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3: Surgery Y3 - Cancer Care [1] (check ILOs) > [8] Acute Myeloid Leukaemia > Flashcards

[8] Acute Myeloid Leukaemia Flashcards

1
Q

What is acute myeloid leukaemia (AML)?

A

A malignant disease of the bone marrow

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2
Q

What happens in AML?

A

The precursors of blood cells are arrested in an early stage of development

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3
Q

What do most AML subtypes show, in terms of blasts?

A

More than 30% blasts of a myeloid lineage in blood, bone marrow, or both

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4
Q

What does the mechanism of maturation arrest in an early stage of development in AML involve?

A

The activation of abnormal genes through chromosomal translocations and other genetic abnormalities

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5
Q

What is the effect of the maturation arrest in an early stage of development in AML?

A

Reduces the normal blood cells

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6
Q

What does failure of apoptosis in AML lead to?

A

Accumulation in various organs, especially the liver and spleen

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7
Q

How common is AML, compared to other leukaemias?

A

It is the most common leukaemia in adults

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8
Q

At what age does AML occur?

A

It can occur at any age, but the incidence increases with age, and the median age of onset is 67

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9
Q

What are the subtypes of AML?

A
  • AML with characteristic genetic abnormalities
  • AML with multi-lineage dysplasia
  • AML and MDS, therapy related
  • AML not otherwise categorised
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10
Q

Who does the subtype of AML with multi-lineage dysplasia include?

A

Patients who have had prior myelodysplastic syndrome (MDS) or myeloproliferative disease that transforms into AML

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11
Q

What does the subtype of AML and MDS, therapy related include?

A

Patients who had had prior chemotherapy and/or radiation

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12
Q

What are the risk factors for AML?

A
  • Other haematological disorders
  • Radiation
  • Congenital disorders
  • Exposure to benzene
  • Survivors of cancer chemotherapy
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13
Q

What other haematological disorders increase the risk of AML?

A
  • Myelodysplastic syndrome
  • Aplastic anaemia
  • Myelofibrosis
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14
Q

What congenital disorders increase the risk of AML?

A
  • Bloom’s syndrome
  • Down’s syndrome
  • Fanconi’s anaemia
  • Neurofibromatosis
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15
Q

What is the presentation of AML related to?

A

Bone marrow failure or organ infiltration

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16
Q

How does the presentation of AML differ between children and older people?

A

Children or young adults may present with acute symptoms over a few days to weeks, whereas older people may present with fatigue over weeks or months

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17
Q

What are the symptoms of AML?

A
  • Dizziness and shortness of breath on exertion
  • Fever
  • Early satiety and fullness in LUQ
  • Bone pain
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18
Q

What feature of the fever may be present with AML?

A

Failure to respond to antibiotics

is that a feature? idk

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19
Q

What causes the early satiety and fullness in LUQ in AML?

A

Splenomegaly

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20
Q

What are the emergency presentations of AML?

A
  • Haemorrhage into lungs, GI tract, or CNS

- Leukostasis

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21
Q

What cause leukostasis in AML?

A

Extremely high WBC

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22
Q

What are the most common sites for infiltration of AML?

A
  • Liver
  • Spleen
  • Gums
23
Q

Why is knowing the most common sites of infiltration of AML clinically important?

A

Should look for signs in those locations

24
Q

What examination features may be present in AML?

A
  • Pallor
  • Signs of infection, e.g. fever, pneumonia
  • Hepatomegaly and splenomegaly
  • Petechiae on lower limbs
  • Gingivitis, with swollen, bleeding gums
25
Q

What does the diagnosis of AML require?

A

The examination of peripheral blood and bone marrow specimens

26
Q

What tests are done on the peripheral blood and bone marrow specimens in AML?

A
  • Morphology
  • Cytochemistry
  • Immunophenotyping
  • Cytogenetics
  • Molecular genetics
27
Q

What investigations are done in AML?

A
  • Blood testing
  • Bone marrow aspiration
  • Allotyping
  • Cytochemical testing
28
Q

What blood tests should be done in AML?

A
  • FBC
  • Clotting screen
  • LDH
  • Liver and renal function
29
Q

What may be found on FBC in AML?

A
  • Variable degree of anaemia and thrombocytopenia
  • Total WBC may be normal, high, or low, and sometimes extremely high
  • Neutrophils usually depleted
30
Q

What condition is commonly found on clotting screen in AML?

A

DIC

31
Q

What findings on clotting screen are suggestive of DIC?

A
  • Prolonged thrombin time
  • Low level of fibrinogen
  • Fibrin degradation products
32
Q

What happens to LDH in AML?

A

Usually raised

33
Q

Why do you need to check liver and renal function in AML?

A

Must be checked before initiating chemotherapy

34
Q

What is the importance of bone marrow aspiration in AML?

A

It is the diagnostic procedure

35
Q

What findings on bone marrow aspiration are required for a diagnosis of AML?

A

More than 20% blasts in the peripheral blood

36
Q

Who should be HLA typed at diagnosis of AML?

A

Patients potentially suitable for allogenic stem cell transplantation, and their first-degree family members

37
Q

What is the purpose of cytochemical staining in AML?

A

It allows for classification of AML into its subtypes

38
Q

What can cytogenetic studies provide in AML?

A

Important information about prognosis

39
Q

What is the usually accepted criteria of therapeutic response in AML?

A
  • Blast clearance in the bone marrow to <5% of all nucleated cells
  • Morphologically normal haematopoiesis
  • Return of peripheral blood cell counts to normal levels
40
Q

Where is treatment for AML co-ordinated?

A

Specialist centres

41
Q

On what basis is AML treatment delivered?

A

Two phases

42
Q

What are the phases of AML treatment?

A
  • Induction

- Post-remission consolidation (intensification)

43
Q

Is stem cell transplantation an option in AML?

A

Yes

44
Q

What are the other aspects of care in AML?

A
  • Blood product replacement
  • Antibiotics for infection
  • Allopurinol to reduce uric acid levels
45
Q

What might patients with excessive leukocytosis require before commencing chemotherapy for AML?

A

Emergency leukophoresis

46
Q

What is the prognosis of AML dependant on?

A
  • Age
  • Cell type
  • Burden of disease
  • Pre-existing medical conditions
47
Q

What social factor affects the prognosis of AML?

A

Prognosis is worse with socio-economic deprivation

48
Q

What % of people with AML develop secondary malignancies?

A

13%

49
Q

What rates of complete remission can be achieved in younger patients?

A

80%

50
Q

What is the 5-year survival of AML in younger patients?

A

40%

51
Q

What are the remission rates of AML in over 60’s?

A

60%

52
Q

What is the limitation of remission in over 60’s?

A

Remissions are usually transient

53
Q

What is the median survival of AML in over 60’s?

A

5-10 months

54
Q

What pre-existing medical conditions are associated with a poorer prognosis from AML?

A
  • Diabetes
  • CHD
  • COPD

3: Surgery Y3 - Cancer Care [1] (check ILOs) (47 decks)

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