Leukaemia Flashcards
what are the 4 broad groups of leukaemia?
Acute lymphoblatic leukaemia ( ALL)
Acute myeloid leukaemia
Chronic lymphocytic leukaemia
Chronic Myeloid leukaemia
summarise leukaemia?
bone marrow disease-> Series of mutations in a single lymphoid or myeloid stem cell
mutations lead the progeny of that cell-> show abnormalities-> lead to steady expansion of leukaemic clone
How is leukaemia different from other cancers?
does not exist as a solid tumour but rather as leukaemic cells replacing normal bone marrow cells in circulation
-> but rather as leukaemic cells replacing normal bone marrow cells in circulation-> this is why it can disseminate quickly
what is acute leukaemia?
rapid increase in immature blood cells which crowd out the bone marrow
abnormal differential+ excessive proliferation
Acute leukaemia= severe leukaemia
what is chronic leukaemia?
excessive build up of abnormal but relatively mature white blood cells
normalish differentiation and excessive proliferation
mainly in older people
summarise the epidemiology of acute lymphoblastic leukaemia?
most common malignancy of acute lymphoblastic leukaemia
peak incidence 2-5 years old
second peak in incidence in the elderly
annual UK incidence: 1/70,000
what is AML?
rapid proliferation of myeloblasts
features of neutropenia, anaemia and thrombocytopenia
what are the risk factors for AML?
incidence increases with age
Downs syndrome, irradiation, anti-cancer drugs
what are the signs and symptoms of AML?
bone marrow failure,: pallor, bleeding, infections
Tissue infiltration: swollen gums, mild splenomegaly
what is an agressive subtype of AML?
acute promyelocytic leukaemia
what is the cause of acute promyelocytic leukaemia?
genetic translocation t(15,17) fuses the PML gene with RAR-alpha gene
what is seen on cytology for acute prolmyelocytic leukaemia?
faggot cells on cytology- lots of auer rods
what is ALL?
rapid proliferation of lymphoblasts
features of neutropenia, anaemia and thrombocytopenia
what are the risk factors for ALL?
Most common childhood cancer
genetics, radiation, influenza
what are the signs and symptoms of ALL?
bone marrow failure: pallor, bleeding, infections
tissue infiltration: lymphadenopathy, hepatosplenomegaly, swollen testes tender bones
how is ALL diagnosed?
more than 20% lymphoblasts on bone marrow
what is CML?
hyperpoliferation of granulocyte precursors-> features of bone marrow failure , hyper metabolism and hyper viscosity
what are the phases of CML?
chronic phase
accelerated phase
blast crisis
Summarise the epidemiology of CLL?
- 90% are > 50 yrs
- Commonest leukaemia – incidence 4/100,000/yr
- More common in MALES
- Rare in Asians
what are the risk factors for CML?
male to female ratio= 1.4: 1
philadelphia chromosome: t(9:22) BCR-ABL 1 fusion gene
what are the signs and symptoms of CML?
up to 50% are asymptomatic
90% have massive splenomegaly
hypermetabolic symptoms: weight loss, malaise, sweating
Bone marrow failure: pallor, bleeding infections
Hyperviscocity symptoms: thrombotic events, headaches
what is CLL?
Progressive accumulation of functionally incompetent lymphocytes
occasional symptoms of bone marrow failure, hyper metabolism
caused by a failure of apoptosis
what are the risk factors for CLL?
male to female ration= 2:1
genetic risk factors
what are the signs and symptoms of CLL?
50% are asymptomatic
occasionally non-tender lymphadenopathy ( small lymphocytic lymphoma)
occasional bone marrow failure symptoms
describe the diagnosis of CLL?
usually diagnosed by routine blood test- leukocytosis
smear. smudge cells on blood film
what are the investigations for leukaemia?
bloods= FBC, LDH, blood smear
Biopsies= bone marrow aspirate
Other tests= immunophenotyping, CXR
what is the typical presentation of CLL?
enlarged rubbery lymph nodes, non tender, also smear cells (Rai and Binet Staging)m increased lymphocyte
What is the typical presentation of CML?
Philadelphia chromosome, sweats, more likely splenomegaly, increased WCC (granulocyte at different stages of maturation)
what is the typical presentation of ALL?
bruising, pale, usually children btw 2-4 years old, hepatosplenomegaly and swollen testes and mediastinal mass (thymus enlargement if T cell infiltration)
what is the typical presentation of AML
Auer rods (sudan black stain - and preferentially stains myeloblasts), SOB, bone pain
what is the typical presentation of promyelocytic leukaemia?
subtype of AML, very aggressive, associated with DIC, t(15;17)
what are the buzz words for leukaemias?
AML= Auer rods
ALL= children < 6 years
CML= philadelphia chromosome t(9,22), BCR-ABL gene
CLL= smear/smudge cells
what is seen on cytology in AML?
auer rods
