Acute Leukaemias Flashcards
What is the most common childhood cancer (0-4 years)?
Acute lymphocytic leukaemia (ALL)
What are the 4 types of leukaemia?
1) Acute lymphocytic leukaemia (ALL)
2) Acute myeloid leukaemia (AML)
3) Chronic lymphocytic leukaemia (CLL)
4) Chronic myeloid leukaemia (CML)
What cells do lymphocytic leukaemias (lymphoid neoplasms) derive from?
Lymphoid stem cell (i.e. cells which when mature become lymphocytes & NK cells)
What cells do myeloid neoplasms incl. leukaemias derive from?
Myeloid stem cell (i.e. cells which when mature become RBCs, platelets & neutrophils/eosinophils/basophils)
What is leukaemia?
Uncontrolled proliferation of immature blood cells causing anaemia, thrombocytopenia and leukopenia
What is infiltration in leukaemia?
When immature WBCs spill out from the bone marrow into other organs
What are risk factors for acute lymphocytic leukaemia?
1) Down’s syndrome
2) XR in pregnancy
What are the symptoms of acute lymphocytic leukaemia?
1) BM failure - infection, anaemia (pallor, SOB), bleeding e.g. gums, epistaxis
2) Infiltration - hepato/splenomegaly, lymph nodes, CNS symptoms, bone pain
What is a complication of acute lymphocytic leukaemia?
SVCO (superior vena cava obstruction)
How do you diagnose all leukaemia?
Bone marrow biopsy
What initial investigations might you do in someone with suspected leukaemia?
FBC, blood film
What would you see on blood film (and BM biopsy) in acute lymphocytic leukaemia?
Blasts
Why does acute lymphocytic leukaemia cause SVCO?
Enlarged thymus due to T cell ALL
What are symptoms of SVCO?
Dysphagia and dyspnoea
What are symptoms of bone marrow failure?
- Fatigue
- Bleeding/bruising (thrombocytopenia)
- Becoming full quickly - due to hepato and splenomegaly, stomach can’t expand
- Lymphadenopathy (painful lymph nodes)
When does acute lymphocytic leukaemia typically present?
Childhood
What is the commonest acute leukaemia in adults/elderly?
Acute myeloid leukaemia
What are risk factors for acute myeloid leukaemia?
- Down’s syndrome
- Myelodysplastic syndrome
- Myeloproliferative syndrome
How do acute leukaemias typically present and therefore how do you treat them?
Medical emergency - supportive treatment e.g. transfusion, IV fluids (prevents TLS) ± abx prophylaxis
How do you treat acute leukaemias?
Combination chemo (intensive e.g. cytarabine) ± BMT (sibling matched allogenic) with ciclosporin (to reduce graft vs host disease)
How does acute myeloid leukaemia present acutely?
Leukocytosis (large WCC in bone marrow)
What would you see on blood film in acute myeloid leukaemia?
Auer rods - in progranulocytes (platelets precursor)
What are symptoms of acute myeloid leukaemia?
- BM failure - infection ± DIC (APML), anaemia, bleeding
- Infiltration - hepato/splenomegaly, gum hypertrophy, skin involvement
What are complications of acute myeloid leukaemia?
- Infection
- Tumour lysis syndrome (TLS) - risk in all leukaemias
- Leukostasis (extremely elevated blast cell count and symptoms of decreased tissue perfusion)
What is the WCC in acute leukaemia?
Total cell count is high - but lots of immature cells rather than mature
Is acute lymphocytic leukaemia easier to cure in children or adults?
Children
How can you tell the difference between lymphoid and myeloid leukaemia?
Blood film or biopsy - NOT symptoms
What is acute promyelocytic leukaemia?
A subtype of acute myeloid leukaemia - 10% (chromosomal translocation 15;17)
When is TLS most likely to occur?
Within a week of starting treatment
What is a life threatening risk of acute leukaemia?
Neutropenic sepsis (complication of neutropenia)
What are symptoms of TLS?
- Hypocalcaemia
- Hyperkalaemia
- Hyper-uricaemia
- Calcium phosphate imbalance
How do you diagnose APML?
- Increased PT, APTT, D-dimers
- Decreased fibrinogen, platelets, TT
What clotting defect happens in APML?
DIC (massive clotting and bleeding)
How do you treat APML?
ATRA (all-trans retinoic acid - chemotherapy) + arsenic
Correct coagulopathy
Which leukaemia occurs in older adults?
AML
