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HAEMATOLOGY > Concepts in Malignant Haematology > Flashcards

Concepts in Malignant Haematology Flashcards

1
Q

What properties do normal haematopoietic stem cells have?

A
  • self-renew
  • proliferation
  • differentiation (commit to certain lineage)
  • maturation
  • apoptosis
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2
Q

How can mature myeloid (i.e. non-lymphoid) cells be identified?

A
  • Morphology
  • Cell surface antigens (glycophorin A = red cells)
  • Enzyme expression (myeloperoxidase = neutrophils)
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3
Q

How can we tell progenitor/ stem cells apart?

A

Immunophenotyping

=> cell surface antigens (CD20/ CD3)

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4
Q

What is malignant haematopoiesis?

A

an increase in abnormal or dysfunctional cells
loss of normal activity
(i.e. in leukaemia, there is loss of haemopoiesis; In lymphoma, there is loss of immune function)

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5
Q

Which of the properties of haematopoietic stem cells are altered during malignant haematopoiesis?

A 
- increased proliferation
BUT decreased:
- differentiation
- maturation
- apoptosis
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6
Q

Describe what happens in an acute leukaemia

A
  • proliferation of progenitors
  • block in differentiation/ maturation
    => lots of common myeloid precursors in the bone marrow
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7
Q

What happens in chronic myeloid leukaemia?

A
  • proliferation of abnormal progenitors

- no differentiation/ maturation block so some mature cells are still formed

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8
Q

What are the potential causes of haematological malignancy?

A
  • somatic mutations in oncogenes or tumour suppressors (driver or passenger mutations)
  • multiple genetic “hits” needed
  • recurrent cytogenetic abnormalities (deletion/abnormal chromosomes)
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9
Q

What is the difference between driver and passenger mutations?

A 
DRIVER = cause of cancer
PASSENGER = causes genetic instability
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10
Q

Cells with a driver mutation are more likely to survive and keep dividing. TRUE/FALSE?

A

TRUE

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11
Q

What screening test performed as a child can be looked at retrospectively to diagnose Acute Lymphoblastic Leukaemia?

A

Guthrie Heel Prick Testing a few days after birth

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12
Q

How are types of haematological malignancies classified?

A

Based on:
- lineage

  • developmental stage within lineage
    => e.g. Acute Leukaemia = no mature cells produced
    => Chronic Leukaemia = mature cells still produced
  • anatomical site
    => Blood = leukaemia
    => Lymph Node = Lymphoma
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13
Q

How do acute leukaemias appear histologically and clinically?

A

HISTOLOGY:

  • large cells
  • high nuclear:cytoplasm ratio
  • rapid proliferation

CLINICAL:

  • rapid progression of symptoms
  • pancytopenia common
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14
Q

What is the definition of acute leukaemia?

A

> 20% blasts in peripheral blood or bone marrow

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15
Q

Acute Lymphoblastic Leukaemia (ALL) is common in what age group?

A

Childhood

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16
Q

What symptoms usually present in ALL?

A
  • marrow failure
    => anaemia
    => infections
    => bleeding
  • high blast count causes obstruction of circulation
  • extra-medullary sites can be affected
  • bone pain
17
Q

Acute Myeloid Leukaemia (AML) is more common in what age group?

A

Elderly (>60s)

18
Q

Why does AML usually occur?

A
  • De novo mutation

OR secondary to having Chronic Myeloid Leukaemia (CML)

19
Q

How do patients usually present with AML?

A
  • similar to ALL
  • marrow failure and consequences
  • some sub-groups (e.g. Promyelocytic AML) have characteristic appearance e.g. DIC
20
Q

How are both types of Acute Leukaemia investigated?

A
  • Blood count/ film

- Coag. screen

21
Q

What does a blood film show in acute leukaemia?

A
  • decrease in normal cells
  • abnormal cells present (BLASTS)
    => high nuclear:cytoplasmic ratio
    => Auer’s Rods also present in AML
22
Q

What is a bone marrow aspirate used for in Acute Leukaemia?

A
  • check morphology of cells
  • immunophenotype to check lineage
    => differentiates between AML and ALL
  • analyse genetics for prognosis
23
Q

When would a Trephine biopsy be used in acute leukaemia?

A

if aspirate sub-optimal

OR to assess morphology better

24
Q

What is the CURATIVE treatment for acute leukaemias?

A

ALL - 2-3 years of multi agent chemo

AML - intensive chemotherapy (2-4 cycles)

  • 5-10 days of chemo then 2-4 weeks recovery
  • prolonged stay in hospital usually req’d
25
Q

HOw do patients with leukaemia usually have their chemotherapy delivered?

A

Via a central venous catheter

e.g. Hickmann line

26
Q

What problems can occur due to suppression of the bone marrow by chemotherapy?

A
  • anaemia
  • neutropenia (increased infection risk)
  • thrombocytopenia (increased bleeding risk)
27
Q

What are the main complications of chemotherapy?

A
  • Nausea and vomiting
  • hair loss (alopecia)
  • liver/ renal dysfunction
  • bacterial infection
  • fungal infection if prolonged neutropenia and fever
28
Q

What are the late complications of chemotherapy?

A
  • loss of fertility

- cardiomyopathy

29
Q

What is considered complete remission in leukaemia?

A

<5% blasts in blood

return of normal haemopoiesis

30
Q

Do patients with leukaemia usually recover?

A

Childhood ALL - many get remission
Adult ALL - 30-40% achieve remission
Elderly AML (>60yrs) - many don’t recover

31
Q

What treatments other than chemotherapy are available for patients with leukaemia?

A

Targeted Tx: e.g. can target Philadelphia Chromosome

Allogenic stem cell transplant

HAEMATOLOGY (24 decks)

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