43 - Acute Leukaemia

Question 1

Acute leukaemia definition

Answer 1

Result of accumulation of early myeloid or lymphoid precursors in the bone marrow, blood and other tissues

Question 2

Acute leukaemia - why?

Answer 2

Somatic mutation in single cell within a population of early progenitor cells

May arise de novo or terminal event of a pre-existing blood disorder

Question 3

Types of acute leukaemia

Answer 3

Acute myeloid leukaemia (AML)

Acute lymphoblastic leukaemia (ALL)

Question 4

Acute leukaemia - clinical presentation

Answer 4

Anaemia
Infections
Easy bruising and haemorrhage
Organ infiltration e.g. spleen, liver, meninges, testes and skin

Question 5

Acute leukaemia - diagnosis

Answer 5

Morphology
Cytochemistry
Immunological markers
Cytogenetics - FISH
Molecular techniques (PCR)

Question 6

What immunological markers and used to detect acute leukaemia?

Answer 6

Monoclonal antibody which fluoresce

Question 7

AML cytogenetic changes

Answer 7

t(8;21) and t(15:17) which are good prognossis

Monosomy 7 in AML is bad

Question 8

ALL cytogenetic changes

Answer 8

t(9;22)

Ph chromosome - BCR-ABL fusion protein with tyrosine kinase activity

Question 9

Poor prognostic factors in ALL

Answer 9

Increasing age
High white cell count
Male sex
Certain cytogenetic abnormalities
Poor response to treatment

Question 10

AML management

Answer 10

Induction treatment to obtain remission, then consolidation with further courses of combo chemo

In younger patients -> bone marrow transplants

Question 11

ALL management

Answer 11

Induction chemo, intensive consolidation chemo and prophylaxis of meningeal leukaemia with intrathecal methotrexate and cranial irradiation

Maintenance chemo given w/ bone marrow transplant in bad-risk patients

Question 12

Complications of acute leukaemia treatment

Answer 12

Intensive chemo causes neutropenia for 10-21 days

Can cause neutropenic fever

Question 13

What is neutropenic fever criteria

Answer 13

Pyrexia in the presence of a neutrophil count of less than 1.0x10^9/l

Question 14

Complications of neutropenic sepsis

Answer 14

Overwhelming gram –ve and/or gram +-ve infection

Cornerstone of management is immediate administration of broad spectrum IV antibiotics (Tazocin & gentamicin)

Question 15

Other measures for neutropenic sepsis

Answer 15

Prevention - protective isolation, prophylactic antibiotics, use of granulocyte colony stimulating factors, strict hand hygiene

Treatment - patient education, strict protocols for antimicrobial therapy