Acute Leukaemia (ALL & AML) Flashcards
Name 2 acute & 2 chronic leukaemia’s & state whether they are primitive or less primitive
Acute myeloid leukaemia - primitive
Acute lymphoblastic leukaemia - primitive
Chronic myeloid leukaemia - primitive
Chronic lymphocytic leukaemia - less primitive
What is an acute leukaemia
Clonal proliferative disorder of progenitor cells with blocked differentiation/ maturation. Defined by an excess of ‘blasts’ (>20%) in either peripheral blood or bone marrow
AML vs ALL affected cells
AML - Proliferation of myeloid progenitor cell (myeloblasts)
ALL - Proliferation of lymphoid progenitor cell (lymphoblasts)
What characterises acute leukaemia (AML/ALL)
Defined by an excess of ‘blasts’ (>20%) in either peripheral blood or bone marrow
Is AML more common in younger or older people
Older age group (>60yrs)
Is ALL more common in younger or older people
Younger age group (most common childhood cancer)
Shared clinical characteristics (S&S) of both AML & ALL
Marrow failure (pancytopenia)
- anaemia (low RBCs)
- infections (neutropenia)
- bleeding (thrombopenia)
What extra-medullary manifestations can occur in ALL
Lymphoblastic cells can migrate to areas outside of the marrow & blood, most commonly the CNS &/ testes.
Lymphoblastic cells can also gather in the blood and obstruct circulation.
Summarise the typical clinical presentation of a patient with ALL
Young patient
Bone pain
Marrow failure (anaemia, neutropenia, thrombopenia)
Leukaemic effects (extra-medullary lymphoblasts - CNS…)
Acute promyelocytic leukaemia is a subtype of AML and has a specific characteristic presentation. What is this?
Coagulation defect - DIC common
Infiltration of what area of the body occurs in multiple subtypes of AML
Gum infiltration
Summarise the typical clinical presentation of a patient with AML
Older patient
Marrow failure (anaemia, neutropenia, thrombopenia)
Subtype specific - coagulation defect/ DIC, gum infiltration
Acute leukaemia investigations
- Blood count & film (morphology)
- Coagulation screen for DIC
- Bone marrow aspirate (morphology)
- Bone marrow aspirate (immunophenotyping)(ALL vs AML)
Other
- cyto/molecular genetics of aspirate (prognostic significance)
- trephine biopsy (if aspirate sub-optimal)
Blood film findings of a patient from acute leukaemia
- WCC not always raised!
- possible pancytopenia
- presence of abnormal cells - blasts (>20%) = characteristic!
- Auer rod in AML
What test is diagnostic of acute leukaemia?
What test must be used to differentiate between AML vs ALL?
What test(s) can be used to identify the specific cancer subgroup?
Acute leukaemia - Blood film or bone marrow (>20% blasts)
AML vs ALL - Bone marrow aspirate immunophenotyping
Subgroup - immunophenotyping or cyto/molecular genetics
Acute lymphoblastic leukaemia management
Multi-agent chemotherapy - can least up to 2-3 years
- Different phases of treatment of varying intensity
- Targeted treatments in certain subtypes
- CNS-directed treatment
- Immunotherapy
- Hickman line for long-term central venous access
Acute myeloid leukaemia management
- Multi-agent chemotherapy
- Between 2-4 cycles of chemotherapy
- Prolonged hospitalisation
- Targeted treatments in subtypes
- Hickman line for long-term central venous access
Acute leukaemia supportive management
Blood products
Antibiotics (prophylaxis or for e.g. neutropenic fever)
Patients with acute leukaemia are often neutropenic, what does this put them at risk of?
- Gram negative bacteria, fulminant life-threatening sepsis.
- Fungal infections
- Opportunistic infections e.g. PJP
How would you treat neutropenic fever
Empirical treatment with broad spectrum antibiotics
Particularly covering gram negatives
Started as soon as fever starts, don’t wait for culture results
What would make you suspect fungal infection (in a patient with acute leukaemia)
Prolonged neutropenia &
Resistant fever that is unresponsive to anti-bacterial agents
Effects of leukaemia treatment
- N&V
- Hair loss
- Liver & renal dysfunction
- Tumour lysis syndrome (during first course of treatment)
- Infection (bacterial, fungal, opportunistic protozoal e.g. PJP)
- late effects e.g. infertility, cardiomyopathy
Do all patients with acute leukaemia have excess blasts in their blood
No - excess blasts will always be in the bone marrow but not necessarily the blood
Describe the morphology of a blast cell
High nucleur:cytoplasmic ratio
Smooth, open chromatin
Nucleoli
