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Clinical Biomedicine > Leukaemia > Flashcards

Leukaemia Flashcards

1
Q

Leukaemia

A
  • The generalised term for WBC cancers

- Most common childhood cancer but affects 3 times as many adults

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2
Q

The leukaemias you need to remember

A

1) Acute Myeloid Leukaemia (AML)
2) Acute Lymphoblastic Leukaemia (ALL)
3) Chronic Myeloid Leukaemia (CML)
4) Chronic Lymphoid Leukaemia (CLL)

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3
Q

Lymphoma

A
  • Cancer of lymphoid tissues
  • Results in swollen lymphoid tissue
  • 40% are Hodgkin lymphoma = Just lymphocytes
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4
Q

Incidence vs Prevalence

A
  • Incidence = Rate of new cases in a given time period, or the number/% of the population at risk of developing the condition
  • Prevalence = Number of people with the condition
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5
Q

Causes of leukaemia

A
  • Usually idiopathic
  • Previous chemotherapy with alkylating agents, increases risk
  • Radiation exposure
  • Benzene/Formaldehyde exposure
  • Genetic conditions ie Down’s Syndrome
  • Myelodysplasia (Pre-leukaemia)
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6
Q

Myeloproliferative neoplasms

A
  • The excess production of myeloid cells, with 4 main types:
    + CML = Excessive granulocytes
    + Excessive thrombocytosis
    + Polycythaemia vera = Excess RBC
    + Primary myelofibrosis = Replacement of bone marrow with collagenous connective tissue
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7
Q

Acute leukaemia characteristics

A

Little/no maturation in defected cells, >20% blast cells in blood/bone marrow at clinical presentations

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8
Q

Chronic leukaemia characteristics

A

Many maturing/mature WBCs

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9
Q

AML

A
  • Uncontrolled proliferation of myeloid stem cell resulting in large numbers in immature WBCs, particularly granulocytes + monocytes
  • Affects all ages, increasing in risk with age
  • In blood we can see elevated blast cells (>2-%) + promyelocytes
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10
Q

AML signs + symptoms

A
  • Acute, often critically ill
  • Malaise, fever + sweats
  • Anaemia symptoms
  • Neutropenia = More infections, bacterial in particular
  • Thrombocytopenia = Bleeding more if injured
  • Overproduction of myeloid blast cells results in overcrowding in bone marrow
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11
Q

ALL

A
  • Uncontrolled proliferation of lymphoid stem cell resulting in large numbers of abnormal lymphoblasts in the bone marrow
  • Cause of 80% of childhood leukaemias
  • 85% B cell incidence, remaining 15% are T cell incidences
  • In blood we see more lymphoblasts (>20%) = prolymphocytes
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12
Q

ALL signs + symptoms

A
  • Abruptly starts
  • Bone + joint pain
  • Symptoms of bone marrow failure
  • Generalised lymphadenopathy - Enlarged lymph nodes due to lymphocytes to lymph nodes to filter lymph
  • Hepatosplenomegaly
  • Testicular + CNS manifestations as “sanctuary site”
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13
Q

CML

A
  • Uncontrolled proliferation of myeloid stem cell resulting in large numbers of circulating leukocytes, particularly neutrophils
  • Peak onset at 65-85 years
  • More common in males than females
  • Caused by ABL gene translocation from chr9 to fuse with breakpoint cluster region gene on chr22
  • In blood we see more differentiated cells of neutrophils + myelocytes
  • Consistently associated with presence of a Philadelphia chromosome
  • Can be either MPO positive or MPO negative
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14
Q

CML signs + symptoms

A
  • Fatigue
  • Weight loss
  • Sweaty
  • Splenomegaly + sensation of fullness
  • Hepatomegaly
  • Gout, bruising
  • Leukostasis - Clumping of leukocytes is often seen
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15
Q

CLL

A
  • Uncontrolled proliferation of B lymphocytes
  • Disease of the elderly <50+ years, peak 90+
  • More common in males than females
  • Almost all cases are B cells
  • Considerable overlap with lymphomas
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16
Q

CLL signs + symptoms

A
  • Often asymptomatic, many patients survive long periods with minimal symptoms, with elderly patients more likely to die from other causes
  • Symmetrical + painless enlargement of lymph nodes is most common clinical sign
  • May have symptoms of anaemia
  • Immunosuppression resulting in bacterial infections in early stages + viral/fungal infections later
  • Weight loss
17
Q

Hodgkin’s Lymphoma

A
  • Malignant B cells that accumulate in lymph nodes, they however only a minority of the tumour, but majority comprising inflammatory cells
  • More common in men than females
  • Peaks at 2 ages = 15-35 years, + <50 years old
18
Q

Hodgkin’s lymphoma sign + symptoms

A
  • Asymmetrical + painless lymphadenopathy, usually in cervical region, disease spreads via lymphatic chain
  • Splenomegaly
  • Fever, night sweats, weight loss, itching + fatigue in the minority
  • Leukopeptidase + bradykinin appear to be the pruritogenic mediators released as an autoimmune response is mounted against malignant lymphoid cells
19
Q

Non-Hodgkin’s Lymphoma

A
  • Large group of lymphoid tumours with more variable presentation + history than Hodgkin’s lymphoma
  • 11th most common in UK
  • Highest incidence of all haematological cancers
  • Increased risk with age, typically >45 years, peak 85-89 year
20
Q

Non- Hodgkin’s Lymphoma signs + symptoms

A
  • Asymmetrical painless lymphadenopathy
  • Less fever + night sweats + weight loss than Hodgkin’s
  • Sore throat
  • Symptoms of anaemia, thrombocytopenia or neutropenia with infections
  • Acute abdominal symptoms due to spleen/liver enlargement + involvement of GI tract
  • 5-10% of patients have diseased oropharyngeal lymphoid structures, causing sore throat or obstructed breathing
  • Recurring chromosomes abnormalities often seen in Non-hodgkin’s
21
Q

AML blood tests

A
  • Includes FBC, with an increase in blast cells in blood film
  • We can’t really predict WBC count as it could be high, low or normal
  • NN anaemia often seen, with erythrocytes unaffected
  • The blasts will usually be MPO positive, allowing us to differentiate + indicate that it is myeloid related
22
Q

AML prognosis

A
  • Chemotherapy leads to complete remission, but older patients tolerate chemo less well, with cure being rarely achievable
  • Chemo targets dividing cells + will affect the most frequently dividing first
23
Q

ALL blood tests

A
  • Similar to AML, but instead we see overcrowding of lymphocytes
  • NN anaemia, neutropenia + thrombocytopenia
  • The WBCs are MPO negative
  • > 20% are lymphoblasts as a result of overcrowding in bone marrow
24
Q

ALL prognosis

A
  • Majority of children are curable with standard chemo + CNS prophylaxis
  • Cure in adults is less frequent, stem cell transplant may be considered
  • Few drugs can reach CSF, so specific drug treatment is required to prevent or treat CNS disease
25
Q

CML blood tests

A
  • Overproduction of myeloid cells resulting in over-crowding in bone marrow causing, primarily leukocytosis + neutrocytosis
  • Increase in complete spectrum of myeloid cells seen in peripheral blood, levels of neutrophils + myelocytes exceed those of blast cells + promyelocytes
  • Increase in basophils
  • NN anaemia
  • Can have thrombocytosis, thrombocytopenia or normal count of platelets
  • Neutrophil alkaline phosphatase score is invariably low, it is increased in the myeloproliferative diseases + infections
  • Increased LDH + urate
  • FISH used for Philadelphia chromosome
26
Q

CML prognosis

A
  • 50% 5 yr survival
  • Indolent chronic phase, followed by period of acceleration, then generally fatal acute leukaemic phase
  • Stem cell transplant is the only known cure but is associated with significant mortality
  • Tyrosine kinase inhibitor Imatinib is the preferred initial therapy
27
Q

CLL blood tests

A
  • Overproduction of lymphocytes results in overcrowding in bone marrow causing lymphocytosis + 70-99% WBCs appear as small round lymphocytes
  • Smear cells where fragile lymphocytes burst during processing
  • Immunotyping of lymphocytes shows them to almost always be B cells, often surface CD19 positive
  • NN anaemia at later stages
  • Thrombocytopenia
28
Q

CLL prognosis

A
  • Initially indolent, chemo is often not needed in early CLL
  • 70% 5 yr survival
  • Patients often die of other causes
  • Becomes more aggressive in advanced stages
29
Q

Hodgkin’s lymphoma blood tests

A
  • NN anaemia is most common, bone marrow involvement is unusual in early disease
  • Eosinophilia + neutrophilia
  • Normal/increased platelet count in early disease
  • In advanced disease - Lymphopenia, thrombocytopenia
  • Requires lymph node biopsy for diagnosis
30
Q

Hodgkin’s lymphoma prognosis

A
  • Good prognosis = 80% 10 yr survival rate
  • Largely determined by disease state
  • Chemotherapy leads to high cure rates even in advanced disease
  • Significant risk of secondary malignancy as a late side effect of treatment
31
Q

Non-Hodgkin’s lymphoma blood tests

A
  • NN anaemia but maybe autoimmune haemolytic anaemia
  • In advanced disease with marrow involvement get neutropenia, thrombocytopenia
  • Cytogenetics used
32
Q

Non-Hodgkin’s lymphoma prognosis

A
  • 63% have 10 yr survivial rate
  • Indolent Non-Hodgkin’s lymphoma responds well to chemo but cure is elusive
  • Aggressive Non-Hodgkin’s lymphoma may be cured with chemo combined with rituximab
  • Stem cell transplants are increasingly used
33
Q

Multiple myeloma

A
  • Cancer of clonal plasma cells in the bone marrow
  • Ab-secreting B cells that secrete a single homogenous Ig called paraprotein
  • Rare before 40 years, peak 85-89 years
  • More common in men than women
  • More common in African Americans than Caucasians
34
Q

Multiple myeloma signs + symptoms

A
  • Bone pain, fracturs most common presenting symptom
  • Symptoms of anaemia + thrombocytopenia, leukopenia
  • Renal failure
  • Hypercalcaemia from bone destruction, resulting in kidney damage = renal failure
  • Amyloidosis
35
Q

Multiple myeloma blood tests

A
  • Bone marrow overcrowded with plasma cells, which can then cause:
    + Increased plasma cells in bone marrow
    + Presence of paraprotein in serum +/or in urine
    + NN anaemia or normochromic + macrocytic anaemia
    + Pancytopenia
    + Elevated Ca2+ levels
36
Q

Multiple myeloma prognosis

A
  • Cure is elusive, chemotherapy followed by stem cell transplant
  • 33% chance of 10 year survival
  • Good palliative care is crucial

Clinical Biomedicine (8 decks)

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