Leukaemia - Types Flashcards
Who is most likely to get acute lymphoblastic leukaemia?
Children
What are the four major different types of leukaemia?
Acute lymphoblastic leukaemia (ALL)
Acute myelogenous leukaemia (AML)
Chronic lymphocytic leukaemia (CLL)
Chronic myelogenous leukaemia (CML)
Who is most likely to get acute myelogenous (or myelobastic) leukaemia?
Older adults
Who is most likely to get the chronic forms of leukaemias?
Older adults
Describe acute lymphoblastic leukaemia.
Lymphoblasts undergo malignant transformation and proliferation, subsequent replacement of normal marrow elements, leading to bone marrow failure and infiltration into other tissues.
Describe chronic lymphocytic leukaemia.
Cell accumulation in blood, bone marrow, liver, spleen and lymph nodes due to impaired apoptosis.
Translocation/somatic trisomy in which chromosome is present in chronic lymphocytic leukaemia? Loss of function on this chromosome of which gene present results in impaired apoptosis?
Chromosome 12. Loss of function mutation in P2X7 gene.
Describe acute myeloblastic myeloid leukaemia.
Myeloblasts, arrested at an early stage of development with varying cytogenic abnormalities, undergo malignant transformation and proliferation, with replacement of normal marrow elements and bone marrow failure.
Describe chronic myeloid leukaemia.
Malignant transformation and proliferation of stem cells with characteristic chromosomal translocation resulting in the Philadelphia Chromosome.
What is the Philadelphia Chromosome?
An abnormally small chromosome sometimes found in the leukocytes of leukaemia patients.
What is a highly sensitive test for chronic myeloid leukaemia? Why is it highly sensitive?
The presence of the translocation t9:22(q34;q11) which means an elongated chromosome 9 and truncated chromosome 22; 95% of CML sufferers have this abnormality.
What are 5 investigations for acute leukaemias?
- Blood film
- Bone marrow aspirate
- Cytogenic analysis
- Immunophenotyping
- FBC
What are the 6 general principles of management of acute leukaemias?
- Decide if you are going to cure it
- Correct anaemia and thrombocytopenia
- Treat any infection
- Leucophoresis
- Treat hyperuricaemia
- Be aware of tumour lysis syndrome
What is thrombocytopoenia? What are normal and abnormal human platelet counts?
A relative decrease of platelets in blood. Normal human platelet count ranges from 150,000 to 450,000 platelets/ul blood. A common ref to thrombocytopoenia is a platelet count below 50,000 platelets/ul blood.
How would one correct anaemia and thrombocytopoenia?
Blood products, platelet transfusions, fresh frozen plasma in pts with disseminated intravascular coagulation.
What is leucophoresis?
Life-saving, centrifugal removal of blast cells.
What is hyperuricaemia and how is it treated?
It is an abnormally high level of uric acid present in blood. It is treated using allopurinol.
What is tumour lysis syndrome? What causes it?
It is a group of metabolic complications that can occur after cancer (lymphomas and leukaemia) treatment. It is caused by the breakdown products of dying cancer cells.
What are the main differences in the character of acute and chronic leukaemias?
Acute -> characterised by a rapid increase in the number of immature blood cell. Crowding of these cells make the bone marrow unable to produce healthy blood cells.
Chronic -> characterised by excessive build up of relatively mature, but still abnormal, leukocytes. Takes months/years to progress.
What is the difference in treatment of acute and chronic leukaemias?
Acute -> Immediate treatment is required due to the rapid progression and accumulation of the malignant leukocytes. These cells spill over into the bloodstream and spread to other organs of the body.
Chronic -> Sometimes monitored for a long period of time before treatment to ensure maximum treatment efficacy.
What are the differences in cells affected by lymphoblastic and myeloid leukaemias?
Lymphoblastic -> Cancerous change takes place in a type of marrow cell that normally goes on to form lymphocytes (most involve B-lymphocyte).
Myeloid -> Cancerous change takes place in a type of marrow cell that normally goes on to form erythrocytes, some leukocytes and platelets.
What is the FAB classification of the morphological variants of acute myeloid leukaemia?
M0-M7
Which classifications of acute myeloid leukaemia present with gingival hyperplasia?
M4 and M5
What is the main treatment for acute myeloid leukaemia?
Combination chemotherapy and stem cell transplantation
What is the prognosis of acute myeloid leukaemia?
Depends on age of pt.
Cure rate is 40-50% in under 60 y/o and chemo is used (more if there is a bone marrow transplant)
If over 60 y/o there is only a 5-10% long term survival
What is the FAB classification of acute lymphoblastic leukaemia?
L1: small lymphoblasts, scanty cytoplasm
L2: larger, heterogenous lymphoblasts
L3: large lymphoblasts
What are the investigative techniques for acute lymphoblastic leukaemia?
Bone marrow aspiration and bone marrow biopsy (AKA trephine biopsy)
What does a bone marrow aspiration and a trephine biopsy show?
Hypercellularity, immunophenotyping, cytogenetics, cytochemistry
What are all four of the investigative procedures for acute lymphoblastic leukaemia?
- Bone marrow aspiration/trephine biopsy
- Lumbar puncture
- CXR/X-sectional imaging
- Bone radiographs
What are the treatments available for acute lymphoblastic leukaemia?
Combination chemotherapy and stem cell transplant
What are the three phases of combination chemotherapy?
- Remission induction
- Consolidation/Intensification
- Maintenance
What is the prognosis for acute lymphoblastic leukaemia?
Childhood is 70% cure
Adult is 30% cure
