Introduction To Leukaemia Flashcards
What is leukaemia?
Malignant disorders of haematopoetic stem cells characteristically associated with an increase number of white cells in bone marrow or land peripheral blood
What are haematopoeitic stem cells?
Multipotent and self-maintaining
What can progenitor cells divide to produce?
Many mature cells
What are examples of progenitor cells?
Lymphoid/myeloid
What are the two types of progenitor cells?
Undifferentiated and committed
What is a clonal disease?
When all malignant cells derive from a single mutant cell
What can you use to diagnose leukaemia?
Peripheral blood blast test
Bone marrow biopsy
Lumbar puncture
What does a peripheral blood blast test in the diagnosis of leukaemia?
To check the presence of blasts and cytopenia
Where is the bone marrow biopsy taken from?
Pelvic bone and results compared with peripheral blood
Why is a lumbar puncture done?
To determine if leukaemia has spread to the CSF
What are the possible predisposing factors for leukaemia?
Genetic risk factors
Environmental risk factors
Lifestyle-related risk factors
What syndromes increase the likelihood of leukaemia?
Downs and fanconi’s anaemia
What are the genetic risk factors for leukaemia?
Gene mutations involving oncogenes and/or tumour suppressors
Chromosome aberrations
Inherited immune system problems
What types of chromosomal abberations increase the risk for leukaemia?
Translocations
Numerical disorders
What are the environmental risk factors for leukaemia?
Radiation exposure
Exposure to chemicals and chemo
Immune system suppression
What type of radiation exposure is a risk factor for leukaemia?
Acute radiation accidents
Atomic bomb survivors
What type of exposure to chemicals and chemo is a risk factor for leukaemia?
Cancer chemo with alkylating agents
Industrial exposure to benzene
What lifestyle risk factors are there for leukaemia?
Smoking
Drinking
Excessive sun exposure
Overweight
What are the risk factors for childhood leukaemia?
Exposure to EM fields Infections early in life Mothers age when the child is born Nuclear power stations Parents smoking history Foetal exposure to hormone
What are the four main types of leukaemia?
Acute lymphoblastic leukaemia (ALL)
Acute myeloblastic leukaemia (AML)
Chronic lymphocytic leukaemia (CLL)
Chronic granulocytic leukaemia (CML)
What are the features of acute disease (in general)?
Rapid onset and short but severe course
What are the features of chronic disease (in general)?
Persisting over a long time
What are the features of acute leukaemia?
Undifferentiated cells decharacterised by uncontrolled cloning and accumulation of blast cells
What are the characteristics of chronic leukaemia?
Differentiated leukaemia
Uncontrolled cloning and accumulation of mature white blood cells (-cyte cells)
What is the normal age of onset of acute leukaemia?
Childhood
What is the normal style of onset of acute leukaemia?
Sudden
What is the normal duration of acute leukaemia?
Weeks to months
What is the normal white blood cell count in acute leukaemia?
Variable
What is the normal age of onset of chronic leukaemia?
Middle age and elderly
What is the normal style of onset of chronic leukaemia?
Insidious
What is the normal duration of chronic leukaemia?
Years
What is the normal white blood cell count in chronic leukaemia?
High
What is ALL characterised by?
Large number of lymphoblasts
What is AML characterised by?
Large number of myeloblasts
What is the overarching issue in acute leukaemia?
Arrest of maturation that breaks the balance of proliferation and death
What are the typical lab symptoms of ALL/AML?
Thrombocytopenia
Neutropenia
Anaemia
What are the clinical symptoms of thrombocytopenia?
Purpura (bruising)
Epistaxis (nosebleed)
Bleeding from gums
What are the clinical features of neutropenia?
Recurrent infections and fever
What are the clinical symptoms of anaemia?
Weakness
Tiredness
Shortness of breath
What are the skin symptoms of leukaemia?
Night sweats
Easy bleeding and bruising
Purplish patches or spots
What are the bone symptoms of leukaemia?
Pain or tenderness
What are the resp symptoms of leukaemia?
Easy shortness of breath
What are the systemic symptoms of leukaemia?
Weight loss
Fever
Frequent infections
What is the most common childhood cancer?
ALL
How do you treat ALL?
Chemo
How is AML classified?
M0-M7
How do you treat AML?
Chemo, immunotherapy
With/without allogenic bone marrow transplant
What is chronic leukaemia characterised by?
Increased number of differentiated cells
What is the average age of CLL onset?
70
What is CLL characterised by?
Large number of mature lymphocytes in bone marrow and peripheral blood
What are the symptoms of CLL?
Recurrent infections Anaemia Thrombocytopenia Lymph node enlargement Hepatosplenomegaly
What is the treatment of CLL?
Regular chemo to reduce cell numbers
What is the average age of CML onset?
85-89
How is CML usually discovered?
Routine blood tests
What are the hallmarks of CML in the blood?
Neutrophilia in blood and bone marrow and the presence of the philadelphia chromosome
What is CML treated by?
Imatinib
What does the BCR gene encode?
A protein that needs to be continually active
What does the ABL gene encode?
tyrosine kinase
What does unregulated BCR-ABL cause?
Proliferation of progenitor cells in the absence of growth factors
Decreased apoptosis
Decreased adhesion to bone marrow
What is imatinib?
A small molecular inhibitor that targets specifically ABL-CML treatment
