Acu Leuk + MDS

Question 1

what about cells in the bone marrow are indicative of acute leukaemia

Answer 1

1/5 bone marrow cells are primitive

Question 2

what is the median age of onset of acute myeloid leukaemia (AML)

Answer 2

69

Question 3

what is the diagnosis of AML

Answer 3

undifferentiated big nucleus of leukaemia cells

immune markers and cytogenetics

Question 4

what are the clinical features of acute myeloid leukaemia

Answer 4

anaemia fatigue
infections - poor immune system
bruising
gum hypertrophy in acute monocytic leukaemia

Question 5

what is a good prognosis marker in AML vs a bad one

Answer 5

NPM1 = good

FLT3ITD most common - bad = mutations mean resistance to chemotherapy

Question 6

what are some risks of chemic IV treatment for tumours

Answer 6

tumour lysis = block kidneys with dead cells, sepsis and infertility

Question 7

what syndrome would you want to start chemo for AML immediately

Answer 7

hyoperviscous syndrome

Question 8

what does treatment of AML depend on

Answer 8

speed of relapse, subtype, physical state, comorbidity, patient wishes

Question 9

what is an example of a low does chemo drug

Answer 9

cytarabine

Question 10

what drugs are increasingly being used to treat AML in older patients

Answer 10

hypomethylating agents such as decitibine and azacytidine

Question 11

what disease mutation occurs in 30% of AML cases

Answer 11

FLT3 ITD which is the poorer prognostic marker

Question 12

give an example of FTL3 ITD inhibitors

Answer 12

midostaurin

Question 13

what are the clinical presentations of ALL and who does it usually affect

Answer 13

sully children with 95% cure rate
fatigue, bruising, weight loss, night sweats
heptosplenomeglgy

Question 14

what are the 4 components of ALL treatment

Answer 14

induction - chemo and steroids (8 weeks)
intensification - IV chemo - methotrexate (4 weeks)
consolidation (20 weeks) -
maintenance for 2 years - high risk patients have bone marrow transplant

Question 15

when is ALL relapse most common

Answer 15

within 18 months stopping chemo

Question 16

if disease of ALL relapses what are the more intensive drugs / techniques to treat it

Answer 16

Inotuzumab - CD22 traget
Chimeric antigen receptor (CAR) T cells = modify T cells
BMT

Question 17

what are the complications of ALL and AML

Answer 17

neutropenic sepsis and bleeding

Question 18

what is the definition of Myeloidysplasia and clinical features

Answer 18

several related disorders with common features reduced production of one or more of the peripheral blood cell lineages
fatigue infection bleeding

Question 19

what is the treatment of MDS

Answer 19

IPSS-R - stratify the disease - depends on neutrophils, platelets, Hb, primitive BM cells
may need BMt if severe