Leukaemia Flashcards
kinetics of normal haemopoiesis
self renewal proliferation differentiation maturation apoptosis
what enzyme do mature neutrophils express
myeloperoxidase
what cell surface antigen to red blood cells express
glycophorin A
what is malignant haemopoiesis characterised by
increased numbers of often dysfunctional cells
loss of normal haemopoietic reserve
what is needed for haemopoeisis to be classified as malignant
one or more of:
- increased proliferation
- lack of differentiation
- lack of maturation
- lack of apoptosis
what is acute leukaemia
abnormal proliferation and maturation
- bone marrow over run by mononuclear cells = loss of variation
- cells unable to mature
what is a driver mutation
mutation that gives a selective advantage to a clone through either increasing its survival or reproduction
causes clonal expansions
what is a passenger mutation
mutation that has no consequence to the cell or growth advantage
most common childhood cancer
acute lymphoblastic leukaemia
what is a ‘clone’
population of cells derived from a single parent cell
clonal features of
- normal haemopoeisis
- malignant haemopoiesis
normal = polyclonal malignant = monoclonal
what are haematological malignancies based on
- speed of presentation
- acute or chronic - based on site
- medullary (marrow) / extramedullary
- blood (leukaemia) / lymph node (lymphoma) - lineage:
- myeloid
- lymphoid
types of haematological malignancy
acute myeloid leukaemia
acute lymphoblastic leukaemia
chronic myeloid leukaemia
chronic lymphocytic leukaemia
what is a myeloma
plasma cell malignancy in marrow
which type of leukaemia can involve both blood/bone marrow and lymph nodes
chronic lymphocytic leukaemia
features of acute leukaemia
rapidly progressive clonal malignancy of marrow/blood with maturation defects
defined as excess of ‘blasts; in either the peripheral blood or bone marrow
decrease/loss of normal haemopoietic reserve
types of acute leukaemia
acute myeloid leukaemia (AML)
acute lymphoblastic leukaemia (ALL)
What is acute lymphoblastic leukaemia (ALL)
malignant disease of lymphocytes- arrest in maturation of lymphoblasts + proliferation
most common childhood cancer
presentation of ALL
anaemia/infection/bleeding – due to marrow failure
High WCC and involvement of extra-medullary areas e.g.CNS
bone pain
who is acute myeloid leukaemia more common in
elderly >60
neoplastic proliferation of myeloblasts
presentation of acute myeloid leukaemia
anaemia/infections/bleeding – marrow failure
investigation for acute leukaemia
blood count + blood film
coagulation screen
bone marrow aspirate
blood results of an acute leukaemia
LOW Hb, platelets + neutrophils
what is required to differentiate AML from ALL
immunophenotyping
what feature on blood film would make you think of acute myeloid leukaemia
AEUR RODS
red staining needle like bodies
immunomarker for stem cell precursors
CD34
immunomarker for myeloid precursors
CD33
treatment for ALL
lasts up to 2-3 years
-different phases of treatment
treatment for AML
normally intensive
- 2-4 cycles of chemotherapy
- prolonged hospitalisation
problems of marrow suppression
anaemia
neutropenia – infections
thrombocytopenia – bleeding
side effects of chemo treatment
N+V hair loss tumour lysis syndrome liver/renal dysfunction infection infertility
which chemotherapy drug has a risk of cardiomyopathy
anthracyclines
what needs to be done as soon as a neutropenic fever develops
empirical treatment with broad spectrum antibiotics
childhood cure rate of ALL
> 85-90%
Potential curative treatment for leukaemia
allogenic stem cell transplantation (donor stem cells)
what is Philadelphia chromosome
genetic abnormality in chromosome 22 of leukaemia cancer cells
what leukaemia is Philadelphia chromosome particular seen in
chronic myeloid leukaemia
aetiology of chronic lymphocytic leukaemia
clone of mature B cells (memory cells)
aetiology of chronic myeloid leukaemia
clonal proliferation of myeloid cells
