Leukaemia Flashcards
What is leukaemia
blood cancers that being with mutation of a bone marrow progenitor cell–
abnormal cells in blood
What are the types of leukaemia
Acute myeloid leukemia
Acute lymphoblastic leukaemia
Chronic lymphocytic leukaemia
chronic myeloid leukaemia
What is the difference between acute and chronic leukaemia
acute - result of impaired cell differentiation hence large numbers of malignant precursor cells in bone marrow
chronic - result of excessive proliferation of mature malignant cells - cell differentiation is unaffected
What is the difference between myeloid and lymphocytic leukaemia
myeloid leukaemia - results from a myeloid precursor cell ( neutrophils)
lymphocytic leukaemia arise from lymphoid precursor - B cells
What is AML
most common in adults
median age of onset -65
What are some risk factors of AML
trisomy 21
irradiation
How may someone with AML present
fever
bone marrow failure
- neutropenia- infections
-anaemia - pallor
-thrombocytopenia - bleeding
Tissue infiltration
- swollen gums
-hepatomegaly and splenomegaly
How is AML classified
subdivided based on potential aetiology
- AML with recurrent genetic abnormalities
-AML with myelodysplasia related changes
-therapy related AML - associated with previous chemo
-AML not otherwise specified
What investigations are required for AML
FBC
- high WCC , panctypoenia
bone marrow biopsy
- Auer rod cells ( needle shaped )
>20% blast cells
- carry out cytogenic analysis
What is management of AML
chemotherapy
-CYTARABINE( anti-metabolic agent)
supportive
- blood products
-infection prophylaxis
-allopurinol, fluids, electrolytes – ( prevent tumour lysis syndrome)
- bone marrow transplant
What is the prognosis of AML
death occurs within 2 months with no treatment
20% 3 year survical in those who undergo treatment
What is ALL
most common cancer in children
What are risk factors of ALL
trisomy 21
neurofibromatosis
How may someone with ALL present
FLAWS
Bone marrow failure
- neutropenia - infections
-anaemia - pallor
-thrombocytopenia - bleeding
Tissue infiltration
-lymphadenopathy
-hepatosplenomegaly
-tender bones
-painless unilateral testicular swelling
meningeal involvement -headache, neck stiffness, cranial nerve palsies
What investigations are required for ALL
FBC -
high WCC ( blast cells) , pancytopenia
Bone marrow biopsy
>20% lymphoblasts
immunophenotyping
What is the management of ALL
chemotherapy
supportive
-blood products
-infection prophylaxis
- allopurinol, fluids, electrolytes
- allo-stem cell transplant
What is prognosis of ALL
children have cure rate of 70-90%
What is CML
most common in middle aged males
associated with philadelphia chromosome
What is the main risk factor for CML
radiation exposure
How does CML usually develop and progress
Chronic phase - 3-5 years
accelerated phase - months
blastic phase - acute leukaemia transformation
How may someone with CML present
can be asymptomatic
insidious onset
MASSIVE SPLENOMEGALY
FLAWS
Bone marrow failure
- neutropenia - infections
-anaemia -pallor
-thrombocytopenia - bleeding
Hyperviscosity
- neurological deficits, visual changes and mucosal bleeding
What are investigations for CML
FBC
-pancytopenia , elevated WCC, raised BASOPHILS
Bone marrow aspirate -
increased myeloblasts
hypercellular
PCR for BCR-ABL1 fusion gene
How do you manage CML
Tyrosine kinase inhibitors
IMATINIB
What is prognosis for CML
median survival is 5-6 years
What is CLL
most common in patients over 60
failure of apoptosis - increased number of non-functional lymphocytes
How does CLL present
usually asymptomatic
insidious onset
during later stages of disease
-symmetrical non tender lymphadenopathy
- bone marrow failure
neutropenia - infections
anaemia - pallor- AIHA
thrombocytopenia - bleeding
FLAWS
What staging is used for CLL
Binet classification in europe
Rai classification in USA
What investigations are required for CLL
FBC
high WCC >100, normal Hb and platelets
Low serum immunoglobulin
Blood film -
smudge/smear cells
lymph node biopsy and phenotyping
Diagnosis is usually made on incidental routine bloods
How do you manage CLL
watchful waiting if slowly progressive
supportive treatment
RITUXIMAB
What is prognosis for CLL
1/3 cases don’t progress
1/3 progress slowly
1/3 progress actively
