Leukaemia

Question 1

What aetiological factors are associated with leukaemia?

Answer 1

• Radiation exposure
• Human T-cell leukaemia virus
• Previous chemo
• Genetic [down’s syndrome x20 more likely]

Question 2

What is the main division used to classify leukaemias?

Answer 2

Acute and Chronic

Question 3

List two types of acute leukaemia

Answer 3

Acute Lymphoblastic leukaemia [ALL]
Acute Myeloblastic leukaemia [AML]

Question 4

List two types of chronic leukaemia

Answer 4

Chronic Lymphocytic leukaemia [CLL]
Chronic Meyloid leukaemia [CML]

Question 5

What are the main differences between acute and chronic leukaemias?

Answer 5

Acute
* tend to grow fast
* cells not specialised at all
* symptoms show quickly

Chronic
* tend to grow slowly
* cells more specialised
* may be present for years before symptoms appear

Question 6

What investigations are used to diagnose leukaemia?

Answer 6

• Bone marrow aspiration
• Full clinical exam & patient history
• Full Blood Count
• Chest X-ray [pneumonia, mediastinal mass,…]

Question 7

What are the common signs and symptoms of acute leukaemias?

Answer 7

• Pallor, tiredness, fever
• Bleeding gums
• Infection
• Pain in left side abdomen [spleen]
• Pain in bones
• Mediastinal mass
• Anaemia
• Enlarged lymph nodes
• Heaptosplenomegaly

Question 8

What treatment management options are used for AM leukaemias?

Answer 8

• Chemo (induction phase)
• Stem cell transplant (consolidation phase)

Question 9

What treatment is used for AL leukaemias?

Answer 9

4 phases
1. Remission induction [chemo]
2. Consolidation [higher dose of chemo]
3. CNS Prophylaxis [RT to get cells in meninges]
4. Maintenance [more chemo]

Prophylaxis only presrcibed if CNS involvement
24 Gy 15#

Question 10

What treatment is used for CL leukaemias?

Answer 10

Incurable, slowly progressive disease
* Watch & wait [early stage]
* Chemoimmunotherapy [adv stage]
* RT 20 Gy 4# [Bulky & no response to chemo]

Question 11

Describe the role of RT for treating leukaemia

Answer 11

• Managing uncomfortable splenomegaly
• Prophylatic Crainial Irradiation
• Bulky disease

Question 12

What dose is used to treat splenomegaly?

Answer 12

Spleen is very radiosensitive
* 0.25 Gy per day
* Can increase up to 1.5-2Gy per day, to a total dose of 3 Gy

Once a week, or once every 2 weeks
Blood levels must be checked prior to irradiation