Leukaemia

Question 1

What is AML?

Answer 1

Acute myeloid leukaemia (AML) is the clonal expansion of myeloid blasts in the bone marrow, peripheral blood, or extramedullary tissues. Bone marrow blasts of at least 20% are diagnostic.

Question 2

What is ALL?

Answer 2

Acute lymphocytic leukaemia (ALL) is a malignant clonal disease that develops when a lymphoid progenitor cell becomes genetically altered through somatic changes and undergoes uncontrolled proliferation.

Question 3

What is CML?

Answer 3

Chronic myelogenous leukaemia (CML) is a malignant clonal disorder of the haematopoietic stem cell that results in marked myeloid hyperplasia of the bone marrow.

Question 4

What is CLL?

Answer 4

Chronic lymphocytic leukaemia (CLL) is an indolent lymphoproliferative disorder in which monoclonal B lymphocytes (>5 x 10⁹/L [>5 x 10³/microlitre]) are predominantly found in peripheral blood.

Question 5

What are the risk factors of AML?

Answer 5

> Age over 65
Previous haematological dyspoeisis or chemotherapy
Genes
Radiation or benzene exposure

Question 6

What are the risk factors of ALL?

Answer 6

> Age: <6, mid 30s, mid 80s

Question 7

What are the risk factors of CML?

Answer 7

> 65-74 years

Question 8

What are the risk factors of CLL?

Answer 8

> Age over 60

> White males

Question 9

What are the signs and symptoms of AML?

Answer 9

> Pallor 
> Ecchymoses or petechiae
> Fatigue
> Dizziness
> Palpitations
> Dyspnoea
> Infections
> Lymphadenopathy
> Hepatosplenomegaly
> Mucosal bleeding

Question 10

What are the signs and symptoms of ALL?

Answer 10

> Lymphadenopathy
> Hepatosplenomegaly
> Pallor, ecchymoses or petechiae
> fever
> Epistaxis/ menorrhagia
> fatigue, dizziness, palpitations and dyspnoea
> Meningism and papilloedema
> Focal neurological
> renal enlargement
> Bony pain

Question 11

What are the signs and symptoms of CML?

Answer 11

> Splenomegaly
> Weight loss
> Excessive sweating
> SOB
> Epistaxis/ arthralgia
> Fever
> Bruising
> Pallor

Question 12

What are the signs and symptoms of CLL?

Answer 12

> SOB
Lymphadenopathy
Splenomegaly

Question 13

What is the epidemiology of the leukaemias?

Answer 13

In 2014 there were 3072 new cases of AML in the UK (55% of thses over 70)

Acute lymphocytic leukaemia (ALL) is rare. Worldwide, the incidence of ALL is about 3 per 100,000 population, with approximately 75% of cases occurring in children less than 6 years.

In the US, it has been estimated that, in 2018, there will be 8430 new cases of CML and 1090 deaths from this cancer.

CLL is the most common leukaemia in the Western world. In the UK, there were 3515 new cases of CLL in 2014

Question 14

What investigations would you do for the leukaemias?

Answer 14

> FBC- anaemia, macrocytosis, leukocytosis, neutropenia, thrombytopenia (AML/ALL)- platelet abnormalities, elevated WBC (CML/ CLL)
peripheral blood smear
coagulation panel (May indicate DIC)
serum electrolytes (var)
renal function (var)
LFTs (var)
serum lactic dehydrogenase (may be elevated AML)
TPMT
Bone marrow aspiration/ trephine biopsy (hypercellularity and infiltration by lymphoblasts, ALL) (granulocyte hyperplasia (CML)
Blood film- CLL(spherocytes, polychromasia etc.)