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IMED2002 > Leukaemia Part 1 > Flashcards

Leukaemia Part 1 Flashcards

1
Q

What are the 4 types of leukemia?

A

Acute lymphoblastic leukaemia

Acute and chronic myeloid leukemia

Chronic lymphocytic leukemia

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2
Q

What is a leukaemia?

A

A group of cancers that happen in the bone marrow resulting in increased numbers of abnormal white blood cells and suppress normal blood cell production.

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3
Q

How is leukaemia diagnosed?

A

Clinical features (symptoms and signs that appear)

Full Blood Count and Blood film

Bone marrow morphology

Flow cytometry

Genetic studies (cytogenic and molecular studies)

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4
Q

How is blood film different in leukaemia than normal blood film?

A

In normal blood film there is diversity in the type of cells that are present. In leukaemia there is a lot of a single kind of leukaemia

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5
Q

Where is a bone marrow biopsy taken to diagnose leukaemia?

A

Pelvis, vertebra

Sternum, ribs

Femur, tibia

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6
Q

What types of samples are taken during a bone marrow biopsy?

A

Trephine biopsy and a bone marrow aspirate

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7
Q

What is a bone marrow trephine?

A

A piece of the bone marrow is taken out and assessed on a slide

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8
Q

What is a bone marrow trephine used for?

A

Assessment of bone marrow architecture and pattern of any abnormal population.

Cellularity of bone marrow is also easy to visualize in a trephine

Trephine is a more macroscopic view of the bone marrow. To take a deeper look an aspirate is taken.

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9
Q

What does the bone marrow aspirate give?

A

Demonstrates fine cytological and morphological details. These samples are used for flow cytometry and cytogenetic studies

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10
Q

How is a bone marrow aspirate prepared?

A

They are either squished together or spread out on a slide

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11
Q

What is flow cytometry?

A

Laser-based technology employed in antigen detection.

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12
Q

What genetic studies are employed for detection of leukemia?

A

Cytogenetic studies (studying chromosomes)

Molecular studies (studing DNA)

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13
Q

What are the types of cytogenetic studies that can be employed for diagnosis of leukemia?

A

Karyotyping

Fluorescence in situ hybridization (FISH)

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14
Q

What happens to chromosomes on a karyotype of someone with leukaemia?

A

Extra chromosomes at several regions

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15
Q

What does a normal FISH look like and what does an abnormal FISH look like?

A

Normal FISH: Chromosome that is lit up would exist as a pair.

Abnormal FISH: Single chromosome lights up fully and another one either doesn’t light up or half lights up meaning there is an issue with one of the genes being probed for

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16
Q

What molecular studies of cells with leukaemia can be done?

A

PCR followed by:

One gene - Sanger’s sequencing

Multiple genes - Next gen sequencing

17
Q

What is the difference between myeloid and lymphoid leukaemia?

A

Myeloid occurs in cells of myeloid origin

Lymphoid occurs in cells of lymphoid origin

18
Q

What is the difference between acute and chronic leukaemia?

A

Acute: Rapid proliferation of myeloid/lymphoid progenitor cells without reaching maturity and progresses rapidly needing immediate treatment.

Chronic: Proliferation is fast but maturation is normal and so disease progresses slowly and immediate treatment is not usually required.

19
Q

How is acute leukaemia treated?

A

Chemotherapy with or without stem cell treatment

20
Q

How common is acute lymphoblastic leukaemia?

A

3.4/100000 and most commonly seen in children

21
Q

What are the types of Acute Lymphoblastic Leukaemia?

A

B-lineage (85% of ALL in children)

T-lineage (15% of ALL in children)

22
Q

What are the signs and symptoms of ALL?

A

Blood film (Anaemia, Leucopenia, Thrombocytopenia, “blast” cells in large numbers)

Lethargy

Infections, fevers

Bleeding, bruising

Bone pain, weight loss, loss of appetite

Enlarged liver and spleen

Enlarged lymph nodes

Pale, conjunctival pallor

Bruises

23
Q

What does pancytopenia refer to?

A

Reduction in all types of cells

24
Q

What does Full Blood Count show in ALL?

A

Pancytopaenia and blast cells

25
Q

What does blood film show in ALL?

A

Lymphoblasts

Pancytopaenia

26
Q

What is used to indicate blast cells?

A

The presence of nucleoli within a large nucleus and vacuolation

27
Q

What does bone marrow trephine sample look like in ALL?

A

Hypercellular and pale cells

28
Q

What shows up on bone marrow aspirate in ALL?

A

Small lymphoblasts (nucleoli, little cytoplasm, and no granules)

B and T cells can’t be differentiated via this method

29
Q

What appears on flow cytometry of ALL?

A

1 type of cell instead of many types of cells.

30
Q

How can B and T cells be distinguished via flow cytometry?

A

B-ALL would show lots of CD10 and CD19

T-ALL would show CD3 and CD34

31
Q

What is a favourable prognosis in B-ALL on the karyotype?

A

hyperdiploidy (>46 chromosomes) as opposed to the poor prognosis of hypodiploidy

32
Q

How is ALL treated?

A

Multiagent chemotherapy (Induction, Consolidation Maintenance, Treatment protocols based on risk)

Allogeneic Stem Cell Transplant

Transfusion and Antimicrobial Support

33
Q

What is the 5 year survival rate of ALL?

A

85%

34
Q

What does induction chemotherapy do?

A

Try eradicate as much lymphoblast as possible to salvage bone marrow as much as possible to trigger normal production again

35
Q

What does consolidation chemotherapy do?

A

Additional chemotherapy is done following induction for 6 - 12 months at milder doses to eradicated invisible malignant cells.

36
Q

What is maintenance chemotherapy?

A

3 - 5 year chemotherapy program in milder doses based on risk (from prognosis)

37
Q

What is an allogeneic stem cell transplant?

A

A transplant of entire immune system

IMED2002 (29 decks)

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