14. Phenotype Chromosomal abnormalities Genes ที่เกี่ยวข้อง Prognesis -Early Pre-BZ ( Common ALL ) Hyperdiploidy(50-60 chromosomes) good t (2;21) TEL AML1 good -Pre-B t (1;19) (q23; p13) PBX E2A intermediate t(9;22)(q34;p11) (Philadelphia chromosome) ABL BCR poor -mature B cell t (8;14) (q24; p32) MYC IGH poor t (2;8) (q12; p24) IGK MYC poor t (8;22) (q24; p11) MYC IGL poor Infant leukemia t (4;11) (q21; p23) AF4 MLL very poor -T cell structural changes involving T-cell receptor genes poor 14q11 TCR , TCR 7q34 TCR 7p15 TCR deletion or tranlocation involving 12p TEL
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16. INTERMEDIATE Age 2-9 years inclusive with WBC = 10,000-49,999 / cu . mm . or Age 2-9 years inclusive with WBC <10,000 / cu . mm . and male ( Platelets <100,000 / cu . mm .) 12-23 months with WBC <50,000 / cu . mm . POOR Age > 10 years, or WBC > 50,000 / cu . mm . ( and >1 yr but < 20 years ) Must not meet Lymphoma Syndrome Criteria FAVORABLE WBC <10,000 / cu . mm . Age 2-9 years inclusive All girls, boys with platelets >100,000 / cu . mm .
19. 1. Complete blood count ( CBC ) anemia and a low number of platelets. A white blood cell count ( WBC ) can be high, low, or normal ตรวจพบมี blast cells ในเลือด 10-20 เปอร์เซ็นต์ ของผู้ป่วยพบมี Auer rod ใน blast cell 2. Bone marrow aspiration : Morphology ( FAB )
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21. Characteristic Acute Lymphobastic Leukemia Acute Myeloblastic Leukemia Size 10-20 m m 14-20 m m Nucleus Shape Round or oval Round or oval Chromatin Smooth, homogeneous Spongy, loose, finely developed meshwork Nucleoli 0-2 and indistinct 2-5 and distinct “punched-out” Nuclear membrane Smooth, round Irregular Nuclear-cytoplasmic ratio High Low Cytoplasm Color Blue Blue-gray Amount Thin rim More abundant Granules Absent Present Auer rods Absent Present Cytochemistry PAS stain Positive Negative Myeloperoxidase Negative Positive Sudan black B Negative Positive Periodic-acid-Schiff +/- - Terminal deoxynucleotidyl transferase (Tdt) + -
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25. 1.Blood cell counts . high lymphocyte count, low red cell count and a low platelet count. 2.Blood cell examination. flow cytometry or immunophenotyping . the type of leukemia – chronic B-cell leukemias are most common, chronic T-cell leukemias are rare and NK (natural killer) leukemia is very rare. 3.Immunoglobulin Test. CLL may have low levels of immunoglobulins. A low immunoglobulin level may be the cause of repeated infections. 4.Bone Marrow Tests and Cytogenetic Tests