Leukaemia

Question 1

define leukaemia.

Answer 1

malignant proliferation of haemopoietic cells, the type of leukaemia is dependent on the cell over proliferated an the length of the disease course.

Question 2

What are the 4 types of leukaemia and what cells do they affect?

Answer 2

• Acute lymphoblastic Leu - lymphoblasts
• Chronic lymphoid Leu - just B lymphocytes
• Acute myeloid Leu - myeloblasts
• Chronic myeloid Leu - neutrophils, basophils and eosinophils

SO chronic leukaemia affects the cells that are further down the blood cell genesis graph - Chronic takes a longer time to get down the cell line.

Question 3

Tell me about AML.

Answer 3

• RF = down’s, previous chemo or radiation exposure, increased age, CML, polycythaemia
• Sx -anaemia, neutropoenia (frequent infection, functioning neutrophils low), thrombocytopenia, hepatosplenomegaly, gum hypertrophy, bone pain, skin involvement.
• French-America-British classification

Question 4

How is acute myeloid leukaemia treated?

Answer 4

• chemo - curative or palliative - long periods - mainly daunorubicin
• allogenic bone marrow transplant - sibling or from a database.
• cyclophosphamide + total body irradiation post pre transplant & cyclosporin +/- MTX after to prevent graft rejection

Question 5

Tell me about CML.

Answer 5

• uncontrolled proliferation of myeloid cells (basophils, eosinophils, neutrophils)
• found in 60-70, maybe incidental
• > 95% have Philadelphia chromosome - w/o prognosis = worse
• Sx - ya blood Ca stuff + >75% massive splenomegaly, bleeding
• Ix- bone marrow= hyperplasic, ph Cr on cyctogenetic testing

Question 6

Treatment for CML?

Answer 6

• imatinib - tyrosine kinase inhibitor - FIRST LINE
• interferon
• bone marrow transplant

Question 7

Tell me about ALL?

Answer 7

• most common malignancy of children
• genetic disposition + environmental trigger
• can have CNS involvement common
• RF= down’s, ionising radiation
• Sx - bone marrow failure sx + neuro (cranial nerve palsy, meningism), INFECTION
• Ix - bone marrow biopsy (lots of blast cells), Xray (LN involvement), LP for in CNS involvement

Question 8

What infections can children with ALL present with?

Answer 8

• PCP
• oral candidiasis
• skin infections
• peri-anal infection
• bacterial sepsis

Question 9

Treatment for ALL?

Answer 9

• supportive - IV fluids, blood transfusion, ALLOPURINOL
• infection management promptly
• Chemotherapy - induce remissionm
• allogenic bone marrow transplant

Question 10

Tell me about CLL?

Answer 10

• Most common leukaemia
• gradual accumulation of B lymphoctyes in bone marrow, bone and nodes
• generally affects older males
• anaemic and infection prone
• severe = weight loss, night sweats, fevers
• often ASYMPTOMATIC incidental finding on FBC
• disease course variable - autoimmune, (ITP/haemolysis), aggressive lymphadenopathy, death from infection
• BINET staging - A-C - A=<3nodes, B=>3 or more nodes C= thrombocytopaenia and/or anaemia

Question 11

What tests are done for CLL? Treatment for it too?

Answer 11

• blood film - shows smudge cells (smear cells)
• immunophenotyping

-nothing, chemo, rituximab, bone marrow transplant, support care

Question 12

Complications of CLL?

Answer 12

• hypogammoglobulinaemia - infection
• warm haemolytic anaemia
• progression to high grade lymphoma

Question 13

What is ritcher’s syndrome?

Answer 13

• CLL transforms into high grade lymphoma
• B cell enters lymph node and changes into high grade fast growing NHL
• lymph node swelling
• fever w/o infection
• weight loss, night sweats, nausea, abdo pain