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Cancer > Leukaemia > Flashcards

Leukaemia Flashcards

1
Q

What was the incidence of leukaemia in 2010?

A

8,257 new cases (4816 male, 3441 female)

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2
Q

Since the 1970s has the mortality rate of leukaemia been increasing or decreasing?

A

The mortality rate is decreasing, consequently the prevalence is increasing.

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3
Q

Which two types of chromosomal translocation cause leukaemia?

A
  1. Placing a strong regulatory element upstream of an oncogene, causing its over-expression.
  2. An inframe fusion event that creates a novel and/or dysfunctional protein.
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4
Q

What are the main symptoms of AML?

A

Bruising
Bleeding gums
Shortness of breath

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5
Q

What is the treatment for AML?

A

Chemotherapy

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6
Q

What is AML?

A

Accumulation of immune myeloid cells (blasts), proliferating in bone marrow.

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7
Q

Give 3 commonly mutated genes in AML.

A

CD117/c-kit
Runx1
CD135/FLT3

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8
Q

Give 4 common chromosomal abnormalities in AML.

A

t(8;21) - Runx1 (AML1-ETO fusion protein)
Inv16 - Core binding factor β subunit
t(15;17) - Retinoic acid receptor α subunit
t(9;11) - MLLT3-MLL

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9
Q

What is Runx1?

A

A transcription factor

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10
Q

What does Runx1 form a complex with?

A

Core binding factor.

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11
Q

Which protein causes DNA binding of Runx1 to increase 10-fold?

A

CBFβ

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12
Q

What does AML1-ETO impede?

A

Myeloid differentiation.

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13
Q

What is the most common paediatric malignancy?

A

ALL

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14
Q

What is the peak age range for ALL?

A

2-5 years old

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15
Q

What is the treatment for ALL?

A

Chemotherapy, radiotherapy, stem cell transplant

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16
Q

What percentage of paediatric patients are cured (5 year survival)?

A

Approximately 95%

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17
Q

What fraction of adult cases show post-5 survival?

A

1/3

18
Q

What are common chromosomal translocations in ALL?

A

t(8;14)
t(9;22)
t(1;19)
t(12;21)

19
Q

What is the most common chromosomal translocation in ALL?

A

T(12;21) TEL-AML1 ( >25%)

20
Q

Which virus could cause overproduction of myc in ALL?

A

Epstein Barr Virus

21
Q

What happens in t(8;14) translocation?

A

Myc moves to regulatory element of Eμ, this drives over-expressions expression of myc.

22
Q

Which translocation is the Philadelphia chromosome?

A

t(9;22)

23
Q

Which fusion protein does t(9;22) give rise to?

A

bcr/abl

24
Q

What does bcr/abl create?

A

A novel protein tyrosine kinase (PTK)

25
Q

Which pathway is the abl PTK linked to?

A

ras/MAP kinase pathway

26
Q

What does the ras/MAP kinase pathway regulate?

A

Cell proliferation

27
Q

Which kinase family is abl a member of?

A

Src

28
Q

The TEL-AML1 fusion protein’s pattern of interaction with transcriptional modifiers is dramatically altered. What does this change?

A

The spectrum of genes targetted and expressed.

29
Q

Which ALL translocation occurs in utero?

A

t(12;21)

30
Q

What are the TEL and AML genes transcriptional regulators for?

A

Haematopoeisis

31
Q

What needs to occur for a child with a TEL/AML translocation to develop leukaemia?

A

The second normal TEL gene is lost.

32
Q

Which environmental factors lead to loss of TEL?

A

Viruses, radiation, immunodeficiency, chemicals

33
Q

What is the most common geriatric malignancy in the West?

A

Chronic Lymphocytic Leukaemia (CLL)

34
Q

Which cells are affected in CLL?

A

BcR+

35
Q

Name 4 commonly mutated genes in CLL.

A

Notch1
p53
MyD88
ATM

36
Q

How can CLL be treated?

A

Incurable, younger patients can get stem cell transplants.

37
Q

What are the two forms of CLL?

A

Indolent - patients don’t know they have it.

Aggressive - poor 5 year survival.

38
Q

What effect does IgVH status have on CLL prognosis?

A

Unmutated VH genes (>98% identity with germline sequence) are at elevated risk of poor prognosis.

Mutated VH genes have better prognosis.

39
Q

What is Zap-70 and how does it affect CLL prognosis?

A

A tyrosine kinase normally associated with TcR.

High level of Zap-70 correlates with CLL progression and a poor outcome.

40
Q

What plasma concentration of sCD23 suggests poor prognosis for CLL patients?

A

> 60ng/ml

41
Q

How do telomeres affect CLL prognosis?

A

Shortened telomeres - poor prognosis.

Telomeres are a very good indicator of prognosis

Cancer (11 decks)

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