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Z Year3 Haem Conditions > Leukaemia > Flashcards

Leukaemia Flashcards

1
Q

What are 4 types of leukaemia?

A
  1. Acute lymphocytic leukaemia (ALL)
  2. Chronic lymphocytic leukaemia (CLL)
  3. Acute Myelogenous leukaemia (AML)
  4. Chronic myelogenous leukaemia (CML)
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2
Q

What is ALL?

A

rapid proliferation of lymphoblasts, severe and rapid increase of lymphoblasts

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3
Q

What age group get ALL?

A

75% in under 6 Child (2-5 years)

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4
Q

What are RF for ALL?

A
  1. Less than 5 years
  2. Late 30s
  3. Mid-80s
  4. Hx malignancy
  5. Chemo/past radiation
  6. Smoking
    Influenza
  7. Genetic disorders e.g trisomy 21
  8. FHx ALL
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5
Q

What are bone marrow failure symptoms of ALL?

A
  1. Pallor
  2. Ecchymoses or petechiae (due tp thrombocytopenia
  3. Fatigue
  4. Fever
  5. Bruising
  6. Infection
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6
Q

What are the signs of infiltration in ALL?

A
  1. Hepatosplenomegaly
  2. Lympahdenopathy
  3. Bone pain
  4. Testicular swelling
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7
Q

What are some differential diagnosis of ALL?

A
  1. Acute myeloid leukaemias (AML)
  2. Reactive lymphocytosis (‘leukaemoid reaction’)
  3. Small-cell lung cancer
  4. Merkel cell tumour
  5. Rhabdomyosarcoma
  6. Aplastic anaemia
  7. Immune thrombocytopaenia (ITP)
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8
Q

What investigations would you carry out for ALL?

A
  1. FBC with differential
  2. Blood film
  3. Serum electrolytes
  4. Bone marrow
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9
Q

What might you see in fbc with differential for ALL?

A
  1. Hb decreased
  2. Platelets decreased
  3. Neutrophils decreased
  4. WCCs increased (blasts)
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10
Q

What do you see in blood film and bone marrow of ALL?

A
  • blast lymphoid cells

- >20% lymphoblasts on bone marrow biopsy

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11
Q

What is the management plan of acute ALL?

A

-1st line: induction therapy
-Plus:
-CNS prophylaxis
-Supportive care
Ph(+) disease: TKI
CD20+ disease: rituximab

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12
Q

What is the ongoing treatment for ALL?

A 
1st line: consolidation therapy 
Adjunct: maintenance therapy or STC 
Plus:
-CNS prophylaxis
-Supportive care
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13
Q

What are possible complications of ALL?

A
  1. Pancytopenia
  2. Febrile neutropenia
  3. Tumour Lysis syndrome
  4. Leukostsis
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14
Q

What is the prognosis of ALL?

A

overall survival at 5 years: >50% for patients aged 15-54 years; <30% for patients 55-64 years; <20% for patients older than 65 years

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15
Q

What age group is affected by CLL?

A

elderly

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16
Q

How do people with CLL present?

A

50% asymptomatic: presents with absolute lymphocytosis as an incidental finding on routine FBC or with asymptomatic lymphadenopathy

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17
Q

What are risk factors for CLL?

A
  1. 60 years
  2. male sex
  3. white ethnicity
  4. FHx
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18
Q

What are symptoms and signs for CLL?

A 
Non-tender lymphadenopathy 
As progresses BM failure symptioms
1.	SOB + fatigue
2.	Lymphadenopathy 
3.	Splenomegaly
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19
Q

What is a differential diagnosis of CLL?

A

Leukemic phase of lymphoma

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20
Q

What investigations would you do for CLL?

A
  1. WBC count with differential
  2. Blood film
  3. Haemoglobin
  4. platelet count
  5. flow cytometry
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21
Q

What would wbc count with differential show with CLL?

A

elevated with absolute lymphocytsosis (mature cells)

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22
Q

What would blood film for CLL show?

A
  1. smudge/smear cells present

2. spherocytes and polychromasia can be seen if there is active haemolysis

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23
Q

What would haemoglobin show in CLL?

A

low aneamia poor prognostic

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24
Q

What would platelet count show in CLL?

A

low eventually

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25
Q

What is the acute management plan of CLL asymptomatic early stage?

A

obervation

26
Q

What is the acute management plan of CLL asymptomatic advanced stage?

A

1st line: chemoimmunotherapy or ibrutinib
With del(17p)/TP53 mutation
1st line: ibrutinib or idelalisibb or venetoclax
Adjunct: allogenic STC

27
Q

What is the management plan of ongoing CLL with late relapse?

A

1st line: repeat first-line chemoimmunotherapy + ibrutinib or idelalisib or ventoclax or clinical trial
Allogenic stem cell transplant

28
Q

What is the management plan of ongoing CLL with early relapse?

A
  1. ibrutinib or idelalisib or ventoclax or clinical trial

2. Allogenic stem cell transplant

29
Q

What are possible complication of CLL?

A
  1. Autoimmune haemolytic anaemia
  2. Chemotherapy-induced neutropenic fever
  3. Chemotherapy-induced tumour lysis syndrome
  4. Second malingnances
30
Q

What staging is seen in CLL?

A
  • Rai Staging system

- Binet staging system

31
Q

What is prognosis of CLL?

A
  • Complete remission rates of 25% to 50% can be achieved with first-line treatment
  • relpase rates are high, with a majority of patients needing further treatment after 2 to 3 years
32
Q

What is AML?

A

rapid proliferation of myeloblasts (immature) so stops future production down line of neutrophils etc

33
Q

What age get AML/RF?

A
  1. Older adults (55% over 70)
  2. Downs syndrome
  3. Irradiation
  4. Anti-cancer drugs
34
Q

What are symptoms of bone marrow failure and tissue infiltration in AML?

A

-Bone marrow failure:
1. Pallor (due to anaemia)
2. Ecchymoses or petechiae (due to thrombocytopenia)
3. Fatigue
4. Infections (due to neutropenia)
Tissue infiltration:
1. Swollen gums
2. Mild splenomegaly

35
Q

What are possible differential diagnosis of AML?

A
  1. Acute lymphocytic leukaemia
  2. Biphenotypic leukaemia
  3. Myelodysplastic syndrome
  4. Vit B12 def
36
Q

What bloods do you do for AML?

A
  1. FBC with differential
  2. Blood smear
  3. Coagulation panel
  4. Serum electrolytes
  5. Renal function
  6. LFTs
  7. Serum lactic dehydrogenase
37
Q

What would the fbc with differential show for AML?

A
  1. anaemia
  2. macrocytosis
  3. leukocytosis
  4. neurtropenia
  5. thrombocytopenia
38
Q

What would peripheral blood smear show for AML?

A

blasts with presence of auer rod

39
Q

What is the management plan for AML?

A

1st line: induction chemotherapy
Adjunct: intrathecal cytarabine + stem cell transplant
2nd line: low dose subcutaneous cytarabine
3rd line: supportive care

40
Q

What are possible complications of AML?

A
  1. Tumour lysis syndrome
  2. Leukostasis
  3. Neutropenia
  4. Pancytopenia
  5. DIC
41
Q

What is prognosis of AML?

A

5-year survival of patients with AML is approximately 25%

42
Q

What is CML?

A
  1. less severe
  2. Relatively mature rbbc
  3. Hyperproliferation of granulocyte precursors
  4. features of bone marrow failure
  5. hypermetabolism and hype viscosity
  6. Cause accumulation of mature rbc
43
Q

What age is affected for CML?

A

65-74yo

40-60yo?

44
Q

What are RF for CML?

A
  1. Male
  2. Age
  3. Exposure to ionsing radiation
  4. Philidelphia chromosome: t(9;22)
    BCR-ABL1 fusion gene
45
Q

What are major symptoms and signs of CML?

A

massive splenomegaly (90%) but 50% asymptomatic and FLAWS

46
Q

What confirms the diagnosis of CML?

A

Presence of Philadelphia chromosome and /or molecular demonstration of the BCR-ABL transcript confirms diagnosis

47
Q

What investigations do you do for CML?

A
  1. FBC
  2. Metabolic profile
  3. Peripheral blood smear
  4. Bone marrow biopsy
  5. Cytogenic
  6. FISH
  7. qRT-PCR
  8. Blood film
48
Q

What does FBC for CML show?

A
  1. elevated WBC count
  2. anaemia
  3. normal platelet count
  4. thrombocytosis (chronic or accelerated phases)
  5. thrombocytopenia (accelerated or blast crisis)
49
Q

What is complete metabolic profile for CML show?

A

elevated K+, uric acid, LDH

50
Q

What does blood smear show for CML?

A
  1. mature or maturing myeloid cells
  2. elevated basophils and eosinophils
  3. left shift
51
Q

What would bone marrow biopsy for CML show?

A

granulocytic hyperplasia

52
Q

What do special tests for CML show?

A
  • FISH: t(9,22) positive

- qRT-PCR : detection of BCR-ABL fusion

53
Q

What is the acute management of chronic phase+accelerated phase CML?

A 
1st line (initial pres): TKI 
1st line: allogenic HSCT plus high-dose induction chemotherapy
54
Q

What is the acute management of bblast phase CML?

A

1st line: TKI + high dose induction chemotherapy followed by allogeneic HSCT

55
Q

What are possible complications of CML?

A
  1. Pancytopenia
  2. TKI-related muscle cramps
  3. Dasantinib-related pleural effusion
  4. TKI related QT prolongation
56
Q

What is prognosis of CML?

A

Chronic: Patients on imatinib who achieve a major molecular response (MMR) by 18 months experience durable responses to therapy with event-free survival at 7 years of approximately 95%

57
Q

What are the hypermetabolic symptoms of CML?

A
  1. Malaise
  2. Weight loss
  3. Sweating
58
Q

What are the bone marrow failure symptoms of CML?

A
  1. Pallor
  2. Bleeding
  3. Infections
59
Q

What are the hyper viscosity symptoms of CML?

A
  1. Thrombotic events

2. Headaches

60
Q

What is CLL?

A
  • less severe
  • relatively mature
  • progressive accumulation of functionally incompetent lymphocytes
  • least worrying of 4
61
Q

What is CLL caused by?

A

failure of apoptosis

Z Year3 Haem Conditions (18 decks)

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