Leukaemias

Question 1

What is a leukaemia?

Answer 1

A group of blood cancers associated with an increase in white blood cells

Question 2

Give two types of acute leukaemia?

Answer 2

Acute myeloid leukaemia (AML)

Acute lymphoblastic leukaemia (ALL)

Question 3

Give two types of chronic leukaemia?

Answer 3

Chronic myeloid leukaemia (CML)

Chronic lymphocytic leukaemia (CLL)

Question 4

What are the three primitive compartment leukaemias?

Answer 4

Acute myeloid leukaemia
Acute lymphoblastic leukaemia
Chronic myeloid leukaemia

Question 5

What is the less primitive compartment leukaemia?

Answer 5

Chronic lymphocytic leukaemia

Question 6

In which cells will chronic myeloid leukaemia arise from in haemopoiesis?

Answer 6

Stem cells

Question 7

In which cells will acute myeloid leukaemia and acute lymphoblastic leukaemia arise from in haemopoiesis?

Answer 7

Multipotent progenitor cells

Question 8

In which cells will chronic lymphocytic leukaemia arise from in haemopoiesis?

Answer 8

Mature B-cell lymphocytes

Question 9

What is chronic myeloid leukaemia?

Answer 9

A clonal stem disorder in the primitive compartment

Excessive proliferation (neutrophils, platelets) and preserved maturation

Question 10

What chromosome is impacted in chronic myeloid leukaemia?

Answer 10

Philadelphia chromosome
(BCR-ABL1 re-arrangement)

Question 11

Which cells are produced excessively in chronic myeloid leukaemia?

Answer 11

Granulocytes and precursor cells

Question 12

What is acute myeloid leukaemia?

Answer 12

A malignant disease of primitive myeloid cells resulting in proliferation with blocked differentiation / maturation

This causes pancytopenia and cells cannot be differentiated as they all look the same

Question 13

What is acute lymphoblastic leukaemia?

Answer 13

A malignant disease of primitive lymphoid cells resulting in proliferation with blocked differentiation / maturation

Causes an excess of lymphoblasts that do not differentiate

Question 14

What is acute leukaemia defined as?

Answer 14

An excess of ‘blasts’ in either the peripheral blood or bone marrow

Question 15

What is the most common haematological childhood cancer?

Answer 15

Acute lymphoblastic leukaemia

Question 16

What is the clinical presentation of acute lymphoblastic leukaemia?

Answer 16

Anaemia, infections, bleeding

Leukaemic effects - high count with obstruction of circulation, involvement of areas outside the marrow and blood

Question 17

How would a coagulation defect of AML present?

Answer 17

DIC in acute promyelocytic leukaemia

Question 18

What investigation should be done in the investigation of acute leukaemia?

What else can be done?

Answer 18

Morphology - blood count + film

Coagulation screen - ‘DIC’
Bone marrow aspirate

Question 19

What is morphology used for in haematological investigations?

Answer 19

To see what the cells look like

Question 20

What is immunophenotyping used for in haematological investigations?

Answer 20

To ascertain if there are lineage-specific proteins on / in cells

Question 21

What investigation is definitive for distinguishing between acute myeloid leukaemia and acute lymphoblastic leukaemia?

Answer 21

Immunophenotyping

Question 22

What are cytogenetics + molecular genetics (NGS) used for in leukaemia investigations?

Answer 22

Diagnostic utility
Prognostic significance

Question 23

How is acute myeloid leukaemia treated?

Answer 23

Supportive care and multi-agent chemotherapy

Up to 2-3- years of targeted treatment, CNS-directed treatment and immunotherapy

Question 24

How is acute lymphoblastic leukaemia treated?

Answer 24

Supportive care and multi-agent chemotherapy

Intensive chemotherapy for 3-4 cycles - prolonged hospitalisation

Question 25

Which type of bacteria can cause fulminant life-threatening sepsis in neutropenic patients?

Answer 25

Gran negative bacteria

Question 26

What are three problems of marrow suppression?

Answer 26

Neutropenia Anaemia Thrombocytopenia - bleeding

Question 27

How is treatment for leukaemia administered to a patient?

Answer 27

Hickman-line

Question 28

What can prolonged neutropenia make patients more susceptible to?

Answer 28

Fungal infections

Question 29

Give some complications of anti-leukaemic treatment?

Answer 29

Nausea + vomiting Hair loss Liver, renal dysfunction Infection

Question 30

What should be done if a bacterial infection occurs as a complication of anti-leukaemic treatment?

Answer 30

Empirical treatment with broad spectrum antibiotics as soon as a neutropenic fever develops

Question 31

What is chronic lymphocytic leukaemia (CLL)?

Answer 31

A malignant clonal lymphoproliferative disorder of the mature B lymphoid compartment

Question 32

What is typically involved in chronic lymphocytic leukaemia?

Answer 32

Lymph nodes, liver and spleen

Question 33

What clinical features can be seen in chronic lymphocytic leukaemia?

Answer 33

Often asymptomatic Non-specific complaints - fever, fatigue, night sweats, weight loss

Question 34

Which infections are chronic lymphocytic leukaemia patients more susceptible to?

Answer 34

Community acquired bacterial infections

Question 35

Why should we be concerned for immunocompromised CLL patients?

Answer 35

They have an increased risk of infection

Question 36

When will Coomb's test be positive?

Answer 36

In the presence of (autoimmune) haemolysis

Question 37

Which important bleeding disorder can be found in some patients with CLL?

Answer 37

Autoimmune thrombocytopenia

Question 38

Which investigations could be used in the diagnosis of chronic lymphocytic leukaemia?

Answer 38

Morphology Immunophenotyping Genetic testing DAT - direct antibody testing

Question 39

What is suggestive of chronic lymphocytic leukaemia in morphology?

Answer 39

Smear cells

Question 40

What management options are there for patients with chronic lymphocytic leukaemia?

Answer 40

Chemotherapy Targeted treatments - kinase inhibitors