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omgmbd > L25: Intro To Leukaemia > Flashcards

L25: Intro To Leukaemia Flashcards

1
Q

Define leukaemia

A

→malignant disorders of haematopoietic stem cells characteristically associated with increase number of white cells in bone marrow or/and peripheral blood.

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2
Q

What are the two features of haematopoietic stem cells?

A

→Multipotent- can give rise to cells of every blood lineage

→Self maintaining- a stem cell can divide to produce more stem cells

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3
Q

What are the three features of progenitor cells?

A

→Can divide to produce many mature cells

→But cannot divide indefinitely

→Eventually differentiate and mature

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4
Q

What is the difference in morphology of undifferentiated and differentiated progenitor cells?

A

→cannot tell the difference between them morphologically because they do not show the characteristics of mature cells.

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5
Q

What is meant by leukaemia being clonal?

A

→all the malignant cells derive from a single mutant stem cell.

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6
Q

What are the first symptoms of all leukaemia?

A

→Abnormal bruising-commonest
→Repeating abnormal infection
→Sometimes anaemia
→Fever

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7
Q

What are the three ways of diagnosing leukaemia?

A

→Peripheral blood blasts test (PB)
→ Bone marrow test/biopsy (BM)
→Lumbar puncture

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8
Q

Why is peripheral blood test used in leukaemia diagnosis?

A

→looks for blasts and cytopenia.

→ if >30% blasts are suspected of acute leukaemia.

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9
Q

Where is bone marrow taken from?

A

→taken from pelvic bone and results compared with PB.

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10
Q

Why is lumbar puncture used in leukaemia diagnosis?

A

→to determine if the leukaemia has spread to the cerebral spinal fluid (CSF)

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11
Q

What techniques are involved in molecular and pathophysiological characterisation of leukaemia testing?

A 
→Cytomorphology
→Immunophenotyping
→Next Generation Sequencing (NGS)
→Flow cytometry
→Fluorescence in situ Hybridation (FISH)
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12
Q

What type of leukaemia are sometimes hereditary?

A

→Chronic Lymphocytic Leukaemia (CLL)

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13
Q

What are some chromosome aberrations which may be genetic risk factors for leukaemia?

A

→Translocations (e.g. BCR-ABL in CML).

→Numerical disorders (e.g. trisomy 21-Down syndrome).

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14
Q

What are some inherited immune system problems that predisposes to leukaemia?

A

→Ataxia-telangiectasia,

→Wiskott-Aldrich syndrome

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15
Q

What are some genetic mutations that predisposes to leukaemia?

A

→TP53- Li-Fraumeni syndrome,

→NF1-Neurofibromatosis

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16
Q

What are some environmental risk factors that predisposes to leukaemia?

A

→Radiation exposure
→Exposure to chemicals and chemotherapy
→Immune system suppression

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17
Q

What are some risk factors linked to childhood leukaemia?

A 
→Exposure to electromagnetic fields
→Foetal exposure to hormones
→Parent’s smoking history
→Infections early in life
→Mother’s age when child is born
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18
Q

What are the classifications of leukaemia?

A 
→Acute Lymphoid Leukaemia (ALL)
→Acute Myeloid Leukaemia (AML)
→Chronic Lymphoid Leukaemia 
(CLL)
→Chronic Myeloid Leukaemia 
(CML)
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19
Q

What is acute leukaemia?

A

→rapid onset and short but severe course

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20
Q

What are characteristics of acute leukaemia?

A

→Undifferentiated leukaemia

→uncontrolled clonal and accumulation of immature white blood cells (-blast)

→High number of blasts in blood

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21
Q

Which cells in the bone marrow are involved in acute leukaemia?

A

→myeloblast

→lymphoblast

22
Q

What are the characteristics of chronic leukaemia?

A

→Differentiated leukaemia

→uncontrolled clonal and accumulation of mature white blood cells (-cyte)

23
Q

Which cells in the bone marrow are involved in chronic leukaemia?

A

→-cytes

24
Q

What is the age of onset for acute and chronic Leukaemia?

A

→ acute= children

→chronic= insidious

25
Q

What is the onset like for acute and chronic leukaemia?

A

→ acute= sudden, weeks to months

→chronic= insidious, years

26
Q

What is the WBC count like in acute and chronic leukaemia?

A 
→acute = Variable- high rates of blasts
→chronic= high
27
Q

What are the two types of acute leukaemia?

A

→Acute Lymphoblastic Leukaemia (ALL)- 75%

→Acute Myeloblastic Leukaemia (AML)-20%

28
Q

What are the typical symptoms of acute leukaemia due to bone marrow suppression?

A 
→Thrombocytopenia: nosebleed
→Neutropenia
→anaemia
→night sweats
→frequent infections
29
Q

Which is the most common childhood cancer?

A

→Acute Lymphoblastic Leukaemia

30
Q

What is the cells classification of ALL?

A

→B-cell & T-cell leukaemia

31
Q

What is the treatment for ALL?

A

→Chemotherapy

32
Q

What is the outcome like for ALL treatment?

A

→5 year event-free survival (EFS) of 87%

→1 out of 10 ALL patients relapse.
→Remission in 50% percent of them after second chemotherapy treatment or bone marrow transplant.

33
Q

Why are adult ALL prognosis poor?

A

→because disease presents different cell of origin and different oncogene mutations.

34
Q

What is the prevalence of AML?

A

→rare in children

35
Q

How is AML classified?

A

→based on FAB system (French-American-British): M0-M7

36
Q

What are the treatments for AML?

A

→Chemotherapy,

→monoclonal antibodies (immunotherapy) +/- allogeneic bone marrow transplant.

37
Q

What is the outcome like for AML?

A

→5 year event-free survival (EFS) of 50-60%.

38
Q

How is AML and ALL differentiated in diagnosis?

A

→use cytomorphological studies

39
Q

What are the symptoms of CLL?

A 
→Recurrent infections due to :
→neutropenia, 
→ anaemia, 
→thrombocytopenia, 
→lymph node enlargement, 
→hepatosplenomegaly.
40
Q

What is the treatment for CLL?

A

→Regular chemotherapy to reduce cell numbers

41
Q

What is the outcome like for CLL?

A

→5-year event-free survival (EFS) of 83%

→ Many patients survive >12 years.

42
Q

What is the peak age for CML?

A

→peak rate = 85-89y/o

43
Q

What are the symptoms of CML?

A

→Often asymptomatic

→discovered through routine blood tests.

44
Q

How is CML diagnosed?

A

→Very high white cells count (neutrophilia) in blood and bone marrow,
→presence of Philadelphia chromosome

45
Q

What is the treatment for CML?

A

→Targeted therapy: Imatinib

→allogeneic bone marrow transplant

46
Q

Why is the BCR-ABL protein an oncogene?

A

→has constitutive (unregulated) protein tyrosine kinase activity
→ABL has a strong promotor and ABL gene encodes a protein tyrosine kinase

47
Q

What does unregulated BCR-ABL tyrosine kinase activity cause?

A

→Proliferation of progenitor cells in the absence of growth factors

→Decreased apoptosis

→Decreased adhesion to bone marrow stroma

48
Q

What might a detection of minimal residual disease mean for treatment?

A

→clue as to the efficacy of treatment

49
Q

How does Imatinib work?

A

→Drugs that specifically inhibit BCR-ABL
→imatinib competes with ATP which binds to BCR-ABL fusion
→ used to detect minimal residual disease

50
Q

What are the differences between targeted therapies and chemotherapy?

A

→Targeted Act on specific molecular targets associated with cancer whereas chemotherapy Act on all rapidly dividing cells (cancerous and normal)

→targeted is cytostatic whereas chemotherapy is cytotoxic

→targeted used oral agents whereas chemotherapy is mainly intravenous with some oral agents

omgmbd (29 decks)

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