Acute leukaemia (ALL & AML)

Question 1

Pathophysiology - general

Acute lymphoblastic leukaemia (ALL)

Acute myeloid leukaemia (AML)

Which one has a worse prognosis?

Answer 1

Proliferation of immature blast cells

Proliferation of lymphocyte progenitors

Proliferation of granulocyte progenitors

AML is more severe than ALL

Question 2

Epidemiology

Answer 2

Commonest cancer in children <5 yrs old

Question 3

S + S:

Cytopenia due to bone marrow failure which leads to…..

Organ infiltration

Answer 3

Anaemia - fatigue, pallor, SOB
Infection - neutropenia
Bleeding - bruising

Hepatosplenomegaly
Lymphadenopathy
CNS - CN palsy, papilloedema, meningism
Testes - unilateral swelling

Question 4

Risk factors

Answer 4

Chemotherapy or radiation exposure
Previous haematological disease
FH
Genetic disease (e.g. Down’s)

Question 5

Investigations

Bloods

Organ infiltration

Answer 5

FBC 
Coag - DIC 
Blood film 
U&E 
LFT's - check baseline before Rx
Blood culture if fever 

CXR, CT or LP

Question 6

How is it diagnosed?

Answer 6

Bone marrow biopsy and or aspiration plus biopsy of infiltrated organs

Immunophenotyping to identify subtype

Cytogenetics

Question 7

Management

Supportive - pancytopenia management
- what can be five for high uric acid from tumour lysis

Other treatments options which are more invasive

Answer 7

Pancytopenia management - RBC and platelet transfusion, antibiotics
Allopurinol

Chemotherapy
Stem cell transplant

Question 8

Iatrogenic complications

Answer 8

Infertility 
N&V
Bone marrow failure 
Tumour lysis syndrome 
Long term risks - cancer, hypothyroidism, pulmonary fibrosis, HF 
Kids - short stature, reduced IQ