Concepts in Malignant Haematology and Acute Leukaemia

Question 1

How can mature cells be identified?

Answer 1

Morphology
Cell surface antigens
Enzyme expression

Question 2

How can normal progenitors/stem cells?

Answer 2

Cell surface antigens
Cell culture assays
Animal models

Question 3

What happens in malignant haemopoiesis?

Answer 3

Increased numbers f often dysfunctional cells

Possible loss of normal haemopoietic reserve

Question 4

Name 4 things that may be present in a malignant haemopoiesis?

Answer 4

Increased proliferation
Lack of differentiation
Lack of maturation
Lack of apoptosis

Question 5

What is the difference between Driver’s and Passenger mutations?

Answer 5

Driver’s confer growth advantage

Passenger ones do not.

Question 6

Is haemopoiesis usually polyclonal or monoclonal?

Answer 6

Polyclonal, unless malignnant, in which case it is monoclonal

Question 7

How can the cancers be classified?

Answer 7

Acute or Chronic

Lymphoid or Myeloid

Question 8

Which is more aggressive, high grade or low grade lymphoma?

Answer 8

High grade

Question 9

Where are myeloma’s?

Answer 9

Plasma cell malignancy in marrow

Question 10

Where is chronic lymphocytic leukaemia?

Answer 10

Blood and Bone marrow and lymph nodes

Question 11

Describe Acute Lymphoblastic Leukaemia? (ALL)

Answer 11

Malignant disease of lymphocytes

Most common childhood cancer

Question 12

How is ALL characterised?

Answer 12

Marrow failure (anaemia, infections, bleeding)
High WCC + involuntary of extra-medullary areas e.g. CNS
Lymph nodes causing venous obstruction
Bone pain

Question 13

Describe Acute Myeloid Leukaemia? (AML)

Answer 13

More common in elderly

May be de novo or secondary

Question 14

What is the presentation in AML?

Answer 14

Similar to ALL

Question 15

How do you investigate acute leukaemia?

Answer 15

Blood count and film
Coagulation screen
Bone marrow aspirate
Morphology
Immunophenotype

Question 16

How does acute leukaemia look on blood film?

Answer 16

Reduction in normal cells
Presence of abnormal cells
Blasts have a high nuclear:cytoplasmic ratio

Question 17

Even when ALL and ALL cells look alike, what can be used to tell the difference between them?

Answer 17

Lineage-associated proteins that are expressed

Question 18

What is trephine and why is it useful?

Answer 18

It’s a piece of bone

Enables better assessment of cellularity and helpful when aspirate sub-optimal

Question 19

What is the treatment of ALL?

Answer 19

Multi-agent chemo
Can last up to 2-3 years
Varying intensity

Question 20

How is AML treated?

Answer 20

Multi-agent chemo
Intensive
2-4 cycles of chemo (5-10 days of chemo) with 2-4 weeks recovery
Prolonged hospitalisation

Question 21

What is the Hickman line?

Answer 21

Chemo is administered via a hickman line.

A central venous catheter that sits near the right venous angle

Question 22

What 3 issues can occur due to marrow suppression?

Answer 22

Anaemia
Neutropenia - infections
Thrombocytopenia - bleeding, purpura, petechiae

Question 23

What are complications of chemo?

Answer 23

Nausea and Vomiting
Hair loss
Liver/renal failure
Tumour lysis syndrome
Infection
Loss of fertility
Cardiomyopathy with anthracyclines

Question 24

What is the cure rate for childhood ALL?

Answer 24

85-90%

Question 25

What is the cure rate for adult ALL?

Answer 25

30-40%

Question 26

What is the cure rate for adult AML?

Answer 26

40-50%

In some subtypes = 90%

Question 27

What is the cure rate for adult AML?

Answer 27

<10%

Question 28

What can potentially be curative?

Answer 28

Allogeneic stem cell transplantation