Lecture 15 Leukemia and Lymphoma Leukemia and Lymphoma Malignant diseases characterized by unregulated proliferation of white blood cells Cancer of B and or T cells Leukemia originates in the bone marrow Lymphoma originates in lymph system e g lymph nodes spleen 156 420 expected new cases of blood cancer diagnosed this year 1 185 053 people living with or are in remission from leukemia and lymphoma 24 000 deaths due to leukemia and 20 000 due to lymphoma Leukemia Risk Factors Not well know Exposure to ionization radiation Repeated exposure to benzene Genetic disorders e g down syndrome Genetic predisposition chromosomal instability Past chemotherapy and radiation therapy Smoking Previous infections Leukemia Leukemias are classified into 2 major groups Chronic The onset is insidious the disease is usually less aggressive and the cells involved are usually more mature cells Acute The onset is usually rapid the disease is very aggressive and the cells involved are usually poorly differentiated Leukemia Types Leukemia CML AML Chronic Chronic Lymphocytic Leukemia CLL or Chronic Myeloid Acute Acute lymphocytic Leukemia ALL and Acute Myeloid Leukemia CLL compared to SLL Small Lymphocytic Lymphoma o Different versions of the same disease o Cancer of small lymphocyte bone marrow CLL vs lymph nodes spleen SLL o Slow growing same treatment incurable w standard treatment Leukemia affects the organs that manufacture blood cells It begins in the bone marrow or lymph system where blood cells originate and mature before being released into the blood stream Acute Lymphoblastic Leukemia ALL o The most common childhood cancer o Almost 80 of children with leukemia have ALL a cancer of the lymphoid cells in the bone marrow and the lymphoid organs of the body Acute Myelogenous Leukemia AML o AML is cancer of the myeloid blood cells which are produced in the bone marrow and which help fight bacteria infections o More common in older adults more in males lifetime risk factor is 1 o 10 480 deaths almost all adults Stem Cell Lineage Leukemia Acute and Chronic Myeloid Leukemia Blood stem cell myeloid stem cell can become red blood cells platelets or granulocytes Acute and Chronic Lymphoblastic Leukemia Blood stem cell lymphoid stem cell lymphoblast B cell T cell or natural killer cell Bone Marrow Where Leukemia Begins Spongy bone contains red marrow Blood vessels in bone marrow This is where blood stem cells red blood cells white blood cells and platelets are Leukemia Treatment transplant A most common treatment includes chemotherapy followed by a bone marrow Bone Marrow Transplant Are probably the best bet for a cure in many cases of leukemia Doctors perform this procedure when leukemia is in remission or when the patient relapses during or after treatment Patients are given a bone marrow transplant so that their body can be given higher doses of chemotherapy drugs that would not be tolerated otherwise Chemotherapy destroys cancer cells but it also kills normal cells in the bone marrow making the bon marrow transplant necessary in order to make up for the destruction of normal cells High Dose Chemotherapy with Autologous Stem Cell Transplant Process 1 Collection Stem cells are collected from the patient s bone marrow or blood 2 Processing Blood or bone marrow is processed in the laboratory to purify and concentrate the stem cells 3 Cryopreservation Blood or bone marrow is frozen to preserve it 4 Chemotherapy High dose chemotherapy and or radiation therapy is given to the 5 Reinfusion Thawed stem cells are reinfused into the patient patient Lymphomas Hodgkin s disease or Hodgkin s Lymphoma Affect lymph nodes nearer to the body s surface such as in the beck armpit and groin area Downward progression systemic symptoms Often diagnosed early Non Hodgkin Lymphomas Affect lymph nodes found deeper within the body include Burkitt s non Burkitt s and Lymphoblastic Lymphoma 85 of all lymphomas 1 in 50 people will be diagnosed 95 cases occur in adults Lymphoma Risk Factors Not well known Exposure to ionization radiation Repeated exposure to benzene Genetic Disorders e g down syndrome Gender Race ethnicity geography Past Chemotherapy and radiation therapy Smoking Previous infections Hodgkin s Disease Hodgkin s disease or Hodgkin s Lymphoma Described in 1832 by Thomas Hodgkin Reed Steinberg Cell Owl eyes cell physical appearance Hodgkin s disease or Hodgkin s Lymphoma Described in 1832 by Thomas Hodgkin Reed Steinberg cell Bi modal age distribution 15 30 and 50 Starts in any part of the body lymph system Often regional or localized to lymph organs But can spread to almost any organ or tissue High 5 year survival rate 85 95 Hodgkin s Disease Symptoms Painless swollen lymph nodes Fever night sweats weight loss Cough Enlarged spleen and or liver Itchy legs Lymphoma The maturation stage of the cell of origin determines the type of lymphoma 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 3 out of 4 Follicular Lymphoma 1 out of 5 lymphomas Burkitt s Lymphoma Sporadic Non African Epstein Barr virus infection African Treatment for Lymphoma New chemotherapy Stem cell transplants Targeted therapy Monoclonal antibodies Lymphoma vaccines lengthens remissions for slow growing lymphomas Lymphatic System Parts of system Destroy toxins microorganisms drains fluid from tissues back into Makes T cells that recognize kill foreign cells Lymph nodes Thymus Lymphatic Vessels Lymphocytes bloodstream and thymus then move to lymph nodes three types Natural killer cell B Cells Organs Carry lymph between nodes and T Cells Attack foreing invaders Make antibodies Where they collect adenoids tonsils spleen appendix small intestine Disease fighting white blood cells that are made in bone marrow
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