Leukaemia Flashcards
What is leukaemia?
Clonal proliferation of malignant blood cells
How does leukaemia happen?
Malignant cells undergo uncontrolled expansion in bone marrow leading to bone marrow failure and the cells circulate in blood and can infiltrate various organs
What are the 2 types of leukaemia?
Acute and chronic
What is acute leukaemia?
Malignant transformation occurs in haemopoietic stem cell
Defined by presence of over 20% blasts in blood or bone marrow
What are 2 types of acute leukaemia?
Acute myloid leukaemia AML (80%)
Acute lymphoblasitc leukaemia ALL (20%)
What is chronic leukaemia?
Proliferation of more mature precurser cell. Slower progression with relatively benign cause
What are 2 types of chronic leukaemia?
Chronic myloid leukaemia CML
Chronic lymphocytic leukaemia CLL
What are the causes of leukaemia?
INHERITED - Downs, klinefelters, immuno deficiencies
ENVIRONMENTAL - radiation, chemo, infection, myeloproliferative disease
What is AML?
Acute myloid leukaemia
Most common acute leukaemia in adults, 70 yrs
PRIMARY - de novo
SECONDARY - after another cause, eg chemo
What are the clinical features of acute leukaemia (AML and ALL)?
BONE MARROW FAILURE
anaemia
neutropoenia
thrombocytopoenia
ORGAN INFLITRATION
lymadenopathy
hepatomegaly
splenomegaly
What investigations would you do for AML?
FBC
blood film - to see myloblasts
bone marrow biopsy
What is the treatment for AML?
combination chemo
supportive treatment
bone marrow transplant
What is the prognosis of AML dependant on?
Age. Higher cure rate if less than 60 yrs
What is ALL?
Acute lymphoblastic leukaemia
Most common leukaemia in children, 2-10 yrs
What investigations would you do for ALL?
FBC
blood film - to see lymphoblasts
bone marrow biopsy
How would you treat ALL?
combo chemo
bone marrow transplant
What is the prognosis for ALL?
70 -80% cure rate in childhood
What is the difference between lymphblasts and myloblasts?
Lymphoblasts have less granules than myloblasts
What is CML?
Chronic myloid leukaemia
Rare clonal myloproliferative disorder charaterised by an increase in mature myelocytes -esp. neutrophils
Adults, 40- 60 yrs
What shows up in CML?
Philadelphia chromosome
What are the 3 phases of CML?
Chronic
Accelerated
Blast transformation to acute
What are the clinical features of CML?
anaemia thrombocytopoenia lymphadenopathy splenomegaly hypermetabolim hepatomegaly
What investigations would you do for CML?
FBC
blood film to be myloid cells
bone marrow biopsy
cytogenics for philadelphia chromosome`
What treatment would you give for CML?
chemo
splenectomy
bone marrow transplant
tyrosine kinase inhibitors
What is CLL?
Chronic lymphocytic leukaemia
Clonal lymphoproliferative disease where lymphocytes accumulate in the blood, bone marrow and spleen as a result of longer life expectancy or reduced apoptosis
Largely elderly, 70 yrs
What are the symptoms of CLL , if it is symptomatic?
lymphadenopathy
splenomegaly
hepatomegaly
immunosuppression
What investigations would you do for CLL?
FBC - see increased WBC
blood film - increase lymphocytes
bone marrow biopsy - see heavy lymphocyte infiltration
What is the treatment for CLL?
chemo - if symptomatic
What is the prognosis?
Deteriorates if any organ is infiltrated
What is a stem cell transplant?
Transplant of multipotent haemopoeitic stem cells, usually derived from bone marrow or peripheral blood
What happen when recipient recieves transplant?
Body wants to reject it so they are given radiation or chemo prior to destroy their own immune system
What is the difference between an autologous stem cell transplant and an allogenic stem cell transplant?
Autologous = patients own stem cells used Allogenic = stem cells from a donor
What does chemo cause in the oral cavity?
ulcers
reduced saliva
