内科学 白血病-谢毅.ppt

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1、Leukemia(白血病)谢毅（Xieyi）Dep.Hematology，HuashanHospitalFuDanUniversity2021/9/181xieYi,HuaShanHospitalConceptofleukemiaDefinitionLeukemiaisamalignantblooddisorder(notsolidtumor),whichistheresultsofthetumorproliferationofheamotopoieticstemcells.（造血干细胞）2021/9/182xieYi,HuaShanHo

2、spital2021/9/183xieYi,HuaShanHospitalHematopoieticStemCell(HSC)istheprimarycellofhematopoieticandimmunesystem2021/9/184xieYi,HuaShanHospitalTumorproliferationofHSCProliferationisoutofcontrolandapoptosisisinhibited.Leukemiacellisclonedandaccumulatedinagreatquantity,thenorm

3、alhemapoiesisisihibited.DifferentiationofHSCisblocked.LeukemiacellsarestoppedonadifferentiationstageofHSC&lackofthenormalfunction.infiltrationandmetastasis2021/9/185xieYi,HuaShanHospitalmalignantblooddisorderspathophysiologyClinicalmanifestationHSCdifferentiationisblocked

4、NormalbloodcellsaredecreasedThefunctionofBloodandimmunesystemareshortof.Anemia,fever,hemorrhageAbnormalmorphologypicturesofbloodandbonemarrow.Proliferationisoutofcontrol,apoptosisisinhibited.Leukemiacellisaccumulatedinagreatquantity.LeukocytesandLeukostasis(白细胞淤滞)Liver,sp

5、leen,lymphnods,skin,CNSetc.areinfiltratedanddysfunctionalfrequently.2021/9/186xieYi,HuaShanHospitalAccordingtotheacutemyeloidleukemia（AML）Differentiation&M0M1M2………………..M7KindofcellblastcrisisofCML，mastcellleukemia，acuteeosinophilicleukemia，basophilic…………leukemiaacutelymph

6、ocyteleukemia（ALL）L1，L2，L3T－ALL、B－ALLchronicleukemia：CML、P－LL、CLL、HCL、……leukemiathetraditionclassification(FAB)ofleukemia2021/9/187xieYi,HuaShanHospitalWHOclassification(2001)1,Acutemyeloidleukemia(AML)(1),AMLwithrecurrentcytogeneticabnormalitiesAMLwitht(8;21)(q22;q22),AM

7、L1/ETOAMLwitht(15;17)(q22;q12),PML/RARAMLwithinv(16)(p13;q22)ort(16;16)(p13;q22),CBF/MYH11AMLwith11q23(MLL)abnormalities(2),AMLwith,MultilineagedysplasiaWithoutpriormyelodysplasticsyndromeWithpriormyelodysplasticsyndrome(3),AMLandmyelodysplasticsyndrome,therapyrelatedAl

8、kylatingagentrelatedTopoisomerasellinhibitor-related2021/9/188xieYi,HuaShanHospitalWHOclassifica