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Year 2 > Clinical Management - Leukaemia > Flashcards

Clinical Management - Leukaemia Flashcards

1
Q

Name four Leukmias

A
  1. Acute Myeloid Leukaemia
  2. Chronic Myeloid Leukaemia
  3. Acute Lymphoblastic Leukaemia
  4. Chronic Lymphocytic leukaemia
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2
Q

What is leukaemia

A

Malignant proliferation of haemopoietic cells

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3
Q

Blood test for leukaemia

A
  1. Haemoglobin ia low
  2. WBC count raised
  3. Low platelet count
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4
Q

What would a blood film show for leukaemia

A
  1. Blast cells seen
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5
Q

What about a bone marrow biopsy indicate

A
  1. Reduced erythropoiesis
  2. Reduced Megakaryocytic
  3. Blast cell replacement
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6
Q

What would the CXR show

A

Mediastinal widening - shows T-lymphoblastic leukaemia

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7
Q

What examination is specific to Acute Lymphocytic Leukaemia

A

Cerebrospinal Fluid examination - risk of CNS involvement is high

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8
Q

What is immunophenotyping

A

Classifying tumour cells by antigen expression profile

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9
Q

Genetic diagnosis for leukaemia

A
  1. Cytogenetics:
    Karyotyping
    FISH
  2. Molecular Genetics:
    PCR
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10
Q

How does the incidence of Acute Myeloid Leukaemia be effected with age

A

Increases

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11
Q

What risks increase the chances of Acute Myeloid Leukaemia

A
  1. Previous haematological disorders
  2. Prior Chemotherapy
  3. Exposure to ionising radiation
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12
Q

Supportive care for Acute Myeloid Leukaemia

A
  1. HML
  2. Blood product support
  3. Prompt treatment of infections
  4. Recognition of atypical/unusual infections

Chemotherapy/Transplantation

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13
Q

What is the approximate cure rates for AML

A

60% children
50% younger adults
Less than 20% older adults

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14
Q

What causes Acute Promyelocytic Leukaemia

A

PML/PARA gene blocks differentiation of promyelocyte to mature granulocyte

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15
Q

Consequence of Acute Promyelocytic Leukaemia

A

Haematological Emergency - DIC

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16
Q

How is Acute Promyelocytic Leukaemia treated

A

targeted ATRA

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17
Q

What age does Chronic Myeloid Leukaemia effect

A

40-60 yrs age

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18
Q

Sign of Chronic Myeloid Leukaemia

A

Splenomegaly

Pallor

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19
Q

What would show in a blood test for Chronic Myeloid Leukaemia

A

High WBC

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20
Q

What is seen on the blood film on CML

A

Left shift + Basophilia

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21
Q

Key diagnostic features of CML

A
  1. Philadelphia Chromosome
  2. t(9;22)
  3. Resulting in 210-kDa fusion protein (activated tyrosine Kinase)
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22
Q

How is t(9;22) diagnosed

A

A signal pattern found when doing BCR/ABL dual colour dual-fusion probe

(Normal should have four dots on the circumference, CML should have four dots circular and central)

23
Q

What is philedelphia chromosome

A

Where the q-arm of chromosome 22 has been shortened by translocation with 9 t(22;9)!

24
Q

How is BCR-ABL signalling activated

A

ATP phosphorylates tyrosine which is bound to membrane-bound substrate on the same cell

25
Q

How is Chronic Myeloid Leukaemia treated

A

Tyrosine Kinase inhibitors

All end in -tinib

Nilotinib, Imatinib

26
Q

Survival rate of CML

A

More than 90% survive first 5 years

27
Q

How can CML be worsened

A

Accelerated phase due to TKI binding site mutations

28
Q

Where is Acute lymphoblastic Leukaemia common (ALL)

A

Common in paediatric malignancy (not in adults)

29
Q

Presentation of ALL

A
  1. Bone Marrow Failure

2. Organ Infiltration (CNS)

30
Q

How is ALL diagnosed

A

Same as AML

31
Q

Cytogenetics of ALL

A

Philadelphia chromosome (poor prognosis if present)

32
Q

Treatment phases for ALL

A
  1. Induction
  2. Consolidation
  3. Delayed intensification
  4. Maintenance

CNS directed therapy
Stem Cell transplant

33
Q

Can most children be cured of ALL

A

Yes

34
Q

Cure rate in adults for ALL

A

50%

35
Q

What is the biggest influential factor for ALL

A

CYtogenetics

36
Q

What is the most common type of leukaemia

A

Chronic Lymphocytic Leukaemia

37
Q

What is CLL

A

Gradual accumulation of B lymphocyte

38
Q

Where do B lymphocytes accumulate

A

Blood
Spleen
Lymph

39
Q

When is CLL usually diagnosed

A

FBC

40
Q

What age group does CLL commonly effect

A

Elderly

Sometimes <55 (20%)

41
Q

Signs of CLL

A
  1. Progressive Lymphadenopathy/Hepatosplenomegaly
  2. Haemolysis (anaemia)
  3. Marrow failure as marrow replacement occurs
  4. Hypogammaglobulinaemia + infection
42
Q

What is stage A CLL

A

Lymphocytosis

43
Q

How long does stage A CLL last for

A

10-15 yrs

44
Q

What is stage B CLL

A

Nodal spread

45
Q

How long does Stage B CLL last

A

5-7 years

46
Q

What is stage C CLL

A

Anaemia + Thrombocytopaenia

47
Q

How long does stage C CLL last for

A

2-3 yrs

48
Q

CLL treatment

A 
Chemotherapy
Monoclonal antibodies (rituximab)
Target therapy (ibrutinib)Marrow tranplsant
49
Q

What is Autologous transplantation

A

Transplant of bone marrow from own host

50
Q

What is Allogenic transplantation

A

From someone else

51
Q

Danger of allogenic transplantation

A

Toxic
15-30% mortality
Stem cells recipient cells as well as tumour

52
Q

When is Allogenic transplantation done

A

Acute and Chronic leukaemias

53
Q

Benefits of autologous transplantation of stem cells

A

Allows escalation of chemo

Low mortality

Year 2 (155 decks)

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