Acute Leukaemia Flashcards
what is acute leukaemia
haematopoietic blast cells constitute >20% bone marrow cells
what is the most common type of malignancy in childhood
ALL
when does AML occur
at all ages
clinical features
short hx symptoms due to bone marrow failure- anaemia, abnormal bruising/bleeding, infection; weating, fever, weight loss, malaise
what signs are present
lymphadenopathy and hepatosplenomegaly freq especially in ALL
what is common in promyelocytic AML
DIC
lab features
anaemia, thrombocytopenia, neutropenia. leucocytosis. infiltration by blast cells.
good prognostic features in ALL
female, 2-9 years, low WCC, absent extramedullary disease, 4 weeks remission speed, 1 week clearance peripheral blood blasts, negative minimal residual disease in bone marrow at 1-3m
good prognostic indicators in AML
remission after one course chemo.
what can AML be a result of (iatrogenic)
chemo treatment eg for lymphoma
what is AML associated with
myelodysplastic states, radiation, syndromes. progresses rapidly
what rods are diagnostic of AML
auer rods
what is the first stage of treatment
remission induction- high dose intensive combination chemo - reduce or eradicate leukaemic cells from bone marrow, re establish normal haemopoiesis. post induction chemo- initially intensive then for ALL less- maintenance chemo
what is remission
normal FBC,
treatment AML
anthracycline- daunorubicin, cytosine arabinoside.
prognosis AML
80% 85% with 2 courses. 30-50% cured 15-55yrs
treatment ALL
remission induction with vincristine, dexamethasone and L-asparaginase; often with daunorubicin or cyclophosphamide.
what is maintenance and how long for in AML
mercaptopurine daily, weekly methotrexate, monthly vincristine and dexamethasone. for further 2-3 years
what system is commonly involved in ALL
CNS- so give intrathecal methotrexate and high dose systemic chemo
when can stem cell transplant be used
allogeneic stem cell transplantation in adults
prognosis ALL
80% children cured
what is tumour lysis syndrome
metabolic abnormalities due to the massive destruction of cells. hyperkalaemia, incr urate, decr calcium, renal injury
treatment tumour lysis syndrome
fluid intake and allopurinol
side effects cancer treatment
tumour lysis syndrome, hyperviscosity, DIC, neutropenic sepsis
what happens in hyperviscosity
if WCC >100x10^9/l thrombi in brain, lungs, heart.
treat hyperviscosity
lower WCC with hydroxycarbamide, transfusion
what is neutropenic sepsis
neutrophils
treatment neutropenic sepsis
piperacillin-tazobactam (tazocin)
what treatment can you give in promyelocytic leukaemia
trans retinoic acid
