Protocols - Hemorio
Protocols - Hemorio
Protocols - Hemorio
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CHRONIC MYELOID LEUKEMIA<br />
LABORATORIAL TESTS TO DIAGNOSIS<br />
Peripheral blood:<br />
- Complete blood count (with specific leukometry + platelet count)<br />
- Uric acid, calcium, creatinine, TGO, TGP, alkaline phosphatase, LDH, triglycerides<br />
- Neutrophils alkaline phosphatase<br />
- patient and siblings’ HLA study<br />
- qualitative RT-PCR to bcr-abl<br />
Bone marrow:<br />
- cytology<br />
- conventional cytogenetic ( 3- 5 ml of bone marrow in sodium heparin)<br />
- FISH in case of cytogenetic without mitosis<br />
- MO biopsy – histopatological test<br />
Suspend hydroxiurea for at least 5 days before collection for cytogenetic<br />
PROGNOSTIC CRITERION - Calculate Sokal index<br />
DIAGNOSIS CONFIRMATION:<br />
- Presence of Philadelphia chromosome (Cr Ph) t(9;22)(q34;q11) or presence of BCR-ABL<br />
PHASE DEFINITIONS:<br />
• Chronic Phase<br />
• Accelerated Phase<br />
• Blasts SP or MO 10 to 29%<br />
• Basophils SP > 20%<br />
• Platelets < 100000 (not by treatment)<br />
• Platelets > 1000000 (no response to treatment)<br />
• Spleen ongoing increase and leukometry<br />
• Clonal progress<br />
• Blastic Crisis<br />
• Blasts > 30 % SP or MO<br />
• Extra medullar proliferation<br />
• Blast nests on bone marrow biopsy<br />
TREATMENT:<br />
After diagnosis confirmation, request imatinib’s release<br />
Cytoreduction until leukometry gets to 15.000 /mm 3 :<br />
- hydroxiurea 15 to 40mg/kg/day in 2 to 3 PO administrations<br />
- alopurinol 300 -600 mg/day (children 10mg/kg/day)<br />
- oral hydration<br />
- hematological and biochemical control<br />
Hyperleukocitary patients, evaluate hospitalization:<br />
- aracythin 100mg/m 2 EV continuous infusion 24h<br />
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