Leukaemia

Question 1

Define acute leukaemia

Answer 1

Defective maturation of myeloid or lymphoid in the bone marrow (BM) which spills out as immature cells that infiltrate

ALL = acute lymphoblastic leukaemia
AML = acute myeloid leukaemia

Question 2

Define chronic leukaemia

Answer 2

Proliferation of mature myeloid or lymphoid cells in the bone marrow (BM) which spill out and cause proliferation effects and infiltrate

CLL = chronic lymphoblastic leukaemia
CML = chronic myeloid leukaemia

Question 3

How should leukaemia be investigated?

Answer 3

Bloods = FBC, blood film, flow cytometry, LDH, urate, folate, clotting

Biopsy

• Cytology
  
  • blast cells (ALL)
  • Auer rods (AML)
  • BM hypercellular (CML)
  • Reed-Sternberg (HL)
• Morphology
  
  • M3 = APML
• Immunophenotyping
  
  • B/T cells (CD markers)
• Cytogenetics
  
  • t(9:22) = Philadelphia (CML)
  • t(15:17) = APML

Imaging

• Lymphoma (Ann Arbor)
  
  • CT TAP
  • PET CT
• Myeloma
  
  • Skeletal survey
  • PET CT

Question 4

What are the possible complications of blood cancer?

Answer 4

Neutropenic sepsis

• neutrophils <0.5, temp >38, sepsis signs
• barrier nursing
• septic screen
• IV Abx
• consider G-CSF and PCP prophylaxis (co-trimoxazole)

Tumour lysis syndrome

• increased urate/K/PO4, decreased Ca, AKI within 7 days of chemo
• hydration
• allopurinol before/during cycle (IV rasburicase if specialist)

DIC

• decreased Hb/plat/fibrinogen, increased INR/APTT/FDPs, schistocytes
• treat underlying cause (APML, sepsis)
• FFP + cryoprecipitate (fibrinogen) + plat

Question 5

Describe the characteristics of myeloid cells

Answer 5

Origin-Bone Marrow

Granulocytes

White blood cells

• Neutrophil
• Eosinophil
• Macrophages
• Basophils
• Megakaryocyte

Red Blood cells

Question 6

Describe the characteristics of lymphoid cells

Answer 6

Origin-Bone Marrow

Lymphocytes

T-Cells

• Mature through thymus “teaching”
• Cell Mediated Immunity

B-Cells

• Mature in the Bone Marrow
• Humoral immune response

Question 7

Outline AML

Answer 7

Acute Myelogenous Leukaemia

Most common type of Leukaemia

Fast growing cancer of the blood and bone marrow

Characterized by

• Leukemic cells in the Bone Marrow
• Blast cells
• Auer Rods (crystals of coalesced granules)

Mx = chemo, +/- allogenic stem cell transplant

Question 8

Outline CML

Answer 8

Chronic Myelogenous Leukaemia

Slow growing cancer of white blood cells

3 Phases = Chronic, Accelerated, Blast Phase

Characterized by
- Too many white blood cells
- massive splenomegaly
- Philadelphia chromosome 
   • t(9;22) 
   • bcr/abl gene 
   • Makes tyrosine kinase

Mx = TKI (tyrosine kinase inhibitors)

Question 9

Outline ALL

Answer 9

Acute Lymphocytic Leukaemia

Greatest risk for ALL is in the first 5 years of life

Fast growing cancer of the blood and bone marrow

Characterized by

• Uncontrollable growth of non-functional lymphoblasts
• Blockade of normal marrow cells (marrow failure)
• Lethargy, generally unwell, petechial rash

Question 10

Outline CLL

Answer 10

Chronic Lymphocytic Leukaemia

Risk associated with CLL increases rapidly >40

Can be a very stable disease, some may not received treatment directly after the diagnosis

Characterized by
- Smear cells
- Staging system (Raior Binet) 
   • # of lymphocytes in blood and marrow
   • Spleen size
   • Lymph node distribution

CLL transformation to high grade lymphoma = richters transformation

Question 11

What is a myeloproliferative neoplasm?

Answer 11

JAK2 mutation

Polycythaemia rubra vera

• RBCs
• S+S = thrombosis, headaches, drowsiness, visual disturbance, pruritis (warm bath), plethoris, gout, splenomegaly

Essential thrombocythaemia

• Platelets
• S+S = thrombosis, haemorrhage (>1000), splenomegaly, leukaemic transformation

CML - Philadelphia chromosome, 9:22
- WBCs