Chronic Leukaemia

Question 1

What are the two different types of CL?

Answer 1

Chronic myeloid leukaemia

Chronic lymphocytic Leukaemia

Question 2

What is CML?

Answer 2

Onsets in patients aged 40-60

95% have philadelphia chromosome which marks better prognosis

Question 3

What are the 3 phases of CML?

Answer 3

1) Chronic phase
- lasts up to 5 years
- patient asymptomatic
- may have incidental raised WCC

2) Accelerated
- proportion of abnormal cells grow to the point where 10-20% of cells are abnormal
- patient begins to be symptomatic

3) Blast
- >30% of cells are abnormal
- patient is highly symptomatic, high chance of pancytopenia and increased fatality

Question 4

What are the symptoms of CML?

Answer 4

Asymptomatic
Recurrent infections
Anaemia
Easy bruising and bleeding
Abdo pain due to extensive splenomegaly 
Gout due to purine breakdown

Question 5

What investigations are needed?

Answer 5

Bloods

• FBC- pancytopenia (can get raised WCC)
• Blood film- myeloid cells

Bone marrow biopsy- hypercellular
PET/CT- staging

Cytogenic analysis of blood or marrow for philadelphia chromosome

Question 6

What is the management?

Answer 6

Imatinib chemo
Allogenic bone marrow transplant
Stem cell transplant

Question 7

What is CLL?

Answer 7

Chronic proliferation of a single type of well differentiated lymphocyte

Affects people >70 and males

Can transform to high grade non hodgkins lymphoma (richters transformation)

Question 8

What are the symptoms of CLL?

Answer 8

Often asymptomatic 
Anaemia
Surprise diagnosis on blood test 
Lymphadenopathy 
Recurrent infections

Question 9

What investigations are needed?

Answer 9

FBC- lymphocytosis and signs of bone marrow failure

Blood film- smudge cells

Question 10

What is the management?

Answer 10

Without treatment 1/3 never progress, 1/3 eventually progress, 1/3 actively progress

Only treat if symptoms or poor prognosis