Acute Leukaemia

Question 1

Define leukaemia.

Answer 1

Any of a group of malignant diseases in which the bone marrow and other blood-forming organs produce increased numbers of abnormal white blood cells

Question 2

What is the cut off between myelodysplastic syndromes and acute leukaemia?

Answer 2

20% blast cells in the bone marrow

Question 3

What are the 4 types of acute leukaemia?

Which cells do they affect?

Answer 3

Stem cell leukaemia (haemopoietic stem cells)
Acute myeloid leukaemia (RBCs, neutrophils, monocytes etc.)
Acute lymphoid leukaemia (B cells, T cells)
Biphenotypic leukaemia (all cells)

Question 4

Which type of acute leukaemia is more common in childhood?

Which type of leukaemia is more common in elderly age?

Answer 4

Childhood - ALL

Elderly - AML

Question 5

List 7 causes of acute leukaemia.

Answer 5

Idiopathic
Chemicals
Chemotherapy
Radiotherapy
Genetics (e.g. Fanconi syndrome)
Pre-leukaemias
Viruses

Question 6

Describe the symptoms of acute myeloid leukaemia. (8)

Answer 6

Rapid onset
Lethargy
Increased susceptibility to infection
Bleeding and easy bruising
Bone pain
Gum swelling
Lymphadenopathy
Skin rash

Question 7

Describe the features of a peripheral blood film in acute myeloid leukaemia. (4)

Answer 7

Anaemia
Neutropenia
Thrombocytopenia
Blast cells

Question 8

Describe the features of blast cells on a blood film. (2)

Answer 8

Large

High nuclear:cytoplasm ratio

Question 9

Describe the features of the bone marrow in acute myeloid leukaemia. (1)

Answer 9

20% blast cells

Question 10

Which mutations indicate a good prognosis in AML? (3)

Answer 10

T(15:17)
Inv16
T(8:21)

Question 11

How do you differentiate between AML and ALL?

Describe how this test works.

Answer 11

Flow cytometry

1. Sample cells passed through a narrow channel, one at a time
2. Light illuminates the cells (some may also be stained with fluorescence)
3. Sensors detect the types of light refracted from each cell; each cell type will have a different pattern
4. Data collected to determine which cell types there are more of

Question 12

List 6 poor prognostic factors in AML.

Answer 12

Secondary AML
Relapsed AML
Progression of MDS to AML
Biphenotypic disease
Elderly patients
Refractory AML

Question 13

How would you treat AML? (3)

Answer 13

Intensive chemotherapy (for young, otherwise fit patients)
Low dose chemotherapy (for old, frail patients)
Supportive care only (for patients too frail for chemo)

Question 14

How is intensive chemotherapy used in treating AML? (3)

Answer 14

Patients entered onto clinical trials to achieve optimal therapy

Types of chemo: antracycline, cytarabine

Cure rate: 15-90%

Question 15

Define remission of AML.

How common is relapse in AML?

Answer 15

<5% blast cells

Relapse in 40-50%

Question 16

Describe how you would monitor patients after chemotherapy.

Answer 16

Every 6-8 weeks for 1st year after treatment

Look for psychological issues

Question 17

Describe the clinical features of acute lymphoid leukaemia. (3)

Answer 17

Limping
Purpuric rash
Bone pain

Question 18

What investigations would you do to diagnose ALL? (3)

Answer 18

Bone marrow aspirate (10+% blast cells)
Flow cytometry 
Cytogenetics, e.g.
-FISH
-Karyotyping
-Reverse transcriptase PCR (detects fusion genes)

Question 19

List 2 genetic abnormalities involved in ALL.

Answer 19

T(9:22)

T(4:11)

Question 20

How would you manage ALL? (8)

Answer 20

Intensive chemotherapy
-CNS directed

Supportive treatment:

• Blood transfusion
• Fresh frozen plasma
• Platelet transfusion
• Antibiotics
• Growth factors (e.g. G-CSF)
• Granuloyctes

Allogenic stem cell transplant

Question 21

List 4 indications for stem cell transplant in ALL.

Answer 21

Relapse
Refractory ALL
Poor prognosis
Age <60 yo)