Concepts in Malignant Haematology and Acute Leukaemia Flashcards
How can mature cells be identified?
Morphology
Cell surface antigens
Enzyme expression
How can normal progenitors/stem cells?
Cell surface antigens
Cell culture assays
Animal models
What happens in malignant haemopoiesis?
Increased numbers f often dysfunctional cells
Possible loss of normal haemopoietic reserve
Name 4 things that may be present in a malignant haemopoiesis?
Increased proliferation
Lack of differentiation
Lack of maturation
Lack of apoptosis
What is the difference between Driver’s and Passenger mutations?
Driver’s confer growth advantage
Passenger ones do not.
Is haemopoiesis usually polyclonal or monoclonal?
Polyclonal, unless malignnant, in which case it is monoclonal
How can the cancers be classified?
Acute or Chronic
Lymphoid or Myeloid
Which is more aggressive, high grade or low grade lymphoma?
High grade
Where are myeloma’s?
Plasma cell malignancy in marrow
Where is chronic lymphocytic leukaemia?
Blood and Bone marrow and lymph nodes
Describe Acute Lymphoblastic Leukaemia? (ALL)
Malignant disease of lymphocytes
Most common childhood cancer
How is ALL characterised?
Marrow failure (anaemia, infections, bleeding)
High WCC + involuntary of extra-medullary areas e.g. CNS
Lymph nodes causing venous obstruction
Bone pain
Describe Acute Myeloid Leukaemia? (AML)
More common in elderly
May be de novo or secondary
What is the presentation in AML?
Similar to ALL
How do you investigate acute leukaemia?
Blood count and film Coagulation screen Bone marrow aspirate Morphology Immunophenotype
How does acute leukaemia look on blood film?
Reduction in normal cells
Presence of abnormal cells
Blasts have a high nuclear:cytoplasmic ratio
Even when ALL and ALL cells look alike, what can be used to tell the difference between them?
Lineage-associated proteins that are expressed
What is trephine and why is it useful?
It’s a piece of bone
Enables better assessment of cellularity and helpful when aspirate sub-optimal
What is the treatment of ALL?
Multi-agent chemo
Can last up to 2-3 years
Varying intensity
How is AML treated?
Multi-agent chemo
Intensive
2-4 cycles of chemo (5-10 days of chemo) with 2-4 weeks recovery
Prolonged hospitalisation
What is the Hickman line?
Chemo is administered via a hickman line.
A central venous catheter that sits near the right venous angle
What 3 issues can occur due to marrow suppression?
Anaemia
Neutropenia - infections
Thrombocytopenia - bleeding, purpura, petechiae
What are complications of chemo?
Nausea and Vomiting Hair loss Liver/renal failure Tumour lysis syndrome Infection Loss of fertility Cardiomyopathy with anthracyclines
What is the cure rate for childhood ALL?
85-90%
What is the cure rate for adult ALL?
30-40%
What is the cure rate for adult AML?
40-50%
In some subtypes = 90%
What is the cure rate for adult AML?
<10%
What can potentially be curative?
Allogeneic stem cell transplantation
