Leukaemia Flashcards
What are the types of leukaemia?
Acute myeloid leukaemia
Acute lymphoblastic leukaemia
Chronic myeloid leukaemia
Chronic lymphocytic leukaemia
What is the most common leukaemia in children?
ALL
What is the presentation of leukaemia?
Fatigue
Fever
Pallor
Petechiae
Bruising
Abnormal bleeding
Lymphadenopathy
Hepatosplenomegaly
What are the top differentials for a non-blanching rash?
Leukaemia
Meningococcal septicaemia
Vasculitis
Henoch Schonlein purpura
ITP
Thrombotic thrombocytopenic purpura
Traumatic or mechanical
Non-accidental injury
What is the initial investigation performed in suspected leukaemia?
FBC - within 48 hours
What other investigations are used to confirm the diagnosis of leukaemia?
Bone marrow biopsy - definitive investigation
Blood film
CT and PET scans - to stage condition
Lymph node biopsy - assess lymph node spread
What is ALL?
ALL affects one of the lymphocyte precursor cells, and usually causes acute proliferation of B lymphocytes
What is chronic lymphocytic leukaemia?
Slow proliferation of well-differentiated lymphocytes - usually B-lymphocytes
What is Richter’s transformation?
CLL can transform in high-grade B cell lymphoma
What is associated with CLL on blood film?
Smear or smudge cells
What are the stages of chronic myeloid leukaemia?
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%)
What finding is associated with chronic myeloid leukaemia?
Philadelphia chromosome
What is the Philadelphia chromosome?
An abnormal chromosome 22, caused by a reciprocal translocation of genetic material between chromosomes 9 and 22
What is a characteristic finding in acute myeloid leukaemia?
Auer rods
What is the management of acute lymphoid leukaemia?
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
What is the management of acute myeloid leukaemia?
Induction
- Combination of cytarabine and anthracycline
Consolidation
- Further chemotherapy is offered
Stem cell transplant
What is the treatment of chronic myeloid leukaemia?
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
What are the complications of chemotherapy?
Failure to treat cancer
Stunted growth and development in children
Infections due to immunosuppression
Neurotoxicity
Infertility
Secondary malignancy
Cardiotoxicity
Tumour lysis syndrome
What electrolyte abnormalities are seen in tumour lysis syndrome?
High uric acid
High potassium
High phosphate
Low calcium
What is the difference between AML and CML on blood work?
AML - thrombocytopenia, neutropenia
CML - high platelets and neutrophils
