Acute Leukaemia

Question 1

What is acute leukaemia?

Answer 1

Result of accumulation of early myeloid or lymphoid precursors in the bone marrow, blood and other tissues

Question 2

How does acute leukaemia arise?

Answer 2

Probably occurs by somatic mutation in a single cell within a population of early progenitor cells
May arise de novo or be the terminal event of a pre-existing blood disorder

Question 3

What two sub groups of acute leukaemia?

Answer 3

Acute myeloid leukaemia (AML)

Acute lymphoblastic leukaemia (ALL)

Question 4

What are the features of the blasts of acute myeloid leukaemia (AML) histologically?

Answer 4

high white cell count
large 
immature
clearly defined nucleoli
high nuclei:cytoplasmic ratio
can contain granules

Question 5

What are the features of the blasts of Acute lymphoblastic leukaemia (ALL) histologically?

Answer 5

smaller
rounder
less cytoplasm

Question 6

What are the main features that patients present with?

Answer 6

bone marrow failure i.e.
anaemia
infections - perianal common. More severe than normal
easy bruising and haemorrhage
Organ infiltration by leukaemia cells may occur e.g. spleen, liver, meninges, testes and skin

Question 7

How are acute leukaemias diagnosed?

Answer 7

Morphology
Cytochemistry
Immunological markers - immunoflouresense
Cytogenetics
FISH
Molecular techniques i.e. polymerase chain reaction (PCR) - early relapse

Question 8

What is flourochrome-coupled antibody labelling?

Answer 8

serum with antibodies for the antigens present
antibodies have florescent markers
florescence detected by lasers

Question 9

What is the Philadelphia Chromosome?

Answer 9

translocation between chromosomes 9 and 22
abi gene from 9 fuses with bcr gene from 22
causes an increase in tyrosine kinase activity = increased immature cell proliferation

Question 10

What is the prognosis for AML with mutations in NPM1? Good or bad?

Answer 10

Good

Question 11

What is the prognosis for AML with mutations in FLT3? Good or bad?

Answer 11

Bad

Question 12

What are the complications of intensive chemotherapy?

Answer 12

neutropenic for 10 – 21 days
Neutropenic Fever - defined as pyrexia in the presence of a neutrophil count of less than 1.0 x 109/l
Neutropenic sepsis

Question 13

What is neutropenic sepsis?

Answer 13

overwhelming gram negative or gram positive infection caused by neutropenic fever

Question 14

What is the prevention management for neutropenic sepsis?

Answer 14

protective isolation
prophylactic antibiotics eg levofloxacin
use of granulocyte colony stimulating factors
strict hand hygiene

Question 15

What is the immediate management for neutropenic sepsis?

Answer 15

administration of broad spectrum IV antibiotics (often Tazocin and Gentamicin)