Acute Lymphocytic Leukaemia (ALL) Flashcards
Leukocyte relates to immune cells of the body. This can be divided into granxulocytes (neutrophils, eosinophils, and basophils), monocytes, and lymphocytes (B, T and NK cells). Acute lymphoblastic leukaemia (ALL) is a malignancy of precursor cells from the lymphocyte lineage. What is the incidence of ALL?
1 - 1 cases per 100,000
2 - 10 cases per 100,000
3 - 100 cases per 100,000
4 - 1000 cases per 100,000
1 - 1 cases per 100,000
Most common childhood malignancy
Slightly more common in males 1.5:1 ratio
Leukocyte relates to immune cells of the body. This can be divided into granulocytes (neutrophils, eosinophils, and basophils), monocytes, and lymphocytes (B, T and NK cells). Acute lymphoblastic leukaemia (ALL) is a malignancy of precursor cells from the lymphocyte lineage. What age does the incidence of ALL typically peak?
1 - <12 months
2 - 1-5 years
3 - 10-20 years
4 - 20-40 years
2 - 1-5 years
When comparing leakaemia and lymphoma, which is a solid and which is a liquid tumour?
- leukaemia = liquid (blood)
- lymphoma = solid (lymph nodes)
When comparing leukaemia and lymphoma, which cells are generally affected?
- leukaemia = myeloid and lymphoid cells (all bone marrow cells)
- lymphoma = lymphoid cells (B, T and NK cells)
When looking at cell lines from the bone marrow we talk about haemopoietic stem cells, which are then able to differentiate into myeloid and lymphoid stem cells. Which of the following is NOT classed as a myeloid stem cell?
1 - erythrocyte
2 - thrombocyte (platelet)
3 - monocyte
4 - natural killer cell
5 - granulocyte
4 - natural killer cell
- these are classed as lymphoblasts
- granulocyte = eosinophil, neutrophil, basophil
When looking at cell lines from the bone marrow we talk about haemopoietic stem cells, which are then able to differentiate into myeloid and lymphoid stem cells. Which of the following is NOT classed as a lymphoblast stem cell?
1 - pre-B cell
2 - thrombocyte (platelet)
3 - Pre-T cell
4 - natural killer cell
2 - thrombocyte (platelet)
Although not definitively known, which of the following has NOT be identified as a cause of Acute lymphoblastic leukaemia (ALL)?
1 - genetics
2 - environmental factors (smoking/radiation)
3 - viral exposure
4 - gender
4 - gender
Although not definitively known, twin studies have shown that genetics is likely to be involved. Which of the following genetic disorders is least likley to have a higher risk of developing ALL?
1 - Trisomy 21
2 - Klinefelter’s syndrome
3 - Haemophilia A
4 - Fanconi anaemia
3 - Haemophilia A
Acute leukaemia is typically caused by mutations to the precursor blood cells in the bone marrow. In acute lymphoblastic leukaemia (ALL), affecting mostly children, what is the most common cause of this?
1 - chromosomal abnormality
2 - poor differentiation of in zygote
3 - genetic mutation passed on by parent
4 - all of the above
1 - chromosomal abnormality
- chromosomal translocation
- abnormal chromosomal number
Acute leukaemia is typically caused by mutations to the precursor blood cells in the bone marrow. In acute lymphoblastic leukaemia (ALL), most common in 1-5 year olds, is due to chromosomal abnormalities. Which 2 of the following are common in ALL?
1 - 12 and 21
2 - 13 and 14
3 - 9 and 22
4 - 18 and 21
1 - 12 and 21
3 - 9 and 22
- Philadelphia chromosome
- 13 and 14 is called the robertsonian translocations
Acute leukaemia is typically caused by mutations to the precursor blood cells in the bone marrow. In acute lymphoblastic leukaemia (ALL), most common in 1-5 year olds, is due to chromosomal abnormalities. 2 of the most common in ALL are 12 and 21 and 9 and 22 (Philadelphia chromosome). What do these chromosomal abnormalities typically cause?
1 - DNA mutations
2 - abnormal protein formation
3 - mRNA damaged
4 - golgi tendon organ is dysfunctional
2 - abnormal protein formation
- affects cellular function and cell division
Acute leukaemia is typically caused by mutations to the precursor blood cells in the bone marrow. In acute lymphoblastic leukaemia (ALL), most common in 1-5 year olds, is due to chromosomal abnormalities. ALL can be further divided into 2 categories. Which 2 of the following are correct?
1 - pre-B cell ALL
2 - pre-megakaryoblast ALL
3 - pre-T cell ALL
4 - pre-myeloblast ALL
1 - pre-B cell ALL
3 - pre-T cell ALL
Which of the following is NOT true in acute lymphoblastic leukaemia (ALL)?
1 - immature lymphoid cells affected
2 - grows rapidly
3 - most common malignancy in children
4 - large amount of cytoplasm on histology
4 - large amount of cytoplasm on histology
- typically there is very little cytoplasm
Ccute lymphoblastic leukaemia (ALL) can be classified based on the cells affected, but which of the following is most common in ALL?
1 - B cell lineage
2 - T cell lineage
3 - NK cell lineage
1 - B cell lineage
Accounts for around 85% of cases
In patients with leukaemia, the bone marrow is unable to effectively make blood cells as the bone marrow is full of immature blood cells. What happens to the level of WBC, RBC and platelets in leaukaemia?
- all can be low
WBC can be low or normal
Symptoms for leukaemia can be vague and non-specific
Leukaemia can present with a variety of symptoms. A low number of which of the following cells can cause bruising, epistaxis and petechial rash (non-blanching rash due to small blood vessels leaking)?
1 - B cells
2 - platelets
3 - RBCs
4 - WBCs
2 - platelets
Leukaemia can present with a variety of symptoms. Which of the folliwng is the main cause for bone pain?
1 - high B cells
2 - low platelets
3 - high lymphoblasts
4 - low lymphoblasts
3 - high lymphoblasts
Leukaemia can present with a variety of symptoms. All of the following are caused by low WBCs and RBCs, EXCEPT which one?
1 - increased risk of infection
2 - testicular enlargement
3 - pallor
4 - lethargy
2 - testicular enlargement
Leukaemia can present with a variety of symptoms. All of the following are RED flags for haematological malignancy according to NICE, EXCEPT which one?
1 - persistent fatigue
2 - unexplained fever
3 - unexplained persistent infection
4 - generalised lymphadenopathy
5 - hepatomegaly
6 - unexplained bruising / bleeding
7 - persistent/unexplained bone pain
5 - hepatomegaly
Can occur but not a red flag sign
In acute lymphoblastic leukaemia (ALL) B cells can be affected, which is the most common form of ALL. This can cause all of the following, EXCEPT which one?
1 - B is for Bone marrow failure
2 - B is for Big spleen
3 - B is for blood loss
4 - B cells affected
3 - B is for blood loss
All the others use B at the beginning, so remember 3 Bs
In acute lymphoblastic leukaemia (ALL) T cells can be affected, which is the most common form of ALL. This can cause all of the following, EXCEPT which one?
1 - T is for Time, with slow progression
2 - T is for Teenage boys affected
3 - T is for Thoracic lymphadenopathy
4 - T is for T cells affected
1 - T is for Time, with slow progression
Rapid and aggressive form of blood cancer
When trying to diagnose acute lymphoblastic leukaemia (ALL), all of the following can occur, but what is the most common symptom observed?
1 - Organomegaly
2 - Fever (persistent, recurrent or refractory fever
3 - Response to an infection that is complicating a dysfunctional immune system.
4 - lymphadenopathy
5 - Haematological discrepancies (bleeding/bruising or a petechial rash)
6 - Anaemia
7 - Musculoskeletal pain
1 - Organomegaly
- hepatomegaly (64%) or splenomegaly (61%) of patients
If acute lymphoblastic leukaemia (ALL) is suspected, which of the following tests is least important to perform?
1 - Infection screen
2 - Coagulation profile
3 - Urea, electrolytes, lactate dehydrogenase, uric acid
4 - Thyroid function
4 - Thyroid function
Infection screen = screen active infections in the presence of a fever, alongside empirical antibiotic administration.
Coagulation profile = assess for clotting derangements.
Urea, electrolytes, lactate dehydrogenase, uric acid = metabolic abnormalities or tumour lysis syndrome
Blood films are used to diagnose acute lymphoblastic leukaemia (ALL). Which of the following would we expect to see on a blood film in someone with ALL?
1 - platelets
2 - immature blast cells
3 - B cells
4 - T cells
2 - immature blast cells
Blood films are used to diagnose acute lymphoblastic leukaemia (ALL), which typically shows immature blast cells. What is the diagnostic threshold for lymphoblasts occupying the bone marrow in ALL?
1 - >2%
2 - >10%
3 - >20%
4 - >50%
3 - >20%
Following a blood smear, typically what test is used to diagnose acute lymphoid leukaemia (ALL)?
1 - bone marrow biopsy
2 - Immunophenotyping
3 - genetic testings
4 - extensive blood profiling
1 - bone marrow biopsy
- sample taken from the iliac crest
- ALL does NOT have auer rods
Which of the following modalities can be used to help identify if the patient has B, T or NK acute lymphoblastic leukaemia (ALL)?
1 - blood smears
2 - chest X-ray
3 - PCR
4 - immunophenotyping
4 - immunophenotyping
Immunophenotyping can be used to help diagnose a patient with suspected acute lymphoid leukaemia (ALL). How does immunophenotyping help diagnose?
1 - specific markers on cells
2 - specific antigens on cells
3 - identify the size of the cells
4 - all of the above
4 - all of the above
When trying to diagnose acute lymphoblastic leukaemia (ALL), we can use imaging such as CT and X-ray. What are we looking for on these imaging modalities?
1 - cardiomegaly
2 - consolidation
3 - lymphadenopathy
4 - bowel dilation
3 - lymphadenopathy
- specifically mediastinal and abdominal lymphadenopathy
Echocardiogram will also need to be done to ensure safety for cardiotoxic medication
Acute myeloid leukaemia (AML) is clinically and morphologically indistinguishable from acute lymphoblastic leukaemia (ALL). Which of AML and ALL has a predisposition for affecting the testicles and CNS?
- ALL = testicles and CNS
- AML = skin, gums and mucus membranes
Acute lymphoblastic leukaemia (ALL) can typically cause all of the following, EXCEPT which one?
1 - bradycardia
2 - tachycardia
3 - fever
4 - tachypneic
1 - bradycardia
If we suspect leukaemia, would the clotting profile be ok or abnormal?
- primary haemostasis will be impaired due to low platelets
A FBC would confirm pancytopenia low platelets, WBC and RBC
Patients with acute myeloid leukaemia (AML) are often taking a medication to address the high levels of urate in the blood due to tumour lysis. What medication is typically given to patients?
1 - rifampicin
2 - cyclizine
3 - omalizumab
4 - allopurinol
4 - allopurinol
High urate is common in malignancy due to lysis of tumours, which is the same medication used in acute gout
Tumour lysis is when there is a rapid cancer cell death (lysis). Is this dangerous?
- Yes
Can be life threatening
Tumour lysis is when there is a rapid cancer cell death (lysis), which can be life threatening. During tumour lysis, which of the following are released in high amounts?
1 - uric acid
2 - phosphate
3 - K+
4 - all of the above
4 - all of the above
Can lead to hypocalcaemia and then hyperphosphataemia.
Essentially, causes acute nephropathy and acute renal failure
Tumour lysis is when there is a rapid cancer cell death (lysis) can be life threatening, causing acute nephropathy and acute renal failure. What is the treatment for this?
1 - Na+ infusion to balance electrolytes
2 - blood drain to dilute
3 - hyperdiuresis via excessive and often forced fluids
4 - all of the above
3 - hyperdiuresis via excessive and often forced fluids
Given alongside allopurinol
Will lactate dehydrogenase be high or low in leukaemia?
- high
Released from cells due to high cell turnover
Will urate levels be high or low in leukaemia?
- high
- Released from cells during breakdown
Patients with acute lymphoid leukaemia (ALL) can have an increased risk of infection due to pancytopenia which is common in both conditions, which is anaemia, leukopenia and thrombocytopenia. How can this be managed?
1 - admit the patient to hospital to protect them from infections and treat with antibiotics
2 - ensure they do not leave their house and provide antibiotics
3 - provide antibiotics, regardless of the location
4 - all of the above
4 - all of the above
In patients with acute lymphoid leukaemia (ALL) the induction therapy (1st therapy given in an attempt to induce remission) is what?
1 - chemotherapy
2 - radiotherapy
3 - immunotherapy
4 - bone marrow transplantation
1 - chemotherapy
- cytotoxic drugs are given that are able to kill cancer cells
- can take months to years
In patients with acute lymphoid leukaemia (ALL) the induction therapy (1st therapy given in an attempt to induce remission) is chemotherapy. What is the definition of remission in leukaemia?
1 - no symptoms for >12 months
2 - no signs of blast cells on blood smears
3 - immune cells are normal
4 - no detectable leukaemia on microscopy
4 - no detectable leukaemia on microscopy
Systemic anti-cancer therapy (SACT) is given to patients as part of an induction therapy. Which of the following is NOT typically part of SACT?
1 - chemotherapy
2 - blood transfusions
3 - immunotherapy
4 - targeted therapies
2 - blood transfusions
Systemic anti-cancer therapy (SACT) is given to patients as part of an induction therapy. Which of the following is a core drug that can be used as an immunotherapy drug in acute lymphoid leukaemia (ALL)?
1 - Naloxone
2 - Cyclizine
3 - Rituximab
4 - Linagliptin
3 - Rituximab
- binds to CD20 on B cells and induces apoptosis
Systemic anti-cancer therapy (SACT) is given to patients as part of an induction therapy. Which of the following is the class of drugs that is the example of targeted therapy that we were taught?
1 - tyrosine kinase inhibitors
2 - ion channel antagonist
3 - GPCR antagonist
4 - tyrosine kinase agonist
1 - tyrosine kinase inhibitors
- most evidence is in chronic myeloid leukaemia
Systemic anti-cancer therapy (SACT) is given to patients as part of an induction therapy as the 1st line treatment with the aim of remission. If a patient goes into relapse, what will they then be offered?
1 - palliative care
2 - radiotherapy
3 - clinical trials with experimental drugs
4 - 2nd round of induction therapy
3 - clinical trials with experimental drugs
Acute leukaemia is typically caused by mutations to the precursor blood cells in the bone marrow. Acute myeloid leukaemia (AML) can be further divided into multiple categories. One of the most common is called Acute promyelocytic leukaemia (APL), which is caused by a chromosomal translocation of chromosomes 15 and 17. This interrupts the normal retinoic acid gene which is important for cell division. How can this be treated?
1 - chemotherapy alone
2 - radiotherapy and steroids
3 - all-trans retinoic acid
4 - all of the above together
3 - all-trans retinoic acid
- binds to retinoic acid receptors on blast cells
- blast cells then develop into mature nautrophils
- neutrophils eventually undergo programmed cell death and reduce the number of blasts in the patient
In patients, where induction therapy has not been successful, they may be offered allogeneic transplantations, which involves a donor, typically a sibling or unrelated donor) providing a sample to help the treat the patient. What is the 1st stage in this process?
1 - get a sample from the donor
2 - whole body radiation from the recipient
3 - chemotherapy for the recipient
4 - whole body radiation for the donor
2 - whole body radiation from the recipient
- idea is to wipe out all immature blast cells before healthy cells from the donor are given
In patients, where induction therapy has not been successful, they may be offered allogeneic transplantations, which involves a donor, typically a sibling or unrelated donor) providing a sample to help the treat the patient. Is the preference to use cells from the bone marrow or stem cells?
- stem cells
- donors sample is treated to remove T cells
- donors must be match to recipient using human leukocyte antigens (HLA)
In patients with leukaemia access to the blood is required. Which of the following are typically used?
1 - Peripherally inserted central catheter (PICC) line
2 - PORT
3 - Hickman line
4 - all of the above
4 - all of the above
Essentially central line access is important given how many blood samples will be needed and chemotherapy given
- ALWAYS CHECK PLACEMENT USING A CHEST X-RAY
What is the cure rate for children with acute lymphoblastic leukaemia?
1 - 2%
2 - 30%
3 - 90%
4 - 100%
3 - 90%
What is the cure rate for adults with acute lymphoblastic leukaemia?
1 - 20%
2 - 40%
3 - 70%
4 - 100%
2 - 40%
