Haematological Malignancy Flashcards
What is Acute Lymphoblastic Leukaemia a malignancy of?
The lymphoid precursor cells in the bone marrow. (lymphoblasts)
In which age group is this cancer most common?
Most common childhood cancer, peaks around 2 - 4 years.
Can also affect adults over 45 yrs.
What condition does ALL have an association with?
Downs syndrome
What chromosome is ALL associated with?
The Philadelphia Chromosome - A translocation of chromosome 9 and 22.
30% of adults.
5% of children.
Which cell type is produced in ALL?
Single type of cell
- Usually B-Lymphocyte
What is it called when other cell types in the bone marrow are replaced in ALL?
Pancytopenia
- Excessive proliferation of B-Lymphocytes causes them to replace the other cell types being created in the bone marrow, leading to a pancytopenia.
What are the two most common subtypes of ALL?
- B-cell (80%)
- T-cell
What are the typical symptoms for a patient with ALL?
The symptoms associated with Marrow failure include;
- Fatigue (due to anaemia)
- Abnormal bleeding/bruising (low platelets)
- and infections (Low white cells)
Symptoms from organ infiltration, such as bone pain.
What are some clinical signs of ALL?
- Painless Lymphadenopathy
- Hepatosplenomegaly
- CNS involvement (cranial nerve palsies, meningism) (very common in ALL in contrast to AML)
- Testicular infiltration (Painless unilateral testicular enlargement)
What are some differentials for ALL?
Aplastic anaemia
- Both cause thrombocytopenia
- However in Aplastic anaemia the bone marrow is HYPOcellular.
CLL
- Both Lymphoid malignancies
- Differ in terms of cell maturity and clinical features.
- CLL typically affects older adults.
Non-Hodgkin Lymphoma
- The lymph nodes are the typical sites of involvement rather than the Bone marrow in ALL.
What does an FBC and Blood film show in ALL?
FBC - Leucocytosis.
Blood film - Blast cells.
What type of investigation is done to differentiate the cell of origin in ALL?
Immunophenotyping.
What does Periodic acid-schiff (PAS) stain for in ALL?
Stains for carbohydrate material
How is ALL usually treated?
- Combination chemotherapy.
What is given to all patients with ALL?
CNS prophylactic agents.
What are some potential complications of ALL?
- Infections
- Bleeding
- CNS involvement - ALL can infiltrate the CNS, leading to neurological symptoms. Intrathecal chemotherapy and CNS prophylaxis are employed to prevent and Treat CNS involvement.
- Chemotherapy-related toxicities.
What is the prognosis in children with ALL on chemotherapy alone?
70-90% cure rate.
What cell type is proliferating in Acute Myeloid Leukaemia?
Myeloid Precursor cells (the progenitor for Granulocytes, Monocytes, erythrocytes or platelets.)
How can AML arise and who does it typically affect?
Typically affects older adults (>60).
- Can arise as progression from Myelodysplastic syndromes.
- Can also Arise De-novo.
What are the clinical features of AML?
- Similar to AML causes Bone Marrow Failure.
- Subtypes of AML may have characteristic presentations… (Coagulation defects / DIC in acute promyelocytic leukeamia)
What are some signs and Symptoms of AML?
Signs of tissue infiltration;
- Hepatomegaly
- Splenomegaly
- Gum Hypertrophy
Bone marrow failure;
- Anaemia, Bleeding, Infections.
What are some differential diagnoses in AML?
Myelodysplastic syndromes (MDS)
- share similarities in bone marrow abnormalities and cytopenias.
- MDS typically have mild cytopenias and dysplastic features.
- AML presents with rapid proliferation of blasts in the bone marrow.
Acute Lymphoblastic Leukaemia (ALL)
- AML and ALL both involve Leukaemia,
- Differ in type of blood cell affected.
What do blood tests show in AML?
- Acute proliferation of Blast cells in either peripheral blood or bone marrow.
- AUER RODS (blast cells have rods inside them names AUER Rods)
What would a bone marrow biopsy show in AML?
- Hypercellular marrow
- The presence of blasts (usually >50%)
- Sometimes Auer rods.
