Lecture 9 - Blood cancers

Question 1

What is Leukaemia?

What happens when it is acute vs chronic?

Answer 1

• proliferation of immature bone marrow cells
• expand and replace normal bone marrow cells
• then the abnromal leuakemic cells spill over into bloood

Acute - cancer
Chronic - asymptomatic and maintain normal activities

Question 2

What are 4 main causes of leukaemia

What is commonly associated with chronic myeloid leukaemia?

What is a drug that can help chronic myeloid leukaemia and how does it work?

Answer 2

congenital / inherited risk factors - e.g down sydrome have an increased incidence
viral infections
radiation
chemical/dna damaging drugs

e.g found philadelhia chromosome found in chronic myeloid leukaemia

imantinib - competes with cancer cell ATP binding site and blocks phosphorylation so cells die by apoptosis
-can survive for longer - proven

Question 3

Acute leukaemia
-ALL vs AML - which age groups generally get this

What are the signs and symptoms? (hint - very clearly linked to bone marrow failure)

Answer 3

ALL - mainly childhood
AML - mainly adulthood

Anaemia - fatigue, dyspnoea , chest pain
Neutropenia - infection, wounds slow to heal as less good white blood cells
Thrombocytopenia - bruising and bleeding
Bone marrow pain
Enlarger liver, spleen, lymph nodes
Gums

-signs and symptoms due to bone marrow failure

Question 4

definition pancytopenia

Answer 4

low red cells, white cells, and platelets

Question 5

How would you diagnose leukaemia? what would you see on a bone marrow biopsy

Answer 5

• bone marrow biopsy
• aspirate
• trephine

can see morphology of bone marrow - if more than 20% blasts myeloid or lymphoid

also do immunophenotyle, chormosomes, molecular studies

Question 6

general/ supportive care for acute leukaemia

Answer 6

General/ supportive care
-intensive transfusion support - red cells, platelets

management of infection
-ID and lab support, antibiotic therapy

Question 7

Other treatment

Chemotherapy

Stem cell transplantation

Answer 7

induction therapy - to induce remisison
consolidation - to mop up residual leukaemia cells
Maintenance therpay - to keep patients in remissom

can take autologous stem cells (patients own stem cells taken in remission) or can take allogenic stem cels - matched sibling or unrelated donor

Question 8

Leukaemias
Myeloproliferative neoplasms
Lymphoma
Myeloma 
Acute myeloid leukaemia
Acute lymphoblastic leukaemia

Answer 8

Leukaemias - bone marrow cancer (immature blood cells result in blood)

Myeloproliferative neoplasms - a blood cancer where to many red or white blood cells are made

polycythaemia - genetic condition where too many red blood cells are made

Lymphomas - cancers that develop in lymph system

Myeloma - cancer of plasma cells

Acute myeloid leukaemia - blood cancer that affects immature blood cells of myeloid linneage

Acute lymphoblastic leukaemia - blood cancer that affects immature blood cells of lymphocyte lineage