leukaemia symposium Flashcards
1
Q
what is cancer? 5
A
- transformed cell phenotype
- uncontrolled proliferation
- failure to undergo apoptosis
- genetic= oncogenes, tumour suppressor genes
- epigenetic= dysregulated gene expression, aberrant DNA methylation
2
Q
name 3 myeloproliferative states?
A
- myelofibrosis (causes massive splenomegaly)
- polycythaemia rubra vera (too many red cells)
- essential thrombocythemia (too many platelets)
3
Q
what is chronic myeloid leukaemia? 6
A
- too many white cells
- ‘philadephila chromosome’
- t(2;22) translocation
- FISHing for CML (FISH= fluorescent in situ hybridisation)
- BCR-ABL oncogene
- can occasionally transform into AML
4
Q
what improve survival in CML? 2
A
- imatinib (Gleevec) normalises the blood counts and improves survival in CML (compared to 50% survival at 5 years pre-imatinib
- targeted therapy
5
Q
what is acute myeloid leukaemia? 3
A
- uncontrolled proliferation of primitive cells in the bone marrow
- causes bone marrow failure- anaemia, infections, bleeding
- blasts identified on blood film
6
Q
what are the clinical features of AML? 6
A
- anaemia
- infections
- DIC (disseminated intravascular coagulation)
- ulcers
- infiltration
- bruising
7
Q
how do we diagnose AML? 5
A
- morphology
- immunophenotyping
- genetic tests
- cytogenetic tests
- molecular tests
8
Q
how do we treat AML? 3
A
- Chemotherapy: kills rapidly dividing cells combination regimes, Myelo-ablative cycles of treatment
- Supportive therapy: antibiotics, antifungals, transfusions of blood and platelets
- Allogenic stem cell transplantation: allograft, sibling (1/4 chance of being match) or matched unrelated donor
9
Q
name some supportive measures for AML? 3
A
- Transfusions red cells, platelets, Cryo/FFP
- Antibiotics prophylactic, broad spectrum
- Antifungals
10
Q
what is allogeneic transplantation?
A
- we can harvest stem cells from donors
11
Q
what is the risk of neutropenic sepsis for people with AML? 3
A
- Medical emergency- high risk of death
- Gram -ve bacteria are most dangerous
- Blood cultures and blind antibiotic therapy if fever is over 38 degrees
12
Q
describe graft vs host disease for people with AML? 5
A
- Caused by donor/ host mismatches in major and minor HLA loci
- Results in acute GVH and chronic GVH post-transplant
- Prevented using:
- T-cell depletion of infused donor cells
- Immunosuppression of recipient
13
Q
what are the clinical manifestations of graft vs host disease? 3
A
- Skin rash, sometimes severe
- Diarrhoea, can be bloody
- Deranged liver function can lead to liver failure
14
Q
how does the stem cell transplant cure leukaemia? 2
A
- graft vs leukaemia effect
- donor lymphocyte infusions post transfusion can treat relapse by augmenting the graft vs leukaemia effect
15
Q
how can we cure leukaemia?
A
if you eradicate all the leukemic stem cells
