Chronic Leukaemia Flashcards
what is CML
clonal myeloproliferative disorder- incr in neutrophils in peripheral blood, increased cellularity of the marrow
what is the chromosome in CML
Philadelphia. BCR-ABLE1. translocation t(9,22)
what cell is increased in CML
neutrophils
what happens in blast transformation
may transform from relatively stable chronic phase to acute leukaemia phase
clinical features CML
at all ages peak 25-45. weight loss, night sweats, itching, left hypochondrial pain, gout. splenomegaly
what can hyperviscosity cause in CML
priapism, visual disturbance, headaches
lab findings CML
raised WCC, anaemia may be present, platelets can do anything, raised uric acid. hypercellular BM
what is the course of CML
most patients are well in chronic phase, death is from transformation to acute leukaemia
what % of blast transformation in CML is to AML
80% (20 to ALL)
what drug can be given for incr WCC
hydroxycarbamide
treatment CML
imatinib- tyrosine kinase inhibitor
what is given to prevent hyperuricaemia
allopurinol
what can be used to treat CML if patient doesn’t respond
allogeneic stem cell transplant
therapy for acute phase CML
as for AML and ALL with tyrosine inhibitor. but prognosis is poor
what is CLL
lymphoproliferative disorder. B cell clonal disease. lymphocytes accumulate in blood, bone marrow, lymph nodes, spleen
what is the most common leukaemia in the west
CLL
what is stage dependent on in CLL
extent of lymphadenopathy
stage A CLL
stage B CLL
> 3 lymphoid areas involved.
stage C CLL
anaemia and thrombocytopenia present
features stages B and C CLL
lymphadenopathy- symmetrical, painless), night sweats, weight loss, symptoms from bone marrow failure
lab findings CLL
incr blood lymphocytes.
favourable prognostic features CLL
female, stage A, lymphocyte doubling time >1y, AIHA absent
what is Richters syndrome
local lymphoblastic transformation in CLL- poor prognosis
treatment for stage A patients CLL
observation for asymptomatic patients
treatments for stage B and C CLL
fludarabine, cyclophosphoramide, ritixumab
what can you give for bone marrow failure
corticosteroids
what can be used in late stage CLL
alemtuzumab. splenectomy
what is prolymphocytic leukaemia
resembles CLL but occurs in older patients, WCC high, poor response to treatment
