Chronic Leukaemias Flashcards
What is the commonest leukaemia?
Chronic lymphocytic leukaemia
What are risk factors for CLL?
- Trisomies e.g. Down’s syndrome
- Del17p13 (deletions)
What are red flag symptoms of CML?
- Night sweats
- Weight loss
- Fever
- Fatigue
What are symptoms of CLL?
- Often asymptomatic
- May be anaemic, infection-prone or have weight loss, sweats, anorexia if severe
What are signs of CLL?
- Lymphadenopathy - enlarged, rubbery, non tender nodes
- Hepatomegaly
- Splenomegaly
What will you see on blood tests in CLL?
- Low platelets
- Haemolytic anaemia (autoimmune)
- Increased lymphocytes
- Decreased neutrophils
What would you see on blood film in CLL?
Smudge/smear cells
How do you diagnose CLL & CML?
BM biopsy
Which infection can be commonly seen in CLL?
Herpes zoster
What are complications of CLL?
- Diffuse large B cell lymphoma (DLBL) - aggressive lymphoma (Richter’s syndrome)
- Autoimmune haemolysis
- Increased infection due to hypogammaglobulinaemia (low IgG)
- Marrow failure
What staging is used in CLL?
Rai staging
What other investigation can you do in all leukaemias?
Immunophenotyping + molecular/cytogenic analysis
What is the first line treatment for CLL?
Chemo + targeted - FCR (fludarabine, cyclophosphamide, rituximab) OR venetoclax ± steroids ± radiotherapy ± stem cell transplantation
What happens in chronic leukaemias?
- Cells mature partly but not functioning completely
- Not as obvious as acute - cells can look quite normal but they are not
- Cells survive longer than normal cells so they gradually crowd out normal cells - harder to fight infection
How is the onset and progression of CLL?
Insidious gradual onset - people can live with it for years
What is the hallmark of CLL?
Progressive accumulation of a malignant clone of functionally incompetent cells
What type of patients get CML?
40-60 years, male predominance
What is the main risk factor for CML present in > 80% of patients?
Philadelphia chromosome (BCR-ABL gene)
What is CML?
Uncontrolled clonal proliferation of myeloid (granulocytic) cells at different stages of differentiation
What are symptoms of CML?
- Chronic & insidious - weight loss, night swears, fatigue, fever
- Features of gout (due to purine breakdown)
- Bleeding (platelet dysfunction)
- Abdominal discomfort (splenic enlargement)
- 30% detected by change
What are the signs of CML?
- Splenomegaly (> 75%) - often massive
- Hepatomegaly
- Anaemia
- Bruising
What is a complication of CML?
Progression to AML (blast crisis/transformation)
How do you treat CML?
Imatinib (BCR-ABL tyrosine kinase inhibitor) - targeted ± BMT
What would you see on blood tests for CML?
- Increased WCC (often > 100) (myeloid cells)
- Low or normal Hb
- Platelets variable
- Increased urate
- Increased B12
