Cause: Unknown
Mechanism: Disruption of growth conrol and differentiation pathway.
Causing Agents:
1. Virus (ex) HIV -> cause all kind of disruptions:
2. Radiation Exposure (ex) X-ray -> lead Lined: protecting your key organs from getting exposed to
the radiation and leading to unfortunate incident.
3. Chemical (ex) cancer drugs, cigarette
- Chemicals can end up disrupting the growth or differentiation pathway of these cells.
General Principle for management
- Diagnosis: SS Box 11-3
- Bone marrow Suppression (3 deficiency)
o Decrease in neutrophile. Ex) leukemia (less than 500cells per micro-L)
More chance for infection
o Decrease in Red Blood Cell Ex) Anemia (25-30% instead of its normal level)
Hemoglobin 8-10g per deco liter
Not getting enough oxygen
o Decrease in megakaryocytes (produces platelets) (Ex) Thrombocytopenia less than
20,000.
Greater chance to lose blood
o These causes the most symptoms -> dec
- Signs - Symptoms & Disease Correlation
Example) Pt is complaining of:
o sternal tenderness. = suspicion Chronic myeloid leukemia. (CML)
o Gingival hyperplasia = more common in Acute myeloid Leukemia (AML)
o Meningeal involvement = Acute lymphoid leukemia (ALL) (common in children)
Since meningeal involved, increase in intracranial pressure => Headaches,
optic nerve located (= visual changes), Nausea, Vomiting.
- Principles of Tx= Kill cells by disrupting DNA and induce apoptosis.
- What about with cells affecting CNS? Lumbar puncture done to deliver chemotherapy
directly to CNS. The danger is that they can end up being nerve damage, either temporary or
permanent.
3 Phases of Chemotherapy
1. Remission Induction
- Destroy cancer cell, CR (complete Remission) => purpose
2. Post remission (Consolid
3. ation): After complete remission to eliminate escaped CA cells
4. Remission maintenance: prolong or maintain the remission.
a. Less toxic drugs used and other therapies such as antibody therapy, monoclonal therapy,
molecular therapy.
, Bone Marrow Transplant (BMT)
2 Types of Bone Marrow Transplant
1. Allogenic :someone else’s gene
2. Autologous: auto itself – bone marrow transplant from yourself
2 possibilities: harvest bone marrow directly
Or can get peripheral blood and spit it down,
find the stem cell, grow those and put those
back into the Pt. -> Before putting it back, they
need to kill bad things completely, so they put
high dosage drugs and irradiation to kill your
bone marrow -> they can replace it with good
stuff.
Allogenic: We need to find a donor who matches you the most, because it not, you are going to have the
issue of hypersensitivity -> where body will attack the foreign bone marrow.
Autologous (AML & CHL)
- High incidence of recurrence. -> Not as effective to those two.
Myeloid Neoplasms
- Think of transformation, proliferation of bone marrow stem cells that lead to this member.
The first graphic showed that the myeloid stem cells are the one that are being affected.
Example)
Myeloproliferative Disease
- The cells look normal, but there are too many of them
- As a result, this can convert to AML.
- Are going to have abnormal chromosomes. Chromosomes that are usually affected with this
is 1,8,9,13,20
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