Haematological malignancies Flashcards
Which subtype of AML should be treated as a medical emergency?
Acute promyelocytic leukaemia (associated with high risk of DIC)
What is the appearance of AML on blood count?
WCC high
Anaemia
Thrombocytopenia
Treatment of AML
Chemo & stem cell transplantation
Which 3 agents are typically used to treat ALL?
Vincristine, steroid, asparaginase
What are the long term side effects of chemo treatment of ALL in children?
Endocrine problems
Secondary leukaemia
Cardiotoxicity
When is the peak incidence of ALL?
Childhood
What is the pathological hallmark of CML?
Philadelphia chromosome and the resulting chimeric BCR-ABL gene
Clinical features of CML
Anaemia
Anorexia
Weight loss
Splenomegaly
What is the preferred definitive drug treatment for patients with CML?
Imatinib
What is the most common form of leukaemia in the western world?
CLL
When should treatment be commenced in CLL?
When the patient develops significant symptoms, when the disease is progressing rapidly or when it is already at an advanced clinical stage
What is the most effective treatment of hairy cell leukaemia?
Nucleoside analogues
How does classical Hodgkin’s lymphoma present clinically?
Asymmetrical painless lymphadenopathy (cervical)
May have splenomegaly & hepatomegaly
How is Hodgkin’s lymphoma diagnosed?
Reed-Sternberg cells on lymph node biopsy
How are stages I & II Hodgkin’s lymphoma treated?
Radiotherapy (short course of chemo if unsuccessful)
How are stages III & IV Hodgkin’s lymphoma treated?
Chemo plus radio if bulky disease
STC for younger patients who fail at chemo
What factors can trigger NHL?
H. Pylori in MALT lymphoma
Hep C in marginal zone lymphoma
Immunosupression
What are the characteristics of high grade NHL?
Large poorly differentiated lymphoid cells
Aggressive clinical course but are often curable
What are the characteristics of low grade NHL?
Smaller better differentiated cells
More indolent clinically but havea tendency to relapse
How does NHL present?
Painless lymphadenopathy in cervical region Extranodal involvement (intestinal, CNS, bone marrow)
What is the prognosis of follicular lymphoma?
Typically disseminated at presentation, initial good response to therapy but increasing relapses
Median survival 6-10 years
What is the commonest type of ‘high grade’ NHL?
Diffuse large B-cell lymphoma
What is the prognosis of diffuse large B-cell lymphoma?
70-80% remission
50% cured
What is the prognosis for mantle cell lymphoma?
Poor (typically disseminated with marrow involvement)
How can MALT lymphoma be treated?
Antibiotics can lead to regression
What is the prognosis for peripheral T-cell lymphomas?
Poor due to high incidence of extra-nodal disease
