Haematological Malignancy Flashcards
haematological malignancies account for what percent of all human cancers?
10%
do blood cancers occur more often in men or women?
adult males
what is the most common cancer among children aged 0-14?
leukaemia
leukaemia makes up what percent of all childhood cancers?
30%
what is the most common form of leukaemia in children?
acute lymphocytic leukaemia
myeloid malignancies arise from what cells?
RBC Platelets Neutrophils Eosinophils Basophils Monocytes
lymphoid malignancies arise from what cells?
B-cell
T-cell
using a diagram describe leukaemia vs lymphoma
see notes
name the major groups of haematological malignancies
acute leukaemia's chronic leukaemia's malignancy lymphomas multiple myeloma myelodysplastic syndromes (MDS) chronic myeloproliferative disease (biologically malignant)
name acute leukaemia’s
acute lymphoblastic leukaemia (ALL)
acute myeloid leukaemia (AML)
name chronic leukaemia’s
chronic myeloid leukaemia (CML) chronic lymphocytic (CLL)
name the malignancy lymphomas
Non-Hodgkin lymphomas (NHL) Hodgkin lymphoma (HL)
describe the features of acute leukaemia
leukaemic cells do not differentiation
bone marrow failure
rapidly fatal if untreated
potentially curable
describe the features of chronic leukaemia
leukaemic cells retain the ability to differentiate
proliferation without bone marrow failure
survival for a few years
not presently curable without BMT
clinical features of acute leukaemia
bone marrow failure
anaemia
thrombocytopenic bleeding
infection because of neutropenia
what is the most likely cause of infection acute leukaemia?
bacterial and fungal
essential investigations in acute leukaemia
- Blood count and blood film
- Bone marrow aspirate/trephine
- Cytogenetics of leukemic blasts
- Immunophenotyping of leukemic blasts
- CSF examination if symptoms
treatment of AML
- Supportive care
- Anti-leukemic chemotherapy
- Stem cell transplantation – allogenic
- All trans retinoic acid in APL
clinical features of chronic myeloid leukaemia
• Anaemia • Splenomegaly, often massive • Weight loss • Hyperleukocytosis – fundal haemorrhage and venous congestion, altered consciousness, respiratory failure Gout
laboratory features of CML
- High WCC (can be very high)
- High platelet count
- Anaemia
- Blood film shows all stages of white cell differentiation with increased basophils
- Bone marrow is hypercellular
- Bone marrow and blood cells contain the Philadelphia chromosome t(9,22)
treatment of CML
• Tyrosine Kinase Inhibitors
o Imatinib (Gilvec), Dasatinib (Sprycel), Nilotinib (Tasigna), Busitinib, Ponatinib
• Direct inhibitors of BCR-ABL is first line
• Allogenic transplantation – only in TKI failures
what are myelodysplastic syndromes?
acquired clonal disorders of the bone marrow
who gets myelodysplastic syndromes?
often old age
what do myelodysplastic syndromes present as?
macrocytic anaemia
pancytopenia
wht are myelodysplastic syndromes fatal?
result of progression to bone marrow failure of AML
treatment of myelodysplastic syndromes
supportive or stem cell transplantation for the few young patients
give 3 examples of myeloproliferative diseases
- Polycythaemia vera
- Essential thrombocythemia
- Idiopathic myelofibrosis
where are B cells found in lymph nodes?
follicles
where are T cells found in lymph nodes?
paracortex
where are plasma cells found in lymph nodes?
medulla
where in the lymph node do cells undergo expansion and selection?
germinal centre
where in the lymph node are naive cells found?
mantle zone
presentation of the lymphomas
• Nodal disease – lymphadenopathy
o >90% HL
o ~60% present purely with nodal disease
• Extranodal disease
o ~40% NHL present with an extranodal component
• Systemic symptoms
o Fever, drenching sweats, loss of weight, pruritis, fatigue
causes of lymphadenopathy: localised and painful
bacterial infection in drainng site
causes of lymphadenopathy: localised and painless
rare infections, catch scratch fever, TB
metastatic carcinoma from draining site - hard
lymphoma - rubbery
reactive, no cause identified
causes of lymphadenopathy: generalised and painful/tender
viral infections: EBV, CMV, hepatitis, HIV
causes of lymphadenopathy: generalised and painless
lymphoma leukaemia connective tissue diseases, sarcoidosis reactive, no cause identified drugs
