Leukaemia - Acute Lymphoid Leukaemia

Question 1

Epidemiology

Answer 1

ALL CeLLmates have CoMmon AMbitions
< 5 YEARS or +45
White males

Question 2

Risk Factors

Answer 2

Previous chemotherapy
Radiation exposure
Down syndrome
Benzene exposure
Family history

Question 3

Pathophysiology

Answer 3

Children = t(12:21)
Adults = Philadelphia chromosome = t(9:22) = BCR-ABL gene fusion
Excess proliferation of lymphoblast and subsequent anaemia

Question 4

Signs

Answer 4

Lymphadenopathy
Hepatosplenomegaly
Pallor
Flow murmur (severe anaemia)
Parotid infiltration
Testicular swelling (due to testicular involvement)
CNS involvement = meningism + cranial nerve palsies

Question 5

Symptoms

Answer 5

Fatigue
Loss of appetite
Easy bruising, prolonged bleeding, mucosal bleeding
Bone pain: due to bone marrow infiltration
Weight loss
Recurrent infections + fever

Question 6

Investigations

Answer 6

FIRST LINE = FBC + blood film
- pancytopenia
GOLD STANDARD = bone marrow aspiration (atleast 20% lymphoblasts present in bone marrow)
Immune phenotyping = differentiating between AML, and ALL
CXR + CT = lymphadenopathy = widened mediastinum

Question 7

Treatment

Answer 7

FIRST LINE =
- Prednisolone
- Chemo - Vincristine or Doxorubicin
+ Imatinib (Philadelphia chromosome)
SECOND LINE =
- bone marrow transplant (definitive)
Maintenance = methotrexate
Supportive = blood transfusions, prophylaxis