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HLB > Haematological Cancer: Leukaemia > Flashcards

Haematological Cancer: Leukaemia Flashcards

1
Q

Leukaemia vs Lymphoma

A
  • liquid tumour vs solid
  • arises in bone marrow vs arises in
    lymph nodes
  • lymphoid/myeloid vs lymphoid
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2
Q

Leukaemia Aetiology:

A
  • oncogene is a mutated gene that
    contributes to the development of
    cancer
  • tumour suppressor gene is a bit
    like an anti-oncogene
  • oncogene triggered by exposure to
    genetic/environmental modifiers
  • leukaemia occurrs
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3
Q

Aetiology of Leukaemia

A
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4
Q

How can we classify leukaemia?

A
  • acute vs chronic
  • myeloid vs lymphoid
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5
Q

Acute Leukaemia features:

A
  • proliferation (division) of immature
    cells
  • rapid onset
  • can have a devastating course if
    untreated
  • younger patients
  • immature cells (blasts) in the
    blood/marrow
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6
Q

Chronic Leukaemia features:

A
  • proliferation (division) of mature
    cells
  • gradual onset
  • indolent course
  • older patients
  • mature cells in the blood/marrow
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7
Q

Lymphoid classification of leukaemia:

A
  • cells from lymphocyte line
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8
Q

Myeloid classification of leukaemia:

A
  • granulocytes
  • monocytes
  • RBCs
  • megakaryocytes
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9
Q

4 main categories of leukaemia and key points summary at end

A
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10
Q

Leukeamia presents with:

A
  • signs of bone marrow failure:
    anaemia, thrombocytopenia,
    conjunctivital pallor,
    bruising/bleeding, petechial rash
  • infections: patients may become
    neutropenic produce too few
    neutrophils hence get frequent
    infections: tonilitis, cellulitis, ulcer,
    sores, candida fungal (especially
    fungal if immunocomprimised) see
    spores in lungs
  • tissue infiltration
  • other: breathless, fatigue, headache, retinal haemarrhoges, cytokine release trigger clots and bleeds
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11
Q

Signs of bone marrow failure:

A

insert conjunctvital pallow

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12
Q

Signs of bone marrow failure:

A

bruising/bleeding because low platelts
insert bruised legs

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13
Q

Signs of bone marrow failure:

A

brusing/bleeding signs
low platelts
insert nose bleeds

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14
Q

Signs of bone marrow failure:

A

petechial rash
insert bottom left

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15
Q

Tissue infiltration:

A

mediastinal widening chest x ray
insert
specific in subtype of lymphoblastic leukaemia TLL; thoracic lymphadenopathy

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16
Q

Tissue Infiltration

A

enlarged spleen and liver down toward illiac fossa
insert

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17
Q

Tissue infiltration

A

Gum thickening
insert

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18
Q

Tissue Infiltration:

A

neurologic involvement, involvement of cranial nerve: occular motor nerve pull

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19
Q

Tissue Infiltration

A

skin involvement

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20
Q

testicular tissue infiltration in which type of leukeamia

A

acute lymphoblastic leukeamia ALL

21
Q

Diagnosis of leukaemia:

A
  • history
  • examination
  • blood count:
  • morphology (blood film)
  • blood biochemistry
  • virology
  • bone marrow biopsy = definitive
    diagnosis
  • genetic testing = chromosomal
    microarray, single gene sequencing
  • immunophenotyping
  • flow cytometry
22
Q

Bone marrow biopsy

A
  • needle inserted into the back of the
    iliac crest
  • patient lying flat
  • take a sample of spongy bone
  • deep to cortical bone
  • stain and look through microscope
  • other types of genetic testing
23
Q

other types of genetic testing:

A
  • chromsomal microarray is much
    quicker than karyotype
  • unravel dna and look for single
    gene disorders
  • genetic
  • acquired mutations
  • look at whole karyotype
24
Q

Immunophenotyping/Flow cytometry:

A
  • immunophenotyping looks for the presence or absence of cell antigens that can give us clues at to blood abnormalities
  • flow cytometry uses monoclonal antibodies to see scattered light from laser
25
Q

ALL:
- stands for
- when common
- presents with (2)
- cell types
- risks and treatments

A
  • acute lymphoblaastic leukaemia
  • presents with:
    - bone marrow involvement
    - bulky disease (mediastinal
    nodes)
  • B cell or T cell
  • risk of cerebro-spinal fluid CSF
    involvement
  • treatment directed at CSF/ analysis
    regularly of CSF
26
Q

B cell ALL:
- stands for
- features (3)

A
  • B cell acute lymphoblastic
    leukaemia
  • Bone marrow failure
  • Big spleen (splenomegaly)
  • CD10 and CD19 higher number on
    genetic phenotyping
27
Q

T cell ALL:
- stands for
- features (3)

A
  • T cell acute lymphoblastic
    leukaemia
  • Teenage boys
  • thoracic lymphadenopathy:
    mediastinal widening on CXR
  • Low CD numbers CD5,7 on genetic
    phenotyping
28
Q

19 year old boy who has a chest x ray that showed mediastinal widening and he had lots of blasts on his blood film, what to consider?

A

T cell leukaemia

29
Q

AML:
- stands for
- features (5)

A
  • acute myeloid leukaemia
  • > 20% blasts in marrow/film,
    spectrum disorder with bone
    marrow failure (myelodysplasia)
    have to have more than 20% blasts
  • myelodysplasia will only lead to
    AML but not always! not other
    leukaemias
  • tend to see in older patients:
    median age 65
  • auer rods are diagnostic ***
30
Q

Auer rods

A

precipitation of granules and proteins
insert diagram

31
Q

Acute Promyelocytic Leukaemia:

  • variant of
  • features (microscopically)
  • associated with
  • Rx
A
  • variant of AML
  • lots of auer rods
  • lots of granules
  • can be associated with severe
    coagulopathy: (bleeding tendancy)
       - activates the clotting pathway 
   - causes depletion og clotting 
     factors 
   - haematological emergency**

Specific treatment:
- all trans retinoic acid ATRA
- causes promyelocytes to
differentiate/mature

blast to promyelocyte to neutrophil

32
Q

Treatment of Acute Leukaemia:

A
  • consider patient factors and
    disease factors
  • curative vs palliative
  • supportive care: symptomatic:
    - prevent beeding
    - correct coag abnormalities
    - prevent menstruation
    - prevent infections
    - preserve fertility
  • trial vs standard of care
  • systemic anti-cancer therapy:
    - chemo (months/years, intense)
    - radiotherapy
    - bone marrow transplantation
    (allogenic)
    - experimental
33
Q

CLL:
- stands for
- types of cell
- blood test results
- blood film observations (2)

A
  • chronic lymphocytic leukaemia
  • good prognosis (median survival 10
    years)
  • B lymphocytes
  • Lymphocyte count >5x109/L but
    can be very high
  • small/medium sized
    lymphocytes+++: film and marrow
  • smear cells on blood film
34
Q

Allogenic Transplantation

A
  • give chemo to remove all stem cells
  • collect stem cells from donor
  • treat stem cells
  • insert, stem cells take root in bone
    marrow, hopefully produce normal
    blood cells without leukaemia
35
Q

Allogenic Transplantation Risks:

A
  • graft failure
  • graft vs host disease GvHD: graft
    attacks
  • infection
  • fertility
  • psychosocial, burden of follow up,
    burden of morbidity
  • relapse of leukaemia
36
Q

venous access for chemotherapy or stem cells:

A
  • pick line
  • long term cannulas into anterior cubital fossa and into right atrium
  • port through subclavian vein
    (better for younger patients as
    covered)
  • hickman line exposed port
  • risk of infection
37
Q

Prognosis in acute leukaemia:

A
  • fatal in weeks/months if untreated
  • varies by type, age and response to
    treatment
  • childhood ALL can be cured in most
    patients (>80%)
  • AML and ALL in the elderly is poor
    prognosis
  • adverse risk factors:
    • age >60
    • male
    • high WBC at presentation
    • CSF involvement
    • residual disease after induction
      chemo
    • recurrent disease
38
Q

CLL presents:
- most commonly found
- symptoms and signs (4)

A
  • chronic lymphoid leukaemia
  • most commonly and incidental
    finding: high WBC count,
    asymptomatic
  • generalised lymphadenopathy
  • splenomegaly
  • symptoms of anaemia:
    autoimmune haemolytic anaemia,
    bone marrow failure
  • infections: reduced
    immunogobulin, reduced WBC
    diversity
39
Q

An 80 year old man presents with a high lymphocyte count and is noted to have smear cells on his blood. whats the diagnosis?

A

chronic lymphocytic leukaemia

40
Q

CLL special considerations:
- haemolysis screen results

A
  • may be coombs test 9DAT) positive
  • CD19+ B cell surface antigens
  • genetic analysis can affect Rx
  • cross-over with lymphoma:
    transform to a high grade
    lymphoma
  • may hear small lymphocytic
    lymphoma can transform
  • usually no treatment required -
    watch and wait = active surveillance
41
Q

CML:
- stands for
- age incidence
- aetiology
- time

A
  • chronic myeloid leukaemia
  • older age, peak in 50 years
  • mutation of stem cell for whole
    myeloid line: raised levels:
    - granulocytes 
- monocytes 
- megakaryocytes
- high platelet count
  • slow course with 3 phases:
    - chronic (<10% blasts0
    - accelerated (10-20% blasts)
    - blast crisis (>20% blasts) =
    worst prognosis of three
42
Q

CML presentation:

A
  • very high WBC
    - all granulocyte lines+immature
  • often asymptomatic
  • rare in young people <19

Symptoms: due to high WBC:
- due to bone marrow failure:
anaemia symptoms
- splenomegaly (massive)
- fever/sweats/weight loss
- due to leucocytosis:
- headache
- retinal bleeding
- priapism

43
Q

CML diagnosis:

A
  • high basophils on peripheral film is
    highly specific
  • high platelet counts
  • very high WBC
  • different phases of illness defined
    by blast count
  • transform to AML or ALL
44
Q

CML aetiology:

A
  • formation of philidelphia chromosome
  • reciprocal translocation between
    ABL gene on chromosome 9 and
    BCR gene chromosome 22 ***
  • CML
45
Q

CML treatment:

A
  • philadelphia chromsome results in the overproduction of a tyrosine kinase signalling protein
    - increases tyrosine kinase
    activity
    • overproduction of myeloid cells
  • specific Rx:
    • tyrosine kinase inhibitor =
      IMATINIB
    • induces complete remission in
      70% cases
  • blast crisis and accelerate phase would also need chemo and surgery
46
Q

Which of the following conditions is most likely to be associated with DAT + haemolytic anaemia?

1 = Acute lymphoblastic leukaemia
2 = Acute myeloid leukaemia
3 = Chronic lymphocytic leukaemia
4 = Chronic myeloid leukaemia
5 = Hairy Cell Leukaemia

A

3 = CLL

47
Q

Which of the following is the Philadelphia Chromosome?

1 = t(15;19)
2 = t(14;18)
3 = t(9;22)
4 = t(1;7)
5 = t(9,21)

A

3
9&22

48
Q

Summary slide

A

insert

HLB (49 decks)

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