Leukaemia

Question 1

What are the types of leukaemia?

Answer 1

Acute myeloid leukaemia
Acute lymphoblastic leukaemia
Chronic myeloid leukaemia
Chronic lymphocytic leukaemia

Question 2

What is the most common leukaemia in children?

Answer 2

ALL

Question 3

What is the presentation of leukaemia?

Answer 3

Fatigue
Fever
Pallor
Petechiae
Bruising
Abnormal bleeding
Lymphadenopathy
Hepatosplenomegaly

Question 4

What are the top differentials for a non-blanching rash?

Answer 4

Leukaemia
Meningococcal septicaemia
Vasculitis
Henoch Schonlein purpura
ITP
Thrombotic thrombocytopenic purpura
Traumatic or mechanical
Non-accidental injury

Question 5

What is the initial investigation performed in suspected leukaemia?

Answer 5

FBC - within 48 hours

Question 6

What other investigations are used to confirm the diagnosis of leukaemia?

Answer 6

Bone marrow biopsy - definitive investigation
Blood film
CT and PET scans - to stage condition
Lymph node biopsy - assess lymph node spread

Question 7

What is ALL?

Answer 7

ALL affects one of the lymphocyte precursor cells, and usually causes acute proliferation of B lymphocytes

Question 8

What is chronic lymphocytic leukaemia?

Answer 8

Slow proliferation of well-differentiated lymphocytes - usually B-lymphocytes

Question 9

What is Richter’s transformation?

Answer 9

CLL can transform in high-grade B cell lymphoma

Question 10

What is associated with CLL on blood film?

Answer 10

Smear or smudge cells

Question 11

What are the stages of chronic myeloid leukaemia?

Answer 11

Chronic phase - asymptomatic

Accelerated phase - abnormal blast cells take up a high proportion of the bone marrow and blood cells

Blast phase - involved an even higher proportion of blast cells in the blood (over 20%)

Question 12

What finding is associated with chronic myeloid leukaemia?

Answer 12

Philadelphia chromosome

Question 13

What is the Philadelphia chromosome?

Answer 13

An abnormal chromosome 22, caused by a reciprocal translocation of genetic material between chromosomes 9 and 22

Question 14

What is a characteristic finding in acute myeloid leukaemia?

Answer 14

Auer rods

Question 15

What is the management of acute lymphoid leukaemia?

Answer 15

Pre-phase
- 5-7 days of corticosteroids
Induction
- 4-8 week of corticosteroid or chemotherapy
Consolidation
- Up to 1 year of high dose chemotherapy
Maintenance
- 2 years of mercaptopurine and methotrexate therapy

Question 16

What is the management of acute myeloid leukaemia?

Answer 16

Induction
- Combination of cytarabine and anthracycline
Consolidation
- Further chemotherapy is offered
Stem cell transplant

Question 17

What is the treatment of chronic myeloid leukaemia?

Answer 17

First line - tyrosine kinase inhibitors

Chronic or accelerated phase:
- Tyrosine kinase inhibitor
- Combine with interferon alpha

Blast phase:
- Tyrosine kinase inhibitor plus high dose chemotherapy
- Followed by stem cell transplantation

Question 18

What are the complications of chemotherapy?

Answer 18

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

Question 19

What electrolyte abnormalities are seen in tumour lysis syndrome?

Answer 19

High uric acid
High potassium
High phosphate
Low calcium