306. Acute myeloid leukemia, Chronic lymphocytic leukemia, Lymphoma's Flashcards
Describe acute myeloid leukemia?
Proliferation of blast cells derived from marrow myeloid elements.
What are the associations between between acute myeloid leukemia
Long term complication of chemo e.g. for lymphomas
associated with myelodysplastic states
radiation and downs also down’s
What are the signs and symptoms of acute myeloid leukemia
Anaemia, infection or bleeding/DIC
Hepatoegaly, splenomegaly, gum hypertrophy
skin involvement and CNS involvememnt at diagnosis is rare
How is Acute myeloid leukemia diagnosed?
WCC is often raised but may be normal or low
Blasts may be hard to see in peripheral blood film
Bone marrow biopsy provides definite diagnosis
How is AML differentiated from ALL on biopsy
Auer rods
What complications are associated with acute myeloid leukemia treated?
Common to develop viral, bacterial or fungal infections
Common organisms present oddly and odd organisms present commonly (watch for candida and aspergillus)
Fever (associated with AML)
Leukostasis
Tumour lysis syndrome
Graft versus host disease
Fe
Allopurinol for tumour lysis
prophylaxis for infections
Chemo- very intesive to induce remission
Bone marrow transplant- in refractory disease
What are myeloproliferative disorders?
Group of disorders that manifest as marrow failure with life threatening bleeding. mostly primary but may develop secondary to chemo
how do you treat the myeloproliferative disorders?
multiple transfusions of red cells and platelets as required
EPO and G-CSF
Allogenic stem cell
What is chronic lymphocytic leukeamia?
Commonest leukemia
Progressive accumulation of malignant B cells
What are the symptoms of chronic lymphocytic leukaemia?
Often none, present as surprise finding on routine bloods.Patients may be anemic or prone to infection.
May also have decreased weight, sweats and anorexia if severe.
Enlarged rubbery non-tender lymph nodes.Splenomegaly, hepatomegaly
What are the tests for chronic lymphocytic leukeamia?
Reduced lymphocytes
Autoimmune heamolysis- reduced Hb, neutrophils and platelets
What are the complications of chronic lymphocytic leukaemia
Autoimmune heamolysis
Increased infection- bacterial and increasingly herpes zoster
Marrow failure
How is CML treated?
Consider drugs if symptomatic
Radiotherapy
Stem cell transplants- only in certain patients
Supportive care- transfusions, IV immunoglobulin if recurrent infection`
Discuss the progression of CLL
1/3rd never progress
!/3rd progress slowly
1/3 progress actively
Death is often due to agressive lypmhoma (reichter’s) or infection
What is meant by the term lymphoma?
What are the broad classifications
Malignant proliferation of lymphocytes
Classically divided into Hodgkin’s and non Hodgkin’s lymphoma
When do people develop lymphoma?
Two peaks-15-24 and 60-75
Associated with:sibling history , EBV, SLE, Post transplant
How does Hodkin’s lymphoma present
Enlarged non tender rubbery lymph nodes
fever, weight loss, lethargy, pruiritus
SVC obstruction
Splen/hepatomegaly
How is Hodgkin’s lymphoma tested for?
Tissue diagnosis
Image guided needle biospy
FBC, film, ESR, LFT, LDH, Urate, Ca2+
Imaging
How are lymphoma’s staged?
ANN ARBOR STAGING:
I- Confined to single node region
II-Invovment of two or more nodes on same side
III- Involvement of nodes on either side of the diaphragm
IV- SPread beyond lymph nodes e.g. liver, marrow
How is Hodgkin’s lymphoma treated?
Radiotherapy and short course chemo for early stages
Advanced chemo for later stages
What is the pneumonic used to remember late stage chemo in Hodgkin’s
Adriamycin
Bleomycin
Vinlablastine
Dacarbazine
What are the complications of treatment in Hodgkin’s lymphoma
Radiotherapy increases risk of second malignancies
Ischeamic heart disease
Hypothyroidsim
Lung fibrosis
Infertility
What are the classifications of Hodkin’s lymphoma
Nodular sclerosing- common and good prognosis
Mixed cellularity
Lymphocyte rich
Lymphocyte depleted- rare and bad prognosis
