Acute Leukaemia (Megan) Flashcards
Acute myeloblastic leukaemia Acute lymphoblastic leukaemia
How does every blood cell start?
In the bone marrow as a haematopoietic cell.
What 2 categories can a haematopoietic stem cell turn into?
- Lymphoblast - B lymphocyte or T lymphocyte
2. Myeloblasts - erythrocyte, thrombocyte/latelet, monocyte, granulocyte (neutrophil, basophil, eosinophil)
What predisposes you to mutations in the bone marrow?
Chemotherapy
radiation
downs syndrome
other genetic abnormalities
What is the pathophysiology behind acute leukaemia’s?
The immature cells lose the ability to differentiate. So they can proliferate but are stuck as a blast cell.
They divide uncontrollably and take up lots of space in the bone marrow - this causes lower levels of all other blood cells.
What is cytopenia?
A reduction in the other red blood cells - as a result of blast cells infiltrating the bone marrow and causing bone marrow failure.
What are the types of cytopenias?
Anaemia - reduced RBCs
Thrombocytopenia - reduced platelets
Neutropenia - reduced neutrophils
What are the symptoms of acute leukaemia’s?
Anaemia: Fatigue Pallor Lethargy Weakness Heart failure
Thrombocytopenia: easier bleeding petechiae purpura bruising (in areas of pressure) epistaxis gum bleeds
Neutropenia:
Frequent Infections
Other: Pain and tenderness Hepatomegaly Splenomegaly Lymphadenopathy fever testicular swelling
How is acute leukaemia diagnosed?
Peripheral blood smear: shows myeloblasts (In AML) and lymphoblasts (In ALL)
Bone marrow biopsy:
Shows increased number of blast cells
What are the 2 main types of acute leukaemia?
Acute lymphoblastic leukaemia
Acute myeloblastic leukaemia
How are ALL and AML differentiated?
Using immunotyping
OR
Using specially stained smears
What blast cell number indicates acute leukaemia?
Normal = 1-2% blast cells
Acute leukaemia = >20%
What is the treatment for acute leukaemia?
Chemotherapy
Biological therapy
Stem cell transplants
Bone marrow transplants
Who is most commonly diagnosed with acute lymphoblastic leukaemia?
Children
Accounts for 80% of childhood leukasmias
What is the peak age to get ALL?
2-5 yrs
Boys>girls
Which features are more common in ALL than in AML?
Hepatosplenomegaly
Lymphadenopathy
What type of ALL do you get?
B cell acute lymphoblastic leukaemia (most common).
T cell acute lymphoblastic leukaemia (least common).
What is the pathophysiology of acute lymphoblastic leukaemia?
Proliferation of lymphoid cells WITHOUT differentiation.
Which chromosome is often associated with ALL?
9 and 22 - the Philadelphia chromosome
What is the most common acute leukaemia in adults?
Acute myeloblastic leukaemia
How can acute myeloblastic leukaemia present?
As a primary disease
Secondary to myeloproliferative disorder
When does myeloproliferative disease become acute myeloid leukaemia?
If the blasts are <20% its myeloproliferative disorder and it becomes AML when the blast cells are >20%.
How does bone marrow failure occur in acute leukaemia?
The bone marrow is replaced with acute leukaemia cells (blasts).
When is CSF testing done?
If there is suspected CNS involvement (more common in children).
Which genes are associated with acute myeloblastic leukaemia?
FLT3
NPM1
What is a complication of acute myeloblastic leukaemia?
Fungal infections
What are the 3 stages of anti leukaemia chemotherapy?
Remission:
1-2 cycles
Consolidation:
1-3 cycles
Maintenance:
Using target therapies
What is the most effective anti leukaemia treatment?
Allogenic transplant
what is important in the treatment of acute myeloblastic leukaemia?
Age - increased age gives a poorer prognosis
What is an example of a targeted antibody?
Gemtusumab
