山东大学《内科学》急性白血病.pptVIP

Post-remission Therapy (age ≥60y ) Complete response Induction failure Clinical trail Standard-dose cytarabine×5~7d×1~2 cycles± anthracycline Reduced HiDAC ×1~2 cycles, For patients with good performance, better-risk or normal kayrotype with favorable moleucaular markers Continue low-dose regimens (5-Aza, decitabine) Every 4~6 weeks until progression Clinical trail Reduced-intensity HCT Best supportive care Chronic Myelogenous Leukemia Definition and Clinical Features Chronic myeloproliferative diseases (CMPDs) are clonal disorders of the hematopoietic stem cell in which marrows are usually hypercellular and acute leukemia may evolve, similar to myelodysplastic syndromes. Chronic myelogenous leukemia (CML) is the most common CMPD, accounts for about 20% to 35% of all adult leukemias. It typically occurs at 40 to 60, with about 20% to 40% patients asymptomatic, the diagnosis have been suggested by hepatosplenomegaly on physical examination or abnormal results—leukocytosis, anemia, or thrombocytosis—on routine hematologic testing. When symptoms occur, they usually relate to splenomegaly, problems from an increased white cell production (bone pain, mild fever, night sweats, weight loss), or anemia. Clinical Manifestations of CML Cachexia and hepatosplenmegaly In CML Upper: Axial CT scan showing enlarged apleen and liver; Lower: Coronal CT scan showing a mildly enlarged spleen. Chronic Phase of CML The disease often goes through three stages: chronic phase (CML-CP), accelerated phase (CML-AP), and blast crisis phase (BP). In the chronic phase, the blood studies typically show mild anemia abd leukocytosis that usually exceeds 25×109/L (median white count of about 170×109/L), primarily comprising neutrophils in various stages of mutation, especially increases in myelocytes and mature neutropils. Basophils are universally increased, and eosinophilia is common. The platelet count is normal or elevated, and may exceed 1,000×109/L, but resulting thrombosis is un