FAB Classification of ALL

2. FAB Classification of ALL The FAB Classification relies on morphology, dividing blasts into L1, L2 and L3 by their appearance.    These are derived from immunophenotypically distinct mature B cells.

6. The leukemia may Relapse in the Blood and bone marrow, Brain, Spinal cord, Testicles or in other parts of the body.

7. Complications of acute leukemia (ALL): • -Tumor lysis syndrome • -Renal failure • -Sepsis • -Bleeding • -Thrombosis • -Typhlitis • -Neuropathy • -Encephalopathy ( CNS Involvment ) • -Seizures • -Secondary malignancy • -Short stature (if craniospinal radiation) • -Growth hormone deficiency

8. Prior to the introduction of total therapy for ALL, about 70% of children, without CNS prophelaxies, developed symptomatic involvement.

9. Lumbar puncture with cytospin morphologic analysis: This is performed before systemic chemotherapy is administered to assess the presence of CNS involvement and to administer intrathecal chemotherapy.

11. Central nervous system (CNS) therapy is usually given during each phase of therapy. Because chemotherapy that is given by mouth or injected into a vein may not reach leukemia cells in the CNS (brain and spinal cord) - Intrathecalchemotherapy and - Radiation therapy are able to reach leukemia cells in the CNS and are given to kill the leukemia cells and prevent the cancer from recurring ( CNS prophylaxis ).

12. Cerebrospinal sign in CNS Involvment with ALL 1-Increased CSF pressure. 2-Elevated level of CSF protein. 3-Decreased glucose value. 4-Pleocytosis ( 5 or moe cellr/ul of CSF).

13. This incidence has been reduced to under 12% with appropriate CNS prophelaxy . approximately 5% of patients present with an initial diagnosis of meningeal leukemia.

14. Cranial irradiation effectively prevents overt CNS relapse. Complication: -Neurotoxicity -Brain tumors Cranial irradiation is necessary for patients with very high-risk. Intrathecal and systemic chemotherapy for most patients has produced excellent results, (with CNS relapse rates of 10 - 2% in most studies.)

15. If CNS disease is present, Cranial irradiation and intrathecal chemotherapy may be given. sign and Symptome: -Headach -Lethargy, -anorexia,and Vomating -EEG changes, -CNS pleocytosis, -Fever. -Bradicardy.  

16. CNS prophylaxis: Radiation therapy may be used to treat childhood ALL that may spread, to the brain and spinal cord.

23. مشخصاات بيماران و نتائج . بودALLتعداد كل بيماران 173 مورد تعداد موارد عود يا گرفتاري مغزي نخاعي 24 مورد. سنبيماران بين 3 تا 18 سال و ميانگين 12 سال. جنس بيماران 13 نفر پسرو 11 نفر دختربود. (‍‍ ‍‍ 14 %)

24. نتائج مطالعه نتائج مطالعه تعداد و درصد بيماران دچار عود مغزي نخاعي بر حسب گروه سني 6 و 12 و 18 سال

25. نتائج تعداد بيماران دچار عود مغزي نخاعي بر حسب فاصله زماني از آغاز درمان نگهدارنده

26. در بررسي آماري نتائج ذيل بدست آمد: 1- عود مغزي نخاعي در لوسمي لنفوبلاستيك حاددر جنس مؤنث بيشتراز (p=0.0001) جنس مذكراست 2- عود مغزي نخاعي در گروه سني بالاتر از 6 سال بيشتر است. 3- در بيمارانيكه تعداد لكوسيتها ( لنفوبلاستها) در شروع بيماري بالاتري (P=0.0001) داشتند بروز اين عارضه بيشتر بود . 4- در بيمارانيكه علائم نارسائي مغز استخوان در شروع درمان داشتند عود مغزي نخاعي بيشتر است. 5- شايعترين علامت عود مغزي نخاعي لوسمي لنفوبلاستيك حاد سردردمقاوم به درمانهاي معمولي است(100%) 6- عود مغري نخاعي لوسمي لنفوبلاستيك حاد بيشتر در 5/1 سال اول آغاز درمان نگهدارنده بوجود مي آيد. (Type II7-بروز عارضه عود مغزي نخاعي در لوسمي لنفوبلاستيك نوع( P=0.0001 با نسبت 82 به 6 درصد است ( (Type I) بيشتر از نوع