Leukaemia Flashcards
What are 4 types of leukaemia?
- Acute lymphocytic leukaemia (ALL)
- Chronic lymphocytic leukaemia (CLL)
- Acute Myelogenous leukaemia (AML)
- Chronic myelogenous leukaemia (CML)
What is ALL?
rapid proliferation of lymphoblasts, severe and rapid increase of lymphoblasts
What age group get ALL?
75% in under 6 Child (2-5 years)
What are RF for ALL?
- Less than 5 years
- Late 30s
- Mid-80s
- Hx malignancy
- Chemo/past radiation
- Smoking
Influenza - Genetic disorders e.g trisomy 21
- FHx ALL
What are bone marrow failure symptoms of ALL?
- Pallor
- Ecchymoses or petechiae (due tp thrombocytopenia
- Fatigue
- Fever
- Bruising
- Infection
What are the signs of infiltration in ALL?
- Hepatosplenomegaly
- Lympahdenopathy
- Bone pain
- Testicular swelling
What are some differential diagnosis of ALL?
- Acute myeloid leukaemias (AML)
- Reactive lymphocytosis (‘leukaemoid reaction’)
- Small-cell lung cancer
- Merkel cell tumour
- Rhabdomyosarcoma
- Aplastic anaemia
- Immune thrombocytopaenia (ITP)
What investigations would you carry out for ALL?
- FBC with differential
- Blood film
- Serum electrolytes
- Bone marrow
What might you see in fbc with differential for ALL?
- Hb decreased
- Platelets decreased
- Neutrophils decreased
- WCCs increased (blasts)
What do you see in blood film and bone marrow of ALL?
- blast lymphoid cells
- >20% lymphoblasts on bone marrow biopsy
What is the management plan of acute ALL?
-1st line: induction therapy
-Plus:
-CNS prophylaxis
-Supportive care
Ph(+) disease: TKI
CD20+ disease: rituximab
What is the ongoing treatment for ALL?
1st line: consolidation therapy Adjunct: maintenance therapy or STC Plus: -CNS prophylaxis -Supportive care
What are possible complications of ALL?
- Pancytopenia
- Febrile neutropenia
- Tumour Lysis syndrome
- Leukostsis
What is the prognosis of ALL?
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
What age group is affected by CLL?
elderly
How do people with CLL present?
50% asymptomatic: presents with absolute lymphocytosis as an incidental finding on routine FBC or with asymptomatic lymphadenopathy
What are risk factors for CLL?
- 60 years
- male sex
- white ethnicity
- FHx
What are symptoms and signs for CLL?
Non-tender lymphadenopathy As progresses BM failure symptioms 1. SOB + fatigue 2. Lymphadenopathy 3. Splenomegaly
What is a differential diagnosis of CLL?
Leukemic phase of lymphoma
What investigations would you do for CLL?
- WBC count with differential
- Blood film
- Haemoglobin
- platelet count
- flow cytometry
What would wbc count with differential show with CLL?
elevated with absolute lymphocytsosis (mature cells)
What would blood film for CLL show?
- smudge/smear cells present
2. spherocytes and polychromasia can be seen if there is active haemolysis
What would haemoglobin show in CLL?
low aneamia poor prognostic
What would platelet count show in CLL?
low eventually
What is the acute management plan of CLL asymptomatic early stage?
obervation
What is the acute management plan of CLL asymptomatic advanced stage?
1st line: chemoimmunotherapy or ibrutinib
With del(17p)/TP53 mutation
1st line: ibrutinib or idelalisibb or venetoclax
Adjunct: allogenic STC
What is the management plan of ongoing CLL with late relapse?
1st line: repeat first-line chemoimmunotherapy + ibrutinib or idelalisib or ventoclax or clinical trial
Allogenic stem cell transplant
What is the management plan of ongoing CLL with early relapse?
- ibrutinib or idelalisib or ventoclax or clinical trial
2. Allogenic stem cell transplant
What are possible complication of CLL?
- Autoimmune haemolytic anaemia
- Chemotherapy-induced neutropenic fever
- Chemotherapy-induced tumour lysis syndrome
- Second malingnances
What staging is seen in CLL?
- Rai Staging system
- Binet staging system
What is prognosis of CLL?
- 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
What is AML?
rapid proliferation of myeloblasts (immature) so stops future production down line of neutrophils etc
What age get AML/RF?
- Older adults (55% over 70)
- Downs syndrome
- Irradiation
- Anti-cancer drugs
What are symptoms of bone marrow failure and tissue infiltration in AML?
-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
What are possible differential diagnosis of AML?
- Acute lymphocytic leukaemia
- Biphenotypic leukaemia
- Myelodysplastic syndrome
- Vit B12 def
What bloods do you do for AML?
- FBC with differential
- Blood smear
- Coagulation panel
- Serum electrolytes
- Renal function
- LFTs
- Serum lactic dehydrogenase
What would the fbc with differential show for AML?
- anaemia
- macrocytosis
- leukocytosis
- neurtropenia
- thrombocytopenia
What would peripheral blood smear show for AML?
blasts with presence of auer rod
What is the management plan for AML?
1st line: induction chemotherapy
Adjunct: intrathecal cytarabine + stem cell transplant
2nd line: low dose subcutaneous cytarabine
3rd line: supportive care
What are possible complications of AML?
- Tumour lysis syndrome
- Leukostasis
- Neutropenia
- Pancytopenia
- DIC
What is prognosis of AML?
5-year survival of patients with AML is approximately 25%
What is CML?
- less severe
- Relatively mature rbbc
- Hyperproliferation of granulocyte precursors
- features of bone marrow failure
- hypermetabolism and hype viscosity
- Cause accumulation of mature rbc
What age is affected for CML?
65-74yo
40-60yo?
What are RF for CML?
- Male
- Age
- Exposure to ionsing radiation
- Philidelphia chromosome: t(9;22)
BCR-ABL1 fusion gene
What are major symptoms and signs of CML?
massive splenomegaly (90%) but 50% asymptomatic and FLAWS
What confirms the diagnosis of CML?
Presence of Philadelphia chromosome and /or molecular demonstration of the BCR-ABL transcript confirms diagnosis
What investigations do you do for CML?
- FBC
- Metabolic profile
- Peripheral blood smear
- Bone marrow biopsy
- Cytogenic
- FISH
- qRT-PCR
- Blood film
What does FBC for CML show?
- elevated WBC count
- anaemia
- normal platelet count
- thrombocytosis (chronic or accelerated phases)
- thrombocytopenia (accelerated or blast crisis)
What is complete metabolic profile for CML show?
elevated K+, uric acid, LDH
What does blood smear show for CML?
- mature or maturing myeloid cells
- elevated basophils and eosinophils
- left shift
What would bone marrow biopsy for CML show?
granulocytic hyperplasia
What do special tests for CML show?
- FISH: t(9,22) positive
- qRT-PCR : detection of BCR-ABL fusion
What is the acute management of chronic phase+accelerated phase CML?
1st line (initial pres): TKI 1st line: allogenic HSCT plus high-dose induction chemotherapy
What is the acute management of bblast phase CML?
1st line: TKI + high dose induction chemotherapy followed by allogeneic HSCT
What are possible complications of CML?
- Pancytopenia
- TKI-related muscle cramps
- Dasantinib-related pleural effusion
- TKI related QT prolongation
What is prognosis of CML?
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%
What are the hypermetabolic symptoms of CML?
- Malaise
- Weight loss
- Sweating
What are the bone marrow failure symptoms of CML?
- Pallor
- Bleeding
- Infections
What are the hyper viscosity symptoms of CML?
- Thrombotic events
2. Headaches
What is CLL?
- less severe
- relatively mature
- progressive accumulation of functionally incompetent lymphocytes
- least worrying of 4
What is CLL caused by?
failure of apoptosis
