Leukaemia, Lymphoma and Myeloma Flashcards
A child presents with anaemia, neutropenia and thrombocytopenia. What is the likely diagnosis?
Acute lymphoblastic leukaemia.
A 55 year old man is investigated for suspected anaemia. He is found to have anaemia and lymphoctytosis on FBC. Blood film reveals smudge cells. What is the likely diagnosis?
Chronic lymphocytic leaukaemaia
A person with CLL gets recurrent infections. What is the likely complication that occured?
Hypogammaglobulinaemia
An individual with CLL develops anaemia with reticulocytosis, raised LDH and jaundice.
What is the likely diagnosis and treatment?
Warm autoimmune haemolytic anaemia
Treat CLL, then steroids +/- ritixumab
What is Richter’s transformation?
When a CLL patient develops high-grade non-Hodgkin’s lymphoma.
This makes them very unwell suddenly.
A 70 year old man develops anaemia, weight loss and splenomegaly. On FBC granulocytosis and thrombocytosis is seen. Blood film reveals granulocytes at different stages of maturation. What is the likely diagnosis?
Chronic myeloid leukaemia
What is first-line treatment for CML? How does it work?
Imatinib - tyrosine kinase inhibitor.
A 70 year old man, who previously is known to have a myeloproliferative disorder, develops anaemia, neutropaenia, thrombocytopenia and splenomegaly. What is the likely diagnosis?
Acute myeloid leukaemia
Auer rods are seen on blood film. What is the likely diagnosis?
Acute myeloid leukaemia
What leukaemia are smear cells seen in?
Chronic lymphocytic leukaemia
What is bone marrow failure?
Inability for bone marrow to produce blood cells:
Anaemia - low Hb
Infections - low neutrophils
Bleeding - low platelets
What is the 4 approaches to management of acute lymphoblastic leukaemia?
Supportive - fluids, transfusion, allopurinol (to avoid TLS)
Infective - start prophylactic antibiotics, antifungals and antivirals due to neutropenia.
Chemotherapy (vincristine)
Matched related allogenic stem cell transplant (after 1st remission in younger patients)
What is the management of acute myeloid leukaemia?
Supportive - fluids, transfusion, allopurinol (to avoid TLS)
Infective - start prophylactic antibiotics, antifungals and antivirals due to neutropenia.
Chemotherapy (daunorubicin)
Bone marrow transplant (ciclosporin + methotrexate for graft vs host disease prophylaxis)
What are the 4 approaches to management of chronic lymphocytic leukaemia?
If symptomatic: fludarabine + rituximab +/- cyclophosphamide
Radiotherapy - for lymphadenopathy and splenomegaly
Stem-cell transplant - only in selected patients
Supportive - transfusions and IVIg if hypogammaglobulinaemia
What is the prognosis for ALL?
Most children are cured. Nearly half of adults are cured.
Poor prognosis if relapsed.
What is the prognosis of CML?
Median survival of 5-6 years
What is the prognosis of CLL?
Rule of 3rds:
1/3 never progress
1/3 progress slowly
1/3 progress rapidly
Death is usually due to infection or Richter’s transformation