Acute Myeloid Leukaemia Flashcards
1
Q
What is AML?
A
- The bone marrow produces WBC called granulocytes and monocytes too quickly
- The leukaemic cells spread to lymph nodes and the spleen
2
Q
How does AML affect you?
A
- Too many WBC overcrowd the bone marrow so there is not enough space for other types of blood cells
- You have lower levels of platelets = leading to bleeding problems and bruising
- You have lower levels of RBCs = leading to to you being breathless
3
Q
What are the symptoms of AML?
A
- General Weakness
- Feeling tired (fatigue)
- A high temperature (fever)
- Frequent infections
- Bruising or bleeding easily ( nosebleeds, bleeding gums when cleaning your teeth, very heavy periods, dark spots on your skin or blood in your urine/ stool)
- Weight loss
- Pain in your bones/ joints
- Breathlessness
- Feeling full in your tummy
- Pale skin
- Swollen lymph nodes (neck, under armpit, groin)
4
Q
What are the Risk Factors for AML?
A
- Myelodysplastic syndrome
- Older age
- Smoking
- Overweight/ Obese
- Ionising radiation
- Exposure to benzene at work
- Inherited conditions (Fanconi Anaemia/ Children with Down’s Syndrome)
- Past chemotherapy (treatment for Hodgkin Lymphoma or Breast Cancer)
- Blood Disorders (myelodysplastic syndrome/ Polycythaemia Rubra Vera)
- Autoimmune Conditions ( RA, Autoimmune Haemolytic Anaemia, Ulcerative Colitis)
5
Q
What are the types of AML?
A
- Granulocytic Sarcoma (lump of cells collected outside the bone marrow)
- Acute Promyelocytic Leukaemia (APL) - Known as AML M3
- Panmyelosis ( Acute panmyelosis with myelofibrosis)
- Mixture of AML/ ALL (Biphenotypic leukaemias)
6
Q
What is the Risk Stratification?
A
- Low risk
- Intermediate risk
- High risk
7
Q
What depends on your risk groups?
A
- Changes in chromosomes
- Gene changes
- markers on leukaemia cells
- white blood cells when you get diagnosed
- age at diagnosis
- whether you have a blood disorder (myelodysplastic syndrome)
- whether leukaemia is linked to treatment for an earlier cancer
- whether there is leukaemia present in your CNS
8
Q
What does it mean to be low risk?
A
- You have a low risk of relapse and are likely to be cured
- You are likely to undergo chemotherapy
9
Q
What does it mean if you have an intermediate risk?
A
- Your risk of relapse is intermediate
- You have chemotherapy and you might have a stem cell transplant
10
Q
What does it mean if you have a high risk?
A
- You have a high risk of relapse
- You have chemotherapy followed by a stem cell transplant
11
Q
When should you send a referral for an urgent RBC?
A
- if you look usually pale
- extreme tiredness
- a high temperature
- unexplained temperature that won’t go away and can’t be explained
- bruising or bleeding for no reason
12
Q
- When should you refer children and young adults immediately?
A
- unexplained petechia ( red/ purple spots on the skin)
- enlarged liver or spleen
13
Q
What are the main treatments for AML?
A
- targeted cancer drugs
- growth factors
- stem cell or bone marrow transplants
- radiotherapy
14
Q
What supportive treatments would you offer for AML?
A
- Anti Sickness Medication
- Painkillers
- Blood transfusions
- Platelet infusions
- Antibiotics
- Allopurinol
15
Q
What are growth factors
A
- Natural substances that stimulate the bone marrow to make blood cells especially white blood cells
16
Q
When might you have growth factors?
A
- Before a stem cell collection for a stem cell/ bone marrow transplant
- After chemotherapy
17
Q
How do you have G- CSF?
A
- You usually have growth factors as an injection under the skin
- Usually via the tummy, into the arm or into the leg
18
Q
What are common side effects of having G-CSF?
A
- Itching around the injection site
- Pain in your bones
- Fever
- Headaches
- Tiredness and fatigue
- Diarrhoea
- Feeling sick
- Hair thinning
- Sore throat
19
Q
What are the phases of treatment for AML?
A
- Induction
- Consolidation
20
Q
What is involved in the induction stage of treatment for AML?
A
- Aim of induction is to destroy the leukaemia cells
- You have a combination of 2 or more chemotherapy drugs to get rid of the leukaemia
- cytarabine and daunorubicin
21
Q
What is involved in the consolidation treatment for AML?
A
- There are different types of consolidation treatment
- When there are no signs of the leukaemia it is in remission
- There are different types of consolidation treatment
- You typically have high dose of chemotherapy and then a bone marrow/ stem cell transplant
22
Q
How do you keep AML away?
A
- The aim of maintenance treatment is to help leukaemia in remission - months to 2 years
- You have more chemotherapy such as azacytidine, decitabine
23
Q
What do you need before you start chemotherapy?
A
- Blood tests are required to ensure that you are safe to start treatment
24
Q
What information might you need to inform a patient after they have had a transplant?
A
- Inform them of the importance of contraception during treatment ( barrier and hormonal contraception is advised)
- Inform them that they are unlikely to be fertile after treatment
- Encourage a healthy diet
- Encourage exercise
25
Q
What are common transformations which cause Acute Myeloid Leukaemia?
A
- It can be the result of a transformation from a myeloproliferative disorder such as polycythaemia vera
or myelofibrosis
26
Q
What will the blood film show?
A
- It will show a high proportion of blast cells
- These blast cells will have rod cells inside their cytoplasm (Auer rods)
27
Q
When would you have definitive transplants ?
A
- high Wcc on FBC
- high cytogenetic risk
- lack of remission
28
Q
What are the complications of AML?
A
- leucostasis ( elevated blast cell count - respiratory/ neurological distress)
- TLS
- DIC
