Cancer 5: Overview of blood cancers

Question 1

Explain the process of haemtopoiesis for a neutrophil

Answer 1

myeloblast -> promyelocyte -> myelocyte -> metamyelocyte -> band neutrophil -> neutrophil

Question 2

Explain the process of haemtopoiesis for a macrophage

Answer 2

myeloblast -> promonocyte -> monocyte -> macrophage

Question 3

what growth factor stimulates neutrophil growth?

Answer 3

G-CSF

Question 4

what is cancer?

Answer 4

Transformed cell phenotype
– Uncontrolled proliferation
– Failure to undergo apoptosis

Question 5

what are the clinical features of a proliferative state?

Answer 5

splenomegaly
hepatomegaly
thrombocytopaenia
polycythaemia

Question 6

what do we see on bone marrow microscopy?

Answer 6

polycythaemia rubra vera

myelofibrosis

Question 7

what do we see on blood film microscopy?

Answer 7

leucoarthroblastic blood picture

Question 8

explain how JAK-STAT signalling leads to AML

Answer 8

mutated JAK2 leads to reactive fibrosis

Question 9

what is CML?

Answer 9

too many white cells

Question 10

what chromosome is linked to CML?

Answer 10

philadephia

Question 11

what does CML lead to?

Answer 11

AML

Question 12

what is leukaemia?

Answer 12

Uncontrolled proliferation of
primitive cells in the bone marrow causing bone marrow failure. 
Leads to: 
1) anaemia 
2) infection 
3) bleeding

Question 13

what do we see on film for AML?

Answer 13

Leukaemic blasts

Question 14

what are the clinical features of AML?

Answer 14

anaemia, infections, DIC, ulcers, infiltration and bruising

Question 15

how do we diagnose AML ?

Answer 15

1) Bone marrow biopsy
2) cytogenic
3) molecular
4) immunophenotyping

Question 16

how is leukaemia treated? (3)

Answer 16

• Chemotherapy – kills rapidly dividing cells:
– Combination regimes
– Myelo-ablative cycles of treatment
• Supportive therapy:
– Antibiotics, antifungals
– Transfusions of blood and platelets
• Stem cell transplantation:
– Autograft
– Allograft (full or reduced intensity)
• Sibling
• Matched donor

Question 17

what is the AML treatment regime?

Answer 17

1) induction
2) consolidation 1/2/3

3) possible stem cell transplant or further consolidation.

Question 18

Explain the process of allogenic transplantation

Answer 18

1) bone marrow aspirated from iliac crest of donor and can do T cell depletion
2) recipient undergoes high dose chemo and radiotherapy
3) donor stem cells are infused IV.
4) patient gets intensive support with antibiotics/cyclosporin and methotrexate.

Question 19

what is neutropenic sepsis?

Answer 19

MEDICAL EMERGENCY – High risk of death

Question 20

how do you manage neutropenic sepsis?

Answer 20

Blood cultures and blind antibiotic therapy if fever > 38°C
• 1
st line – Tazocin (Piperacillin/Tazobactam) +/- Gentamicin
• 2
nd line – Switch to Meropenem +/- Teicoplanin (for Gram +ve)
• 3
rd line – Add anti-fungal e.g. Ambisome (Amphotericin)
• Resuscitate patient with i.v. fluids if hypotensive
• May require inotropic support on ITU

Question 21

name some opportunistic infections you may get

Answer 21

PCP

fungal infections