of low, generally occur in older
people.
Category:
The disease classification method has two, one is the 1980s FAB classification, the other is the newly launched 2001 WHO classification. In the FAB classification, according to the leukemia cell differentiation, and cell sources were divided into eight kinds of M0 to M7. Their diagnosis of cancer cells including bone marrow extraction to obtain the type of observation, supplemented by cytochemical staining and the determination of surface markers, and to get the correct diagnosis and classification. In the new WHO classification, places FAB classification is basic, but must be considered together with the chromosomal changes in cancer cells, is divided into (1) those who have a fixed chromosomal changes, such as 15 and 17 pairs of chromosome translocation (t ( 15; 17)), which is the FAB classification M3. (2) have previously undergoing chemotherapy or radiation therapy and transition from acute myeloid leukemia (therapy-related AML). (3) There are many types of chemical and biological characteristics of those who are poor leukemia (AML with multi-lineage dysplasia). (4) Other of acute myelogenous leukemia and (5) systems discrepancy unknown acute leukemia (acute leukemia of ambiguous lineage).
Disease due to:
Is nothing more than the interaction between the environment and genes.
Environmental factors:
Including radiation, benzene, and general treatment of cancer chemotherapy may increase the future risk of acute myelogenous leukemia opportunities.
Disease factors:
Chronic myelogenous leukemia and other chronic myeloid proliferative diseases are likely to evolve into acute myelogenous leukemia, and the poor prognosis of this leukemia. Some diseases such as congenital immune deficiency also have more opportunities to suffer from the disease.
Genetic factors:
All must have leukemia gene mutations, but only about half of the opportunity to observed with an optical microscope chromosome mutation, these apparent chromosomal aberrations including chromosomal translocation, such as t (8; 21) (q22; q22). Article 8 on the long arm of chromosome with the first part of the long arm of chromosome 22 pairs a part of a balanced exchange of results, making it one of the first eight pairs of chromosome 21 chromosome pick a part (Figure III ), the result of this translocation AML1 gene (located on chromosome 21) and ETO (located on eight pairs of chromosomes) fused together to form the AML1-ETO fusion gene. Similar fusion gene in leukemia is very common form of the disease's play a very important role. The rest of the chromosome changes include increases or shortfalls in certain chromosomes. For those chromosome examination showed no abnormalities, but also hidden mutations such as NPM1 (nucleophosmin), FLT3 mutations, etc.. As technology developed, these previously unknown mutations will be discovered one by one, on the etiology of acute myeloid leukemia there must be a great help in clarifying. Although leukemia is a gene variation, but few familial cases, showing that those diseases are acquired mutations obtained.
Clinical symptoms:
Acute myeloid leukemia is more rapid onset of their symptoms from normal blood cells of hematopoietic cells are suppressed from. Enough red blood cells, the patient had fatigue, weakness, pallor; when leukocyte function is suppressed, the patient will be infected with fever performance; when the platelet is insufficient, skin bruising, bleeding gums, and often difficult to stop the bleeding at blood . Because the symptoms the patient is nothing more than the ㄧ to seek treatment and get diagnosed. Some subtypes of acute myelogenous leukemia exceptional symptoms, such as M3, known as acute promyelocytic leukemia patients, particularly easy bleeding. No breakthrough in previously treated, the patient often died of intracerebral hemorrhage, patients are often required to suppress the blood at constant, otherwise the blood will flow in a long time. The monocyte series myeloid leukemia (M4 or M5) are more often than bone marrow invasion. Skin, gastrointestinal tract, respiratory tract, urinary tract, bone marrow and central nervous system and other areas are likely to have cancer of the blood of the invasion. Sometimes the outer region of the bone marrow of acute myeloid white blood cells to form tumor-like disease, called myeloid sarcoma (myeloid sarcoma, or granulocytic sarcoma). A small portion of patients have no symptoms, at the general health check found in blood leukocyte classification in bud cells (blast) occurs, the result is a very early bone marrow examination revealed leukemia.
Laboratory data:
Diagnosis of acute myeloid leukemia, in general, very easy. Especially now that blood testing is widespread, as long as the blood after a few minutes you can see the blood data inkling about the situation. Typically patients have varying degrees of anemia and thrombocytopenia, while the number of white blood cells may be high or low or normal, but if we look at the classification of leukocytes, neutrophils usually phenomenon is suppressed in order to use the machine to the current general Category leukocyte's case, there may be in leukocyte classification misjudgment happens to be observed by professionals to smear leukocyte types to get the correct interpretation and from delays in treatment. If the data are suspected peripheral blood leukemia, bone marrow examination is then necessary steps, from the bone marrow cells of the type and degree of differentiation before they can do the right FAB and WHO classification, and sometimes not yet appeared bud cells in peripheral blood, the bone marrow is certainly filled with malignant cells. The cells can be further staining to determine cell belongs monocyte series, or others. In addition, chromosome analysis is an important basis for the diagnosis because the diagnosis of chromosomal changes the recognition and subsequent treatment and prognosis significance. Flow cytometry can interpret cell surface markers that like ID cards, via such precision check the identity of each of the blood cells can be confirmed, one can determine their cellular origin, on the one hand can not abnormal cell markers As the amount of residual disease after treatment in future judgment basis.
Advances in molecular biology have been greatly now, the prognosis for many gene mutations have a significant impact on the choice of treatment has great reference value, and can take advantage of these mutations as a disease of the residue after treatment assessment basis. Thus, cells can be extracted nucleotide for mutation analysis. But the test items, the most primitive but the most basic is morphology determination. Figure IV lists some of the acute myelogenous leukemia cell type, with normal peripheral blood leukocytes seen as a distinct maturation of contrast. Acute myeloid leukemia cells look bigger, nuclear accounted for relatively large proportion of the cells, but the texture is delicate nuclear, and sometimes you can see the nucleolus, and cytoplasm bluer, occasional particles. Special attention is required to the M3, blood, often dumbbell-shaped nucleus, cytoplasm and showed a lot of red particles, often fagot like Auer Rods exist, sometimes a cell with more than 10 Auer Rods, shape with "Oath" is a very exceptional features, but seeing one of these cells, the diagnosis can almost be confirmed immediately administered for this type of leukemia special treatment (see below), reducing patients' bleeding crisis .
Treatment
General principles:
Disposal of leukemia patients have some particularities: Most of the patients have low immunity, often with severe infection, acute leukemia and solid tumors more than chemotherapy generally strong, toxicity is also large, and sometimes blood cells start to chemotherapy The sensitivity is very high, may cause tumor cell lysis and the release of some toxic substances and deadly. These problems are beginning to make a deal with acute leukemia, particularly troublesome. At the beginning of treatment of patients with acute leukemia, the first stabilize the patient's life, living conditions, such as infection control and prevention of bleeding to stop the phenomenon, the amount of fluid replenishment, closely monitor the patient's vital signs and visceral functions, in addition to exclude M3, acute myeloid leukemia, because of this type of treatment different from those of the other (detailed later). Treatment of acute leukemia, you must carefully assess the patient's physical condition, age, and usually the presence or absence of chronic diseases, because these factors determine a prescription with which, for example, a 85-year-old man, has long been a result of cerebrovascular disease and long-term bed rest, perhaps not lend active chemotherapy are more sensible approach; Conversely, younger patients or older ones are very good physical condition, but who, in a good explanation and communications, should be actively treated to cure as the goal, usually the first to give guided therapy (induction ) supplemented with consolidation therapy (consolidation), and depending on their risk of disease and hematopoietic stem cell donors decide whether to accept the presence or absence of transplantation. Figure five representatives of non-M3 subtype of acute myeloid leukemia treatment principles.
If the patient is the M3 subtype of acute myeloid leukemia, it is a lesser evil, because by vitamin A acid (all trans retinoic acid) combined light dose of chemotherapy, five-year disease-free survival rate of eighty percent; if you are unfortunate relapse , as well as arsenic trioxide can be used, again complete remission rate is still as high as 80%, can be regarded as the highest cure rate of cancer subsequently.
Category:
The disease classification method has two, one is the 1980s FAB classification, the other is the newly launched 2001 WHO classification. In the FAB classification, according to the leukemia cell differentiation, and cell sources were divided into eight kinds of M0 to M7. Their diagnosis of cancer cells including bone marrow extraction to obtain the type of observation, supplemented by cytochemical staining and the determination of surface markers, and to get the correct diagnosis and classification. In the new WHO classification, places FAB classification is basic, but must be considered together with the chromosomal changes in cancer cells, is divided into (1) those who have a fixed chromosomal changes, such as 15 and 17 pairs of chromosome translocation (t ( 15; 17)), which is the FAB classification M3. (2) have previously undergoing chemotherapy or radiation therapy and transition from acute myeloid leukemia (therapy-related AML). (3) There are many types of chemical and biological characteristics of those who are poor leukemia (AML with multi-lineage dysplasia). (4) Other of acute myelogenous leukemia and (5) systems discrepancy unknown acute leukemia (acute leukemia of ambiguous lineage).
Disease due to:
Is nothing more than the interaction between the environment and genes.
Environmental factors:
Including radiation, benzene, and general treatment of cancer chemotherapy may increase the future risk of acute myelogenous leukemia opportunities.
Disease factors:
Chronic myelogenous leukemia and other chronic myeloid proliferative diseases are likely to evolve into acute myelogenous leukemia, and the poor prognosis of this leukemia. Some diseases such as congenital immune deficiency also have more opportunities to suffer from the disease.
Genetic factors:
All must have leukemia gene mutations, but only about half of the opportunity to observed with an optical microscope chromosome mutation, these apparent chromosomal aberrations including chromosomal translocation, such as t (8; 21) (q22; q22). Article 8 on the long arm of chromosome with the first part of the long arm of chromosome 22 pairs a part of a balanced exchange of results, making it one of the first eight pairs of chromosome 21 chromosome pick a part (Figure III ), the result of this translocation AML1 gene (located on chromosome 21) and ETO (located on eight pairs of chromosomes) fused together to form the AML1-ETO fusion gene. Similar fusion gene in leukemia is very common form of the disease's play a very important role. The rest of the chromosome changes include increases or shortfalls in certain chromosomes. For those chromosome examination showed no abnormalities, but also hidden mutations such as NPM1 (nucleophosmin), FLT3 mutations, etc.. As technology developed, these previously unknown mutations will be discovered one by one, on the etiology of acute myeloid leukemia there must be a great help in clarifying. Although leukemia is a gene variation, but few familial cases, showing that those diseases are acquired mutations obtained.
Clinical symptoms:
Acute myeloid leukemia is more rapid onset of their symptoms from normal blood cells of hematopoietic cells are suppressed from. Enough red blood cells, the patient had fatigue, weakness, pallor; when leukocyte function is suppressed, the patient will be infected with fever performance; when the platelet is insufficient, skin bruising, bleeding gums, and often difficult to stop the bleeding at blood . Because the symptoms the patient is nothing more than the ㄧ to seek treatment and get diagnosed. Some subtypes of acute myelogenous leukemia exceptional symptoms, such as M3, known as acute promyelocytic leukemia patients, particularly easy bleeding. No breakthrough in previously treated, the patient often died of intracerebral hemorrhage, patients are often required to suppress the blood at constant, otherwise the blood will flow in a long time. The monocyte series myeloid leukemia (M4 or M5) are more often than bone marrow invasion. Skin, gastrointestinal tract, respiratory tract, urinary tract, bone marrow and central nervous system and other areas are likely to have cancer of the blood of the invasion. Sometimes the outer region of the bone marrow of acute myeloid white blood cells to form tumor-like disease, called myeloid sarcoma (myeloid sarcoma, or granulocytic sarcoma). A small portion of patients have no symptoms, at the general health check found in blood leukocyte classification in bud cells (blast) occurs, the result is a very early bone marrow examination revealed leukemia.
Laboratory data:
Diagnosis of acute myeloid leukemia, in general, very easy. Especially now that blood testing is widespread, as long as the blood after a few minutes you can see the blood data inkling about the situation. Typically patients have varying degrees of anemia and thrombocytopenia, while the number of white blood cells may be high or low or normal, but if we look at the classification of leukocytes, neutrophils usually phenomenon is suppressed in order to use the machine to the current general Category leukocyte's case, there may be in leukocyte classification misjudgment happens to be observed by professionals to smear leukocyte types to get the correct interpretation and from delays in treatment. If the data are suspected peripheral blood leukemia, bone marrow examination is then necessary steps, from the bone marrow cells of the type and degree of differentiation before they can do the right FAB and WHO classification, and sometimes not yet appeared bud cells in peripheral blood, the bone marrow is certainly filled with malignant cells. The cells can be further staining to determine cell belongs monocyte series, or others. In addition, chromosome analysis is an important basis for the diagnosis because the diagnosis of chromosomal changes the recognition and subsequent treatment and prognosis significance. Flow cytometry can interpret cell surface markers that like ID cards, via such precision check the identity of each of the blood cells can be confirmed, one can determine their cellular origin, on the one hand can not abnormal cell markers As the amount of residual disease after treatment in future judgment basis.
Advances in molecular biology have been greatly now, the prognosis for many gene mutations have a significant impact on the choice of treatment has great reference value, and can take advantage of these mutations as a disease of the residue after treatment assessment basis. Thus, cells can be extracted nucleotide for mutation analysis. But the test items, the most primitive but the most basic is morphology determination. Figure IV lists some of the acute myelogenous leukemia cell type, with normal peripheral blood leukocytes seen as a distinct maturation of contrast. Acute myeloid leukemia cells look bigger, nuclear accounted for relatively large proportion of the cells, but the texture is delicate nuclear, and sometimes you can see the nucleolus, and cytoplasm bluer, occasional particles. Special attention is required to the M3, blood, often dumbbell-shaped nucleus, cytoplasm and showed a lot of red particles, often fagot like Auer Rods exist, sometimes a cell with more than 10 Auer Rods, shape with "Oath" is a very exceptional features, but seeing one of these cells, the diagnosis can almost be confirmed immediately administered for this type of leukemia special treatment (see below), reducing patients' bleeding crisis .
Treatment
General principles:
Disposal of leukemia patients have some particularities: Most of the patients have low immunity, often with severe infection, acute leukemia and solid tumors more than chemotherapy generally strong, toxicity is also large, and sometimes blood cells start to chemotherapy The sensitivity is very high, may cause tumor cell lysis and the release of some toxic substances and deadly. These problems are beginning to make a deal with acute leukemia, particularly troublesome. At the beginning of treatment of patients with acute leukemia, the first stabilize the patient's life, living conditions, such as infection control and prevention of bleeding to stop the phenomenon, the amount of fluid replenishment, closely monitor the patient's vital signs and visceral functions, in addition to exclude M3, acute myeloid leukemia, because of this type of treatment different from those of the other (detailed later). Treatment of acute leukemia, you must carefully assess the patient's physical condition, age, and usually the presence or absence of chronic diseases, because these factors determine a prescription with which, for example, a 85-year-old man, has long been a result of cerebrovascular disease and long-term bed rest, perhaps not lend active chemotherapy are more sensible approach; Conversely, younger patients or older ones are very good physical condition, but who, in a good explanation and communications, should be actively treated to cure as the goal, usually the first to give guided therapy (induction ) supplemented with consolidation therapy (consolidation), and depending on their risk of disease and hematopoietic stem cell donors decide whether to accept the presence or absence of transplantation. Figure five representatives of non-M3 subtype of acute myeloid leukemia treatment principles.
If the patient is the M3 subtype of acute myeloid leukemia, it is a lesser evil, because by vitamin A acid (all trans retinoic acid) combined light dose of chemotherapy, five-year disease-free survival rate of eighty percent; if you are unfortunate relapse , as well as arsenic trioxide can be used, again complete remission rate is still as high as 80%, can be regarded as the highest cure rate of cancer subsequently.
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