Leukaemia Flashcards
What is leukaemia?
cancer of a particular line of the stem cells in the bone marrow.
Causes unregulated production of certain types of WBCs
How are leukaemias classified?
depending on how rapidly they progress (slow = chronic or fast = acute) and the cell line that is affected (myeloid or lymphoid)
4 main types of leukaemia
Acute myeloid leukaemia
Acute lymphoblastic leukaemia
Chronic myeloid leukaemia
Chronic lymphocytic leukaemia
Pathophysiology of leukaemia
Form of cancer cells in BM
Genetic mutation in one of the precursor cells in bone marrow leads to excessive production of single type of abnormal white blood cell
What does excessive production of a single type of cell lead to?
suppression of the other cell lines causing underproduction of other cell types. This results in a pancytopenia, which is a combination of low red blood cells (anaemia), white blood cells (leukopenia) and platelets (thrombocytopenia).
Pneumonic for ages of leukaemia
ALL CeLLmates have CoMmon AMbitions
Under 5 and over 45 – acute lymphoblastic leukaemia (ALL)
Over 55 – chronic lymphocytic leukaemia (CeLLmates)
Over 65 – chronic myeloid leukaemia (CoMmon)
Over 75 – acute myeloid leukaemia (AMbitions)
Presentation of leukaemia?
Non specific
Fatigue
Fever
Failure to thrive (children)
Pallor due to anaemia
Petechiae and abnormal bruising due to thrombocytopenia
Abnormal bleeding
Lymphadenopathy
Hepatosplenomegaly
One of the key presenting features of leukaemia?
Petechiae
What is petechiae caused by?
Thrombocytopenia (low platelets)
Differential diagnosis for leukaemia? (Due to petechiae) Same for all leukaemias pretty much
Meningococcal septicaemia
Vasculitis
Henoch-Schonlein Purpura (HSP)
Idiopathic Thrombocytopenia Purpura (ITP)
Non-accidental injury
Gold standard initial investigation?
Full blood count
8 hours for patients with suspected leukaemia. Children or young adults with ptechiae or hepatosplenomegaly should be referred immediately to the hospital.
Main investigation for diagnosing leukaemia?
Bone marrow biopsy - can be used to analyse the cells in the bone marrow
Other tests for leukaemia
Blood film: can be used to look for abnormal cells and inclusions.
Lactate dehydrogenase (LDH): is a blood test that is often raised in leukaemia but is not specific to leukaemia. It can be raised in other cancers and many non-cancerous diseases.
Chest xray may show infection or mediastinal lymphadenopathy.
Lymph node biopsy can be used to assess lymph node involvement or investigate for lymphoma.
Lumbar puncture may be used if there is central nervous system involvement.
CT, MRI and PET scans can be used for staging and assessing for lymphoma and other tumours.
Bone marrow aspiration
involves taking a liquid sample full of cells from within the bone marrow.
Bone marrow trephine
Involves taking a solid core sample of the bone marrow and provides a better assessment of the cells and structure.
Bone marrow biopsy
taken from the iliac crest. It involves a local anaesthetic and a specialist needle. Samples from bone marrow aspiration can be examined straight away however a trephine sample requires a few days of preparation.
Acute Lymphoblastic Leukaemia
Malignant change in one of the lymphocyte precursor cells.
It causes acute proliferation of a single type of lymphocyte, usually B-lymphocytes.
Excessive proliferation of these cells causes them to replace the other cell types being created in the bone marrow, leading to a pancytopenia.
RFs for ALL
- Previous chemotherapy
- Radiation exposure
- Down syndrome:20-fold increased risk
- Benzene exposure: painters, petroleum, rubber manufacturers
- Family history:
Signs and symptoms of ALL?
lymphadenopathy
Hepatosplenomegaly
Pallor
Fatigue
Loss of appetite
Weight loss
Easy bruising
If philadelphia gene is present prognosis is poor
Prephase treatment for ALL
- 5 - 7 daysof treatment shortly after diagnosis
- Treat withcorticosteroids, with or without an additionalchemotherapyagent
Induction treatment for ALL
- 4 - 8 weektherapy, e.g.corticosteroids,vincristineordoxorubicin(chemotherapy)
- Imatinibcan be used in addition if Philadelphia chromosome-positive
- Intrathecal therapy (administration into CSF) can be used if there is CNS involvement
2nd line treatment for ALL
BM transplant
Consolidation and maintenance therapy for ALL
Consolidation:
- Up to1 yearof high-dosechemotherapy, which is startedaftercomplete remission
Maintenance:
-2yearsofmercaptopurineandmethotrexatetherapy