第九章节白血病幻灯片.pptVIP

* * * * ATRA与化疗药物相比，较为安全。其副作用主要有皮肤粘膜干燥、头痛、恶心、食欲不振、骨关节疼痛及肝功能改变. 少数病人可由于白细胞增高而发生白细胞瘀滞。 维甲酸综合症为另一严重并发症，主要表现为发热、呼吸困难、体重增加、胸腔积液、下肢水肿等表现 * [slide 5] Clinical Presentation of CML The most common symptoms at presentation in the chronic phase of CML include fatigue, weight loss, abdominal fullness, and night sweats. In 50% of cases, the clinical presentation is asymptomatic. Physical examination shows palpable splenomegaly in more than 50% of patients. Typical laboratory results include leukocytosis with an abnormal differential, anaemia, basophilia, and thrombocytosis.1,2 References 1. Faderl S, Talpaz M, Estrov Z, et al. Chronic myelogenous leukemia: biology and therapy. Ann Intern Med. 1999;131:207-219. 2. Goldman JM. Chronic myeloid leukemia. Curr Opin Hematol. 1997;4:277-285. * [slide 7] Clinical Course: Phases of CML CML progresses through 3 phases characterised by increasing refractoriness to therapy and worsening clinical features and laboratory findings. These stages include chronic phase, accelerated phase, and blast crisis. Although the majority of patients present in chronic phase and then progress to accelerated phase, 25% to 40% of patients progress directly from chronic phase to the terminal blastic phase without evidence of a transitional accelerated phase.1,2 Chronic phase. In the chronic phase, there are less than 10% blasts in peripheral blood and bone marrow, and the white blood cell (WBC) count at presentation is typically elevated to ?20 x 109/L. Signs and symptoms may be mild initially and develop as the disease progresses. The chronic phase of CML may last 5 to 6 years before the disease accelerates.1,3,4 Accelerated phase. There are more than 10% to 15% (but less than 30%) blasts in either peripheral blood or bone marrow. Symptoms may increase and include unexplained fever, bone pain, splenomegaly, and hepatomegaly. Basophilia, decreased platelet counts, and cytogenetic progression may also be observed. Cytogenetic