复旦大学附属中山医院：《内科学》课程教学资源（PPT讲稿）谢毅－白血病 Leukemia

Leukemia(自血病 湖毅( Xie yi Dep Hematology, Huashan Hospital

2021/1/21 xie Yi,Hua Shan Hospital 1 Leukemia (白血病) 谢毅（Xie yi） Dep.Hematology，Huashan Hospital

Concept of leukemia Definition It is the results of the tumor proliferation of heamotopoietic stem cells.(造血干细胞) Leukemia is a malignant blood disorder. (not solid tumor) 2021/1/21 xie Yi, Hua Shan Hospital

2021/1/21 xie Yi,Hua Shan Hospital 2 Concept of leukemia Definition It is the results of the tumor proliferation of heamotopoietic stem cells.（造血干细胞） Leukemia is a malignant blood disorder. (not solid tumor)

Hematopoietic stem cell reproduction HSC lymphoid HSC HSC differentiation early progenitor CFU-GEMM myeloid HSC Heamatopoietic Stem cell(Hsc) is the primary cell of Heamatopoietic system and immune system 2021/1/21 xie Yi, Hua Shan Hospital

2021/1/21 xie Yi,Hua Shan Hospital 3 Heamatopoietic stem cell reproduction HSC lymphoid HSC HSC differentiation early progenitor CFU-GEMM myeloid HSC Heamatopoietic Stem Cell (HSC) is the primary cell of Heamatopoietic system and immune system

需魔以是能坐R Multipotent stem Cell Lymphoid stem Cell Myelaid Stem cell (CFU-S) ⑨◎ pre-T Cell pre-B Cell NK cell o⊙e⑤◎ CFU-Meo CFU-Eo CFU-GM cFU吧E ③ B Lymphocyte RIBC Mast cell EosinophIl Plasma 3 CD4 CD8 ◎◎ Cell Memon B Call Monocyte Neutrophil T Lymphocytes Megacaryocyte Macrophage From Immunology A Synthesis"(Golub and Green, 1991)

Tumor proliferation of Hsc Differentiation of hsc is blocked Leukemia cells are stopped on a differentiation stage of hsC lack of the normal function Proliferation is out of control and apoptosis is inhibited Leukemia cell is cloned and accumulated in a great quantity. infiltration and metastasis 2021/1/21 xie Yi, Hua Shan Hospital 5

2021/1/21 xie Yi,Hua Shan Hospital 5 Tumor proliferation of HSC Differentiation of HSC is blocked. Leukemia cells are stopped on a differentiation stage of HSC & lack of the normal function . Proliferation is out of control and apoptosis is inhibited. Leukemia cell is cloned and accumulated in a great quantity. infiltration and metastasis

malignant blood disorders HSC differentiation is blocked Normal blood cells are decreased and leukemia cell is increased The function of blood and immune system are short of Fever, bleeding, anemia 2021/1/21 xie Yi, Hua Shan Hospital 6

2021/1/21 xie Yi,Hua Shan Hospital 6 malignant blood disorders HSC differentiation is blocked. Normal blood cells are decreased and leukemia cell is increased. The function of Blood and immune system are short of. Fever ，bleeding ，anemia

malignant blood disorders Proliferation is out of control apoptosis is inhibited and leukemia cell is accumulated in a great quantity. Leukostasis(白细胞淤滞) Abnormal morphology pictures of blood and bone marrow Liver, spleen, lymph nods, skin, CNS are infiltrated and dysfunctional frequently. 2021/1/21 xie Yi, Hua Shan Hospital 7

2021/1/21 xie Yi,Hua Shan Hospital 7 malignant blood disorders Proliferation is out of control ,apoptosis is inhibited and leukemia cell is accumulated in a great quantity. Leukostasis(白细胞淤滞) Abnormal morphology pictures of blood and bone marrow Liver,spleen,lymph nods, skin,CNS are infiltrated and dysfunctional frequently

the tradition classification(FAB)of leukemia According to the acute myeloid leukemia(AML) Differentiation& MO M1 M2 M7 Kind of cel∥ blast crisis of CMl mast cell leukemia acute eosinophilic leukemia, basophilic leukemia acute lymphocyte leukemia (ALL) L1,L2,L3 T一ALL、B-ALL chronic leukemia:CML、P一LL、CLL、HCL 2021/1/21 xie Yi, Hua Shan Hospital 8

2021/1/21 xie Yi,Hua Shan Hospital 8 According to the acute myeloid leukemia（AML） Differentiation & M0 M1 M2 ……………….. M7 Kind of cell blast crisis of CML，mast cell leukemia， acute eosinophilic leukemia，basophilic………… leukemia acute lymphocyte leukemia（ALL） L1，L2，L3 T－ALL、B－ALL chronic leukemia： CML、P－LL、CLL、HCL、 …… leukemia the tradition classification (FAB)of leukemia

WHO Classification(2001) 1, Acute myeloid leukemia(AML) (1), AML With recurrent cytogenetic abnormallities AML with t8;21)1q22:q22)AME70) AML with t(15:17(922: q12), (PML/ RARa AML with inv(16)(p13: g22)or t(16:16013:q22), CBFB/MYH11 AML With 11g23(MLl) abnormalities 2021/1/21 xie Yi, Hua Shan Hospital 9

2021/1/21 xie Yi,Hua Shan Hospital 9 WHO classification (2001) 1, Acute myeloid leukemia(AML) (1), AML with recurrent cytogenetic abnormalities • AML with t(8;21)(q22;q22),(AML1/ETO) • AML with t(15;17)(q22;q12),(PML/RAR) • AML with inv(16)(p13;q22) or t(16;16)(p13;q22) ,CBF/MYH11 • AML with 11q23 (MLL) abnormalities

WHO Classification(2001) 2), AML with mu/ti/ineage dysp/as ia With prior mye /dysplastic syndrome Without prior mye/odysp/astic syndrome (3), AML and mye/dysplastic syndrome therapy related A/kyat ing agent related Topoisomerase //inhibitor-related 2021/1/21 xie Yi, Hua Shan Hospital 10

2021/1/21 xie Yi,Hua Shan Hospital 10 WHO classification (2001) (2), AML with multilineage dysplasia • With prior myelodysplastic syndrome • Without prior myelodysplastic syndrome (3),AML and myelodysplastic syndrome, therapy related • Alkylating agent related • Topoisomerase ll inhibitor-related