Acute Leukaemia

Question 1

What is it?

Answer 1

Cancer of the bone marrow
Causes dysregulation of production of certain blood cells

Genetic predisposition leads to production of a single type of abnormal white cell and inhibits formation of any other WBC

Question 2

What are the two types?

Answer 2

Acute lymphoblastic leukaemia and acute myeloid leukaemia

Question 3

What is acute lymphoblastic leukaemia?

Answer 3

Most commonly affects B cells
Onsets in children
Peak onset age 2-5 and in males
Blood film shows blast cells
Common association with down syndrome

Question 4

What is acute myeloid leukaemia?

Answer 4

Affects older adults (middle aged and above)
Blood film shows blast cells with rods- auer cells

Can develop from myeloproliferative disorders e.g. polycythaemia ruby vera and myelofibrosis

Question 5

What are the symptoms?

Answer 5

Fatigue
Night sweats
Weight loss
Fever
Recurrent infections
Easy bruising and bleeding (petechiae)
Hepatosplenomegaly 
Bone pain

Question 6

What investigations are needed?

Answer 6

Bloods

• FBC= anaemia, neutropenia, thrombocytopenia
• LDH- raised (non-specific)
• Blood film
• • blast cells in ALL and blast cells with rods in AML

CXR
-mediastinal widening in ALL

Lymph node biopsy
Bone marrow biopsy= gold standard

PET/MRI/CT scanning for staging
LP- if CNS involvement

Question 7

What is the management?

Answer 7

High calorie diet
Regular blood and platelet transfusions

ALL

• high dose chemo to induce remission
• then blocks of chemo thereafter and maintenance for 2-3 years
• marrow transplant if poor prognosis or relapse

AML

• high dose chemo
• poor prognosis= marrow transplant from HLA matched relative after 1st block so higher dose chemo can be used
• intermediate prognosis= marrow transplant so lower chemo dose can be used

Abx for infections
- if signs of neutropenic sepsis then begin IV tazocin immediately

Question 8

What are complications of chemo?

Answer 8

Infertility
Neurotoxicity
FTT in children
Stunted growth
Neutropenia
Failure
Tumour lysis syndrome

Question 9

What is tumour lysis syndrome and how is it managed?

Answer 9

Excessive break down of blood cells due to chemo causing release of uric acid
High levels of uric acid leads to crystal deposition in tubules and interstitial tissues of kidneys causing AKI

Treated with allopurinol
Can cause hyperkalaemia, hyperphosphatemia and hypocalcaemia