world cancer report - iarc
world cancer report - iarc
world cancer report - iarc
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A B<br />
Fig. 5.113 Acute myeloid leukaemia; agranular myeloblasts (A) and granulated myeloblasts (B).<br />
bone marrow and lymph nodes, admixed<br />
with prolymphocytes and paraimmunoblasts,<br />
usually expressing CD5 and<br />
CD23 surface antigen [5]. Chronic lymphocytic<br />
leukaemia [10] is a heterogeneous<br />
disease which can occur in an indolent<br />
form with very little progression, whilst at<br />
the other extreme it may present with<br />
severe bone marrow failure and a poor<br />
prognosis.<br />
Management<br />
Remarkable progress in the understanding<br />
and treatment of leukaemia has been<br />
made in the past century [11]. In the first<br />
instance, this generalization refers specifically<br />
to paediatric disease. Prior to 1960,<br />
leukaemia was the leading cause of death<br />
Fig. 5.115 Spectral karyotyping of a chronic myeloid leukaemia case reveals<br />
a variant Philadelphia chromosome involving translocations between chromosomes<br />
3, 9, 12 and 22. Secondary changes involving chromosomes 1, 5,<br />
8, 18 and X are also seen, indicating advanced disease.<br />
from malignancy in children under 15; currently,<br />
more than 80% of children with<br />
acute lymphoblastic leukaemia can be<br />
cured with chemotherapy [12]. Treatment<br />
involves induction of remission with combinations<br />
of agents (such as vincristine,<br />
daunorubicin, cytarabine [cytosine arabinoside],<br />
L-asparaginase, 6-thioguanine,<br />
and steroids) followed by consolidation,<br />
maintenance and post-remission intensification<br />
therapy to eradicate residual<br />
leukaemic blast cells, aiming at cure.<br />
Intensive supportive care throughout treatment<br />
is of major importance. Prophylactic<br />
treatment with intrathecal methotrexate<br />
injections, with or without craniospinal<br />
irradiation, is mandatory in the management<br />
of acute lymphoblastic leukaemia to<br />
Fig. 5.114 A bone marrow biopsy of acute promyelocytic<br />
leukaemia. Abnormal promyelocytes have<br />
abundant hypergranulated cytoplasm. The nuclei<br />
are generally round to oval, several being irregular<br />
and invaginated.<br />
prevent possible involvement of or relapse<br />
in the central nervous system. The use of<br />
radiotherapy is limited because of the<br />
potential long-term side-effects, particularly<br />
effects on the growth of the young child<br />
and the risk of second malignancies. The<br />
adult form of acute lymphoblastic<br />
leukaemia is also susceptible to therapy<br />
and can be cured, (although not as readily<br />
as childhood leukaemia), with intensive<br />
combination therapy [13].<br />
For acute leukaemia in adults, the initial<br />
aim of management is to stabilize the<br />
patient with supportive measures to counteract<br />
bone marrow failure which leads to<br />
anaemia, neutropenia and thrombocytopenia.<br />
Most patients with leukaemia<br />
who die in the first three weeks of diagno-<br />
Fig. 5.116 Acute promyelocytic leukaemia cells with t(15;17)(q22;q12)<br />
translocation. Fluorescence in situ hybridization with probes for PML (red)<br />
and RARα (green) demonstrates the presence of a PML/RARα fusion protein<br />
(overlapping of red and green = yellow signal) resulting from the breakage<br />
and fusion of these chromosome bands.<br />
Leukaemia<br />
245