Acute Myeloid Leukaemia

Question 1

Does it tend to affect older or younger people?

Answer 1

older

Question 2

what is the malignant cell in AML?

Answer 2

myeloblast

Question 3

What causes sx in AML?

Answer 3

build up of blast cells which tend to displace or interfere w development of normal blood cells in the bone marrow

Question 4

How does AML present?

Answer 4

can have NO sx

1. Infiltration of the BM:
   - anaemia - fatigue, pale, SOB
   - Thrombocytopenia - easy bleeding + bruising
   - Neutropenia - more infections
2. Generalised - fever, WL, appetite loss, bone/joint pain
3. Others:
   - hepatosplenomegaly
   - swollen gums
   - Chloroma
   - Swollen LN

Question 5

What causes swollen gums

Answer 5

infiltration of leukaemic cells in gum tissue

Question 6

What tests would u do to investigate and what would u see?

Answer 6

1. FBC: 
↑wbc
↓rbc
↓platelets
2. BM biopsy:
leukaemic cells
Auer rods
3. Cytochemical stains:
- helps subtype AML
4. Cytogenetic analysis:
affects rx recommendations and guides prognosis

Question 7

How is chemotherapy given when treating AML?

Answer 7

2 phase:

1. INDUCTION - to reduce no. of leukaemic cells to undetectable levels
2. CONSOLIDATION - eliminate residual to achieve cure

Question 8

What are the risks of chemotherapy?

Answer 8

long periods of BM suppression w neutropenia and reduced platelets so increased risk of infection

Question 9

How often is chemotherapy usually given for AML?

Answer 9

5 cycles in 1 week blocks

Question 10

when are bone marrow transplants indicated?

Answer 10

during first remission in those w poor prognosis

Question 11

explain how BM transplants work i.e. what meds are given alongside

Answer 11

collect pluripotent haematopoietic stem cells from BM

i. destroy leukaemic cells + immune system w cyclophosphamide + total body irradiation
ii. repopulate BM from matched donor w infused IV
iii. Ciclosporin +/- methotrexate can reduce effect of new BM attacking pts body

Question 12

what criteria must BM donation follow to be transplanted?

Answer 12

must be:
allogeneic
HLA-matched

Question 13

What is involved in supportive care of AML?

Answer 13

1. Blood/platelet transfusions
2. IV fluids
3. IV access w Hickman line
4. walking exercises to relieve fatigue

Question 14

what are complications of BMT ?

Answer 14

Graft vs host disease
opportunistic inf
relapse of AML
infertility

Question 15

what are complications of treatment of AML

Answer 15

1. inf - relating to both rx and disease, septicaemia
2. increased plasma urate - due to tumour lysis during chemo
3. leukostasis

Question 16

What is leukostasis and why is it dangerous?

Answer 16

myeloblast counts extremely raised
blast crisis
causes reduced tissue perfusion

Question 17

what is the treatment of increased plasma urate?

Answer 17

allopurinol and plenty of iV fluids