14: Leukaemia Flashcards

1
Q

What is the site disease in Leukaemia?

A

Leukaemia is “cancer of the blood”, more specifically

  • bone marrow disease (not all patients have abnormal cells in the blood)
  • it is cancer in lymphoid/myeloid stem cells
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2
Q

What are the different types of cells that can be affected in leukaemia?

A
  1. Pluripotent haematopoietic Stem Cell
    • would lead to mixed phenotype leukaemia
    1. Myeloid Stem Cell
      1. Myeloid leukaemia
    2. Lymphoid Stem Cell
      1. Lmphatic leukaemias
      2. Pre B Lymphocyte
      3. Pro T Lymphocyte
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3
Q

Explain and summarise the development of leukaemias

A

Leukaemias need

  • multiple mutations in a single myelod/lympoid stem cell
    • leading to a potency of cell for increased proliferation, differentiation, or cell survival
  • Leading to expansion of the leukaemic clone
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4
Q

Why can’t the concepts of invasion and metastisis not be applied to leukaemias?

A

Because blood cells (also haematopoietic stem cells) are physiologically found in the body and infiltrate tissues

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5
Q

How are “benign” and “malignant” forms of leukaemia determined and named?

A

The words chronic and acute are used

  1. Chronic
    • behave in a “benign” manner, the disease goes on for a long time
  2. Acute
    • behaves “malignant”, untreated the disease is agressive and the patient dies rapidly
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6
Q

How are the chronic and acute forms of leukaemias derived from lymphoid precursor cells called?

A

–Acute lymphoblastic leukaemia (ALL)

–Chronic lymphocytic leukaemia (CLL)

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7
Q

How are leukaemias derived from Myeloid cells called?

A

Acute/Chronic myeloid leukaemias

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8
Q

What are the important factors in the development of leukaemia?

A

Requires a series of mutations (basically just like any other cancer)

Importnatn identified mutations include

  • There are normally multiple genes affected, in particular transcription factors so that the transcription of multiple genes is affected and cell behavior profoundly disturbed
    • in proto-oncogenes
    • creatin of a novel gene (chiameric/fusion gene)
    • mutation in promoter/enhancer of a structurally normal gene
    • loss of TSG
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9
Q

What are certain risk factors to the development of leukaemias?

A

Some inherited mutations e.g. in

  • down syndrome
  • defects in DNA repair etc.

Or exposure to

  • Irradiation
  • Anti-cancer drugs
  • Cigarette smoking
  • Chemicals—benzene
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10
Q

What happens during AML?

A

, cells continue to proliferate but they no longer mature so there is

  • Built up of immautre (myeloblast) cells in the BM and spread into the blood
  • Together with a Failure to produce normal cells e.g. neutrophils, monocytes, erythrocytes, platelets

Failure of production of End Cells

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11
Q

What are the genetic causes for the production of AML?

A
  • Often Transcription factors involved
    • Transcripition of multiple genes affected
  • Normal function of proteins are not possible (because they are supressed by an oncogene product)

–> Cell behaviour is profoundly disturbed

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12
Q

What are the genetic causes for developement of CML?

A

mutations usually affect a gene encoding a protein in the signalling pathway between a cell surface receptor and the nucleus

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13
Q

What happes during CML?

A
  • cell kinetics and funcitons are not as seriously affected as in AML
  • BUT: reduced apoptosis and increase proliferation –> slow progression of leukaemic clones

Increased production of end cells

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14
Q

What is the Differnce between acute and chronic LL?

A
  • •Acute lymphoblastic leukaemia (ALL)
    • increase in immature cells (lymphoblasts)
    • no maturation into B and T cells
  • Chronic lymphoid leukaemias (CML)
    • , the leukaemic cells are mature,
    • although abnormal, T cells or B cells
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15
Q

What are the general symptoms of leukaemia?

What is the underlying cause?

A

Normally caused by an accumulation of cells or infiltration of tissues

  • bone pain (if acute)
    • high metabolic rate and high proliferation
  • hepatomegaly and splenomegaly
    • extramedullary blood formation (due to no more formation in BM) and increased infiltration of tissues by cells
  • lymphadenopathy (if lymphoid),
  • thymic enlargement (if T lymphoid),
  • skin infiltration
  • overall: increased metabolic rate
    • weight loss sweating, low grade fever
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16
Q

What are general haematological findings that cause symptoms in Leukaemia?

A

•Crowding out of normal cells leading to

  • anaemia,
  • neutropenia,
  • thrombocytopenia

–> + associated symptoms

In CLL

  • loss of function of T+B-lymphocytes: loss or normal immune function
    *
17
Q

When does Acute lymphblastic leukaemia usually occur?

What might protect you from developing ALL?

A

Main incidence in children

  • Protective: early exposure to common antigens
    • relates to family size, new towns, socio-economic class, early social interactions, variations between countries
18
Q

What might be causes of ALL in children?

A

Some (limited) evidence for:

  • Irradiation in utero
  • In utero exposure to certain chemicals ? Baygon, ? Dipyrone
  • ? Epstein–Barr virus infection

•Rarely any ALL results from exposure to a mutagenic drug

19
Q

What are symptoms of ALL?

A

Resulting from accumulation of abnormal cells (+inflitration of tissues) leading to:

  • Bone pain
  • Hepatomegaly
  • Splenomegaly
  • Lymphadenopathy
  • Thymic enlargement
  • Testicular enlargement

And Resulting from crowding out of normal cells (ANT symptoms)

  • Anaemia casuing Fatigue, lethargy, pallor, breathlessness
  • Neutropenia: Fever and other features of infection
  • Thrombocytopenia: Bruising, petechiae, bleeding
20
Q

What are haematological findings in ALL?

A
  • Leucocytosis with lymphoblasts in the blood
  • Anaemia (normocytic, normochromic)
  • Neutropenia
  • Thrombocytopenia
  • Replacement of normal bone marrow cells by lymphoblasts
21
Q

Which investigations would you perform in someone you suspect having an ALL?

A
  • Blood count and film
  • Check of liver and renal function and uric acid (because of high DNA turnover)
  • Bone marrow aspirate
  • Cytogenetic/molecular analysis –> which type of ALL?
  • Chest X-ray (thymoid swelling)
22
Q

Explain the importance of immunophenotyping in ALL

A

It is important to determine the cause of the Leukaemia

  • B cell? T cell?
  • Done by flourescent analysis of cells (binding to CD factors of cells)
23
Q

Explain the use of cytogenetic and molecular genetic analysis in ALL

A

Analysisng individual patient to determine prognosis

  • E.g. •Hyperdiploidy—good prognosis
  • •t(4;11) translocation—poor prognosis
24
Q

Which genetic factors often lead to the development of ALL?

A
  • Formation of a fusion gene (translocation) (9,22 Philadelphia and 12+21) –> production of abnormal intracellular proteins
    • can be detected via FISH analysis
  • Dysregulation of a proto-oncogene by juxtaposition of it to the promoter of another gene, e.g. a T-cell receptor gene (tranlocations)
  • Point mutation in a proto-oncogene
25
Q

Summarise the treatment in ALL

A
  1. Supportive treatment
    1. blood/platelet transplants if needed
    2. antibiotics in signs of infection
  2. Systemic chemotherapy
  3. Intrathecal chemotherapy –> otherwise poorer prognosis+ higher chance of return of disease (often vie LP)
26
Q

What is the prognosis of an ALL with trisomy 4?

A

-good