leukaemia symposium

Question 1

what is cancer?

Answer 1

• transformed cell phenotype: uncontrolled proliferation, failure to undergo apoptosis
• genetic: oncogenes, tumour suppressor genes
• epigenetic: dysregulated gene expression, aberrant DAN methylation

Question 2

what are the clinical features of cancer?

Answer 2

• myelofibrosis (causes splenomegaly)
• polycythemia rubra vera (too many red cells)
• essential thrombocythemia (too many platelets)

Question 3

what is JAK-STAT signalling?

Answer 3

signal transduction pathways for EPO and G-CSF

Question 4

what is acute myeloid leukaemia?

Answer 4

• uncontrolled proliferation of primitive cells in the bone marrow
• causes bone marrow failure: anaemia, infections, bleeding
• blasts identified on blood film

Question 5

what are the clinical features of myeloid leukaemia?

Answer 5

• anaemia
• infections
• DIC
• ulcers
• infiltration
• bruising

Question 6

how is acute myeloid leukaemia treated?

Answer 6

• chemotherapy kills rapidly dividing cells: combination regimes, myelo-ablative cycles of treatment
• supportive therapy: antibiotics, antifungals, transfusions of blood and platelets
• allogenic stem cell transplantations: allograft (full or reduced intensity)

Question 7

what are the supportive measures for acute myeloid leukaemia?

Answer 7

• transfusions: red cells, platelets, cryo/FFP
• antibiotics: prophylactic, broad spectrum
• antifungals

Question 8

what are the risk of neutropenic sepsis?

Answer 8

• medical emergency
• gram -ve bacteria are most dangerous
• blood cultures and blind antibiotic therapy if fever >38 degrees
• 1st line - Tazocin +/- gentamicin
• 2nd line - wtich to meropenem +/- teicoplanin (for gram +ve)
• 3rd line - add antifungal
• resuscitate patient with iv fluids if hypotensive
• may require inotropic support on ICU

Question 9

what is graft vs host disease?

Answer 9

• caused by donor/host mismatches in major and minor HLA loci
• results in acute GVH and chronic GVH post transplant
• prevented by using: T cell depletion of infused donor cells or immunosuppression of recipient
• effect how the stem cell transplant cures leukaemia
• donor lymphocyte infusions post Tx can treat relapse by augmenting GVL effect

Question 10

what are the clinical manifestations of graft vs host disease?

Answer 10

• skin rash
• diarrhoea
• deranged liver function