Lecture 9: Haematological Malignancies (Parts 1-4)

Question 1

Compare AML and ALL:

Answer 1

AML:
Myeloid lineage (CD13+, CD33+)
Auer rods on blood film
Peak in adults
t(15;17) PML-RARA (APL)

ALL:
Lymphoid lineage (CD10+, CD19+)
Agranular blasts with high N:C ratio
Peak in children (3-7 years)
t(12;21) TEL-AML1 (good prognosis)

Question 2

Key FBC findings in AML?

Answer 2

↓Hb, ↓platelets, ↑WBC (blasts), neutropenia.

Question 3

What is the first-line treatment for ALL?

Answer 3

Induction chemotherapy (vincristine, dexamethasone, asparaginase) + CNS prophylaxis.

Question 4

What defines CML?

Answer 4

Philadelphia chromosome t(9;22) → BCR-ABL1 fusion → constitutive tyrosine kinase activity.

Blood film: Myeloid precursors (metamyelocytes, basophilia).

Treatment: Tyrosine kinase inhibitors (imatinib).

Question 5

How is CLL diagnosed?

Answer 5

Lymphocytosis (>5×10⁹/L), smudge cells on film, CD5+/CD19+/CD23+ on flow cytometry.

Binet staging: Determines prognosis (Stage A: >13 years survival).

Question 6

Which translocation is diagnostic for CML?

Answer 6

t(9;22)(q34;q11) → BCR-ABL1.

Question 7

What immunophenotypic markers distinguish B-ALL from T-ALL?

Answer 7

B-ALL: CD10, CD19, TdT.

T-ALL: CD3, CD7, TdT.

Question 8

What is the significance of Auer rods?

Answer 8

Pathognomonic for AML (seen in myeloblasts).

Question 9

Classic symptoms of CLL?

Answer 9

Fatigue, lymphadenopathy, recurrent infections, hepatosplenomegaly.

Question 10

How is APL (AML-M3) treated?

Answer 10

ATRA (All-Trans Retinoic Acid) + arsenic trioxide (targets PML-RARA fusion).

Question 11

Why is imatinib used in CML?

Answer 11

Inhibits BCR-ABL1 tyrosine kinase → halts proliferation.