Leukaemia

Question 1

What is leukaemia?

Answer 1

cancer of a particular line of stem cells in the bone marrow, causing unregulated production of a specific type of blood cell.

Question 2

What are the 4 types of leukaemia?

Answer 2

1. Acute myeloid leukaemia (rapidly progressing cancer of the myeloid cell line)
   
   2. Acute lymphoblastic leukaemia (rapidly progressing cancer of the lymphoid cell line)
   3. Chronic myeloid leukaemia (slowly progressing cancer of the myeloid cell line)
   4. Chronic lymphocytic leukaemia (slowly progressing cancer of the lymphoid cell line)

Question 3

Which leukaemia is most common in children?

Answer 3

ALL

Question 4

Which leukaemia is associated with auer rods?

Answer 4

AML

Question 5

Which leukaemia can be as a result of myeloproliferative disorder?

Answer 5

AML

Question 6

Which leukaemia is associated with Down syndrome?

Answer 6

ALL

Question 7

Which leukaemia has 3 phases?

Answer 7

CML

Question 8

Which leukaemia is associated with the Philadelphia chromosome?

Answer 8

CML

Question 9

Which leukaemia is associated with warm haemolytic anaemia, ritchers transformation and smudge cells?

Answer 9

CLL

Question 10

What is pancytopenia?

Answer 10

combination of low red blood cells (anaemia), white blood cells (leukopenia) and platelets (thrombocytopenia).

Question 11

What are some potential presenting features of leukaemia? (8)

Answer 11

• Fatigue
• Fever
• Pallor due to anaemia
• Petechiae or bruising due to thrombocytopenia
• Abnormal bleeding
• Lymphadenopathy
• Hepatosplenomegaly
• Failure to thrive (children)

Question 12

What is one of the key features of leukaemia?

Answer 12

bleeding under the skin due to thrombocytopenia.

Question 13

What are petechiae?

Answer 13

Non blanching lesions <3mm caused by burst capillary’s

Question 14

What are purpura?

Answer 14

Non-blanching lesions from 3-10mm

Question 15

What is ecchymosis?

Answer 15

Non blanching lesion >1cm

Question 16

What is seen on a blood film in AML? (2)

Answer 16

High proportion of Blast cells
Auer rods in cytoplasm of blast cells

Question 17

What is seen on bone marrow biopsy in AML?

Answer 17

High proportion of blast cells

Question 18

What is the most commonly proliferated cell in ALL?

Answer 18

B lymphocytes

Question 19

What feature is present in ALL but more commonly seen in CML?

Answer 19

Philadelphia chromosome

Question 20

What are the 3 phases of CML?

Answer 20

1. Chronic phase
   
   2. Accelerated phase
   3. Blast phase

Question 21

What is the longest phase of CML?

Answer 21

Chronic phase - can last several years

Question 22

When does the accelerated phase of CML occur?

Answer 22

• Occurs when the abnormal blast cells take up a high proportion (10-20%) of the bone marrow and blood cells.

Question 23

What symptoms are acquired in the accelerated phase of CML? (3)

Answer 23

Anaemia
Thrombocytopenia
Immunodeficiency

Question 24

What is the symptoms in the blast phase of CML?

Answer 24

• The blast phase has severe symptoms and pancytopenia and is often fatal.

Question 25

When is the blast phase in CML?

Answer 25

• Follows the accelerated phase and involves an even higher proportion (over 20%) of blast cells in the blood.

Question 26

Which leukaemia is the Philadelphia chromosome most associated with?

Answer 26

CML

Question 27

What is the Philadelphia chromosome?

Answer 27

○ This refers to an abnormal chromosome 22 caused by a reciprocal translocation (swap) of genetic material between a section of chromosome 9 and chromosome 22. ○ This translocation creates an abnormal gene sequence called BCR-ABL1, which codes for an abnormal tyrosine kinase enzyme that drives the proliferation of the abnormal cells.

Question 28

What does BCR-ABL1 code for?

Answer 28

An abnormal tyrosine kinase enzyme that drives the drives proliferation of abnormal cells

Question 29

Which cell is most often proliferated in CLL?

Answer 29

B lymphocytes

Question 30

What is the presentation of CLL?

Answer 30

• It is often asymptomatic but can present with infections, anaemia, bleeding and weight loss.

Question 31

What is anaemia is CLL associated with?

Answer 31

Warm autoimmune haemolytic anaemia

Question 32

What is ritchers transformation?

Answer 32

Rare transformation of CLL into high grade b cell lymphoma

Question 33

What’s seen on a blood film in CLL?

Answer 33

Smear or smudge cells

Question 34

What investigation is done in suspected leukaemia? When?

Answer 34

Fbc within 48hours

Question 35

When should children be sent for immediate specialist assessment in suspected leukaemia?

Answer 35

Petechiae or hepatosplenomegaly

Question 36

What test is a sign for non-specific marker of tissue damage in leukaemia?

Answer 36

Lactate dehydrogenase (LDH)

Question 37

What test gives a definitive diagnosis of leukaemia?

Answer 37

Bone marrow biopsy

Question 38

Where are bone marrow biopsies usually taken from?

Answer 38

Iliac crest

Question 39

What are the 2 types of bone marrow biopsy?

Answer 39

○ Bone marrow aspiration involves taking a liquid sample 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.

Question 40

What is leukaemia mainly treated with?

Answer 40

Chemo and targeted therapies

Question 41

What are 2 targeted therapies used in CLL?

Answer 41

• Tyrosine kinase inhibitors (e.g., ibrutinib) Monoclonal antibodies (e.g., rituximab, which targets B-cells)

Question 42

What are some complications of chemo? (8)

Answer 42

• Failure to treat cancer • Stunted growth and development in children • Infections due to immunosuppression • Neurotoxicity • Infertility • Secondary malignancy • Cardiotoxicity (heart damage) • Tumour lysis syndrome

Question 43

What is tumour lysis syndrome?

Answer 43

Tumour lysis syndrome results from chemicals released when cells are destroyed by chemotherapy,

Question 44

What can tumour lysis syndrome result in? (4)

Answer 44

High Uric acid High potassium High phosphate Low calcium

Question 45

What helps prevent tumour lysis syndrome?

Answer 45

Good hydration and urine output before chemo

Question 46

What drugs can be used to suppress uric acid levels? (2)

Answer 46

Allopurinol Rasburicase