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Essential Haematology > Chronic Leukemias > Flashcards

Chronic Leukemias Flashcards

1
Q

What is the main distinguishing feature between chronic leukemia’s and acute leukemia’s

A

The chronic leukemia’s are distinguished from acute leukemia is by the slower progression
They are also more difficult to cure

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2
Q

What are the two subdivisions of chronic leukemia’s

A

myeloid and lymphoid groups

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3
Q

Define chronic myeloid leukemia

A

This is a clonal disorder of pluripotent stem cell

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4
Q

This is a clonal disorder of pluripotent stem cell

A

Chronic Myeloid Leukemia

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5
Q

Which disease accounts for 15% of leukemia’s

A

Chronic myeloid leukemia CML

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6
Q

Chronic Myeloid Leukemia (CML) accounts for what percentage of Leukemias?

A

15%

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7
Q

The diagnosis of chronic myeloid Leukemia is rarely difficult and is assisted by the characteristic presence of what

A

Ph chromosome

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8
Q

True or false the PH translocation in Chronic Myeloid Leukemia is also seen in Acute lymphoblastic Leukemia

A

True

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9
Q

Chronic Myeloid leukemia occurs most frequently between ages

A

Between the ages of 40 and 60 yrs old

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10
Q

True or False

Chronic Myeloid Leukemia can occur in children, neonates and the very old

A

True

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11
Q

List five clinical features of Chronic Myeloid Leukemia

A

Symptoms related to hypermetabolism (weight loss, lassitude, anorexia, night sweat)
Splenomegaly
Features of anemia
Signs of abnormal platelet function (bruising, epistaxis, menorrhagia, haemorrhage)
Gout or Renal impairment from Hyperuricaemia (from excess purine breakdown)

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12
Q

List five laboratory findings in chronic myeloid leukocytosis

A 
Leukocytosis is usually >50 x 10^9 
Increased circulating basophils
Normochromic, normocytic anemia
Platelet count increased (most frequently), may be normal or decreased
Neutrophil alkaline phosphatase low
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13
Q

What is the basophil count in chronic myeloid leukemia

A

Increased

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14
Q

What is the color and size of red blood cells in chronic myeloid leukemia

A

Normochromic

Normocytic

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15
Q

What is the first line drug in management of chronic myeloid leukemia

A

Imatinib (Glivec) tyrosine kinase inhibitor

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16
Q

How does Imatinib (Glivec) work

A

Specific inhibitor of the BCR-ABL fusion protein and blocks tyrosine kinase activity by competing with ATP binding

17
Q

What is the dosage of Imatinib administered to pts with Chronic Myeloid Leukemia

A

400mg/day

18
Q

List some side effects of Imatinib

A

Skin rash
Fluid retention
Muscle pains
Nausea

(Sometimes neutropenia and thrombocytopenia)

19
Q

What is done If neutropenia occurs during treatment of CML with Imatinib

A

Granulocyte Stimulating Factor

20
Q

Define a complete cytogenetic response to treatment for Chronic Myeloid Leukemia

A

The absence of PH positive metaphases on cytogenetic analysis of the bone marrow

21
Q

Patients with sub optimal response to treatment for chronic myeloid leukemia can be identified as those who

A

Fail to achieve a complete hematological response after three months

Failed to achieve any significant cytogenetic response in bone marrow after six months

Fails to achieve a major cytogenetic response in bone marrow which is less than 25% Ph+ metaphases by cytogenetic analysis after 1 year

22
Q

Eventhough it is unclear how patients who have suboptimal response to chronic myeloid leukemia treatment should be treated, what are the potential options

A

Increase in dose of Imatinib to 600-800 mg/day

Or

Substitution or addition of second generation tyrosine kinase inhibitors DASATINIB or NILOTINIB (which can ivercome resistance to Imatinib)

23
Q

How do you test for acquired resistance to Imatinib in pts treated for Chronic Myeloid Leukemia

A

Molecular Screening for mutations in the BCR-ABL fusion gene

24
Q

What drug is used in the initial phase of treatment for Chronic Myeloid Leukemia CML to treat gout and prevent hyperuricaemia

A

Allopurinol

25
Q

What is the purpose of Allopurinol in treatment of CML

A

used in the initial phase of treatment for Chronic Myeloid Leukemia CML to treat gout and prevent hyperuricaemia

26
Q

Second line therapy for pts unable to take Imatinib in treatment for CML have a poor response, name two

A

Chemotherapy: Hydroxyurea, Busulfan

Alpha Interferon:

27
Q

Describe the administration of Chemotherapy: Hydroxyurea treatment for CML

A

1.0-2.0g/day and then reduce in weekly increments to maintain 0.5-1.5g/day

(Busulfan only used in pts intolerant of Hydroxyurea)

28
Q

Allogenic Stem Cell Transplantation (SCT) is the only established curative treatment for CML but, because of the risk, it is usually reserved for Imatinib failures.

A

Read

29
Q

Only pts under what age can tolerate SCT

A

Under 65yrs

30
Q

True or False

CML usually shows an excellent response to Imatinib in the chronic phase

A

True

Essential Haematology (14 decks)

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