Lecture 18 Leukemia and lymphoma Leukemia and lymphoma Malignant diseases characterized by unregulated growth of white blood cells Cancer of B or T cells Leukemia originates in the bone marrow Lymphoma originates in lymph system lymph nodes spleen 24 000 deaths due to leukemia 20 000 due to lymphoma Leukemia risk factors not well known exposure to ionization radiation repeated exposure to benzene genetic disorders ex down syndrome genetic predisposition chromosomal instability past chemotherapy and radiation therapy smoking previous infections 2 major groups of leukemia chronic onset is insidious slow the disease is usually less aggressive and the cells involved are usually more mature cells more likely to relapse less threatening less motivated to use aggressive treatments 2 types Chronic Lymphocytic Leukemia CLL and Chronic Myeloid Leukemia CML acute usually rapid very aggressive and cells involved are usually poorly differentiated 2 types Acute Lymphocytic Leukemia ALL and Acute Myeloid Leukemia AML Leukemia ALL AML Leukemia affects the organs that manufactures blood cells It beings in the bone marrow or lymph system where blood cells originate and mature before being released into the blood stream most common childhood cancer almost 80 of children with leukemia have it a cancer of the lymphoid cellsin the bone marrow and the lymphoid organs of the body cancer of the myeloid blood cells which are produced in the bone marrow and which help fight bacterial infections more common in older adults Bone marrow where leukemia begins Leukemia treatment most common treatment is chemotherapy followed by a bone marrow transplant high dose chemotherapy with autologous stem cell transplant 1 collection stem cells are collected from the patient s bone marrow blood 2 processing blood bone marrow is processed in laboratory to purify and concentrate the stem cells 3 cryopreservation blood bone marrow is frozen to preserve it 4 chemotherapy high dose chemotherapy radiation therapy is given to patient 5 thawed stem cells are re infused into the patient Lymphomas Hodgkin s lymphoma Non Hodgkin Lymphomas affects lymph nodes nearer to the body surface such as the neck armpit and groin area downward progression systemic symptoms often diagnosed early invasive Same risk factors as leukemia but also includes gender male more common race and ethnicity and geography appears more in developed countries and previous infections affect lymph nodes found deep within the body more Hodgkin s disease or Hodgkin s lymphoma Reed Steinberg cell described by Thomas Hodgkin in 1832 Starts in any part of body lymph system Often regional or localized to lymph organs but can spread to almost any organ or tissue High 5 year survival rate Bi modal age distribution 15 30 and 50 Symptoms Painless swollen lymph nodes Fever night sweats and weight loss Cough Enlarged spleen and or liver Itchy legs Non Hodgkin s lymphoma Not Hodgkin s many subtypes can be difficult to classify Diffuse large cell lymphoma most common 1 out of 3 cases of lymphoma rapidly fatal if not caught when localized BUT easy to treat and easy to cure Follicular lymphoma Burkitt s lymphoma Sporadic non African Epstein Barr virus infection African Treatment for lymphoma New chemotherapy Stem cell transplants Targeted therapy Monoclonal antibodies target specific antigens CD20 ritumximab CD22 CD52 antibody linked toxins Lymphoma vaccines lengthens remissions for slow growing lymphomas
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