Haematology 1 - Acute leukaemia Flashcards
What is the median age of presentation of AML?
65-70
Recall some genetic associations of AML
t(8:21)- good prognosis M2 AML t(15;17) - good prognosis M3 AML (APML) inv(16) - good prognosis M4 AML (myelomonocytic) Trisomy 21 5q deletion- bad prognosis 7q deletion
Which type of leukaemia is most likely to cause haemorrhage?
Acute Promyelocytic leukaemia (APML)
Which type of leukaemia is most likely to cause DIC?
APML
What is the key triad of clinical features of AML?
Anaemia
Thrombocytopaenia
Neutropaenia
Recall some clinical signs that can be used to identify AML
Hepatosplenomegaly
Monocytic gum infiltration (M5 AML)
CNS disease (More in ALL)
Occasional lymphadenopathy
How can myeloid lineage be proved on blood film?
Presence of auer rods
What is the most effective investigation for differentiating AML and ALL, and what results would it show for each?
Immunophenotyping:
AML: CD13/1/15
ALL: CD3/4/18/19/20
Recall some useful supportive therapies for AML
Blood products: red cells, platelets and FFP
Antibiotics
Long line
Allopurinol (as uric acid may be released from dying cells when treatment is started)
Which type of leukaemia is most likely to present with long bone pain?
ALL
Recall some sights of leukaemic involvement in ALL that you wouldnt see in AML
Thymus, testes, CNS
Which ALL patients are appropriate for imatinib treatment?
Philadelphia chromosome positive
Treatment for APML
ATRA (retinoic acid)
Often do not need chemo
AML Chemotherapy
Remission: Daunorubicin, cytarabine (damage dna-prevent synthesis)
Consolidation: cytarabine
Targeted treatments: ATRA for acute promyelocytic leukaemia (often don’t need conventional chemo) Midostaurin – FLT3 mutations Gemtuzumab – CD33 immunotherapy Enasidenib– IDH mutations
Acute promelocytic leukaemia treated with All-trans-retinoic acid (ATRA)
Type 1 mutation: FLT3-ITD
Type 2 mutation: PML-RARa- t(15;17) fusion gene
