Acute & Chronic Leukaemia Flashcards
etiology of leukaemia?
mostly unknown
prev cytotoxic therapy
ionizing radiation
benzene
Trisomy 21 risk of what leukaemia?
AML
acute leukaemia presentation?
Anaemia
Neutropenia
thrombocytopenia
B-symptoms
what are B-symptoms?
fevers, sweats, weight loss
what’s a real night sweat?
need to change clothes and sheets
hyperleucocytosis presents how?
stroke, MI, ischaemic symptoms
What can present with mediastinal mass?
Acute lymphoblastic leukaemia
key Ix of acute leukaemia?
FBE and film bone marrow biopsy immunophenotyping cytogenetics molecular studies
what do you see on blood film in acute leukaemia?
blasts
how many blasts needed to have acute leukaemia
> 20% blasts = acute leukaemia
Auer Rods?
acute myeloid leukaemia
what is flow cytometry for?
find out lineage commitment to see if myeloid/lymphoid
primitive cells have what surface markers for flow cytometry for AML?
CD34, CD33, CD11
what means good prognosis for AML?
cure with standard chemo without bone marrow transplant
when do molecular testing?
ppl with AML and in the intermediate risk group
AML mutations, what is good what is poor prognosis? molecular testing?
Poor: FLT3
Good: nucleophosmin 1, CEBPA, PML-RARA
what is morphological remission in bone marrow re: blasts?
ALL therapies different how?
younger people age 18-30 get the paediatric protocol for ALL
crucial drug in ALL ?
L-asparaginase
APML is what?
a good prognosis of AML
How does APML present?
bleeding and bruising, cytopaenia
DIC
low fibrinogen , high INR, high APTT, due to release of procoagulants from malignant prothrombocyets
what kind of cells in APML?
Faggot cell filled with Auer Rods
APML cytogenetics?
t(15,17)
get’s PML-RARA
how to treat APML in country?
platelets, pryoprecipitate, fibrinogen
THen get to a centre to use:
use All trans retinoic acid (ATRA) and arsenic (induce promyelocyte differentiation)
CML cytogenetics? treatment?
t9:22, philedelphia chromosone, BCR-ABL, treated with imitinib, glivec
Chronic leukaemia 3 stages natural history
chronic: usu. present here. big spleen, raised WBC
accelerated: hepatosplenomegaly, B-symptoms
blasts: (3-5 yrs): then get acute leukaemia
CML blood film see what?
full spectrum of neutrophils, blasts, mature, mature, nucleated RBCs, basophils, eosinophilia
CML cytogenetics see what? rx how?
BCR-ABL fusion: t(9:22)
Tyrosine kinase inhibitors
how to monitor CML response to therapy?
PCR 3/12 bcr-abl
2 second generation tyrosine kinase inhibitors?
dasatinic
niltoinib
Chronic lymphocytic leukaemia presentation?
picked up on FBE
Chronic lymphocytic leukaemia anaemias?
auto-immune hemolytic anaemia
Chronic lymphocytic leukaemia on blood film?
smear cells, small mature lymphocytes
CD19 - B-cell marker
CD5 - T-cell marker
coexisting: they should coexist
Nasty CLL deletions?
17p (loss of p53) or 11q deletion
indolent CLL markers?
13q
when do you treat CLL?
only when symptomatic:
B-cells, bulky glands, big spleen
management of Chronic lymphocytic leukaemia?
FCR: fludarabine, cyclophosph, rituximab
also alemtuzumab
cure for Chronic lymphocytic leukaemia?
alllograft
rituximab monoclonal antibody to what?
CD20
leukaemia classifications?
Acute or chronic
Myeloid or lymphoid
