Leukaemia

Question 1

what are the kinetics of normal haemopoiesis

Answer 1

Self renewal (stem cells)
Proliferation 
Differentiation/lineage commitment
Maturation 
Apoptosis

Question 2

what is malignant haemopoiesis characterised by

Answer 2

increased numbers of often dysfunctional cells and may have loss of the normal haemopoietic reserve.

Question 3

what is needed for malignant haemopoiesis

Answer 3

One or more of the following:

Increased proliferation
Lack of differentiation
Lack of maturation
Lack of apoptosis

Question 4

what is acute leukaemia

Answer 4

abnormal proliferation and maturation

• bone marrow over run by mononuclear cells = loss of normal variation
• cells unable to mature

Question 5

what are the types of mutations seen in blood cells

Answer 5

Driver mutation = a mutation that gives a selective advantage to a clone through either increasing its survival or reproduction. Cause clonal expansions.

Passenger mutation = mutations that have no consequence to the cell or growth advantage

Question 6

what is the most common childhood cancer

Answer 6

acute lymphoblastic leukaemia

Question 7

what is a key features of malignant haemopoiesis

Answer 7

monoclonal

Question 8

what are the types go haematological malignancies

Answer 8

Acute Myeloid Leukaemia

Acute Lymphoblastic Leukaemia

Chronic Myeloid Leukaemia

Chronic Lymphocytic Leukaemia

Question 9

what is features of acute leukaemia

Answer 9

Rapidly progressive clonal malignancy of the marrow/blood (myeloid or lymphoid) with maturation defect(s)

defined as an excess of ‘blasts’ in either the peripheral blood or bone marrow

Decrease/loss of normal haemopoietic reserve

Question 10

what is ALL

Answer 10

malignant disease of lymphocytes

most common childhood cancer

Question 11

how does ALL present

Answer 11

anaemia, infections, bleeding
- due to marrow failure

high WCC and involvement of extra-medullary areas e.g. CNS,
- leukaemic effects

Bone pain

Question 12

what are features of AML

Answer 12

more common in the > 60y/o

presentation similar to ALL

Question 13

Ix for acute leukaemia

Answer 13

1 - blood count and film
2 - coagulation screen
3 - bone marrow aspirate

Question 14

how will a blood count be in an acute leukaemia

Answer 14

Hb, platelets and neutrophils are LOW

Question 15

what feature on a blood film would make you think AML

Answer 15

AEUR ROD

Question 16

what general features on a blood film would make you think Acute leukaemia

Answer 16

reduction in normal
presence of abnormal

“Blasts” with a high nuclear;cytoplasm ratio

Question 17

what are immunomarkers for: stem cells and myeloid precursors

Answer 17

CD34 = stem cells

CD33 = myeloid precursors

Question 18

what Ix is needed for a definitive diagnosis of either AML or ALL

Answer 18

Immunophenotyping

Question 19

how does Tx for acute leukaemia differ

Answer 19

ALL

• lasts up to 2-3 years
• different phases of treatment

AML

• normally intensive
• between 2-4 cycles of chemo
• prolonged hospitalisation

Question 20

what are complications of Tx

Answer 20

Nausea and vomiting
Hair loss
Liver, renal dysfunction
Tumour lysis syndrome
Infection 
Loss of fertility
Cardiomyopathy with anthracyclines

Question 21

what needs to be done as soon as a neutropenic fever develop

Answer 21

empirical treatment with broad spectrum antibiotics (particularly covering Gram negative organisms)

Question 22

what is a potential curative Tx for Leukaemia

Answer 22

Allogeneic stem cell transplantation

- get stem cells from a donor

Question 23

what is philadelphia chromosome

Answer 23

genetic abnormality in chromosome 22 of leukemia cancer cells
= particularly in CML