Leukaemias

Question 1

Leukaemia

Answer 1

Group of heterogenous neoplastic disorders of white blood cells.
Two types divided by origin - myeloid or lymphoid.
Designated acute or chronic

Question 2

Presentation in general

Answer 2

Acute leukaemias - haemorrhage, anaemia, infection, infiltration of organs
Chronic - asymptomatic, splenomegaly, fever, weight loss, malaise, frequent infections, bleeding, thrombosis, lymphadenopathy

Question 3

Blast phase

Answer 3

Can be seen in chronic leukaemias where clinical manifestations are similar to acute leukaemias

Question 4

Chronic myelogenous leukaemia (CML)

Answer 4

Uncontrolled proliferation of granulocytes and also
proliferation of erythroid cells and megakaryoctyes usually present.
Often asymptomatic but may present with splenomegaly, weight loss, malaise, bleeding, thrombosis.

Question 5

Chronic lymphocytic leukaemia (CLL)

Answer 5

Monoclonal expansion of lymphocytes. 95% cases predominantly malignant clonal disorder of B lymphocytes. 5% secondary to a T-cell clone
Neoplastic cell - hypoproliferative, immunologically incompetent small lymphocyte
1o involvement of bone marrow and 2o release into peripheral spleen and liver.
Most asymptomatic at diagnosis. With progression - lymphadenopathy, splenomegaly, hepatomegaly

Question 6

Acute lymphocytic leukaemia (ALL)

Answer 6

Malignant clonal disorder of bone marrow lymphopoietic precursor cells.
Progressive medullary and extramedullary accumulations of lymphoblasts present that lack potential for differentiation and maturation - inhibition of normal development of haematopoietic cell elements occurs
Progressive weakness & fatigue 2o to anaemia, infection 2o to leukopenia and bleeding 2o to thrombocytopenia

Question 7

Acute myelogenous leukaemia (AML)

Answer 7

Neoplastic disorders of haematopoeitic precursors cells of bone marrow.
6 categories depending on morphology
Not a rapidly proliferating neoplastic cell disorder. Failure of maturation of neoplastic cell clone exists - bone marrow gradually replaced by blast cells
Progressive anaemia, leukopenia, thrombocytopenia.

Question 8

AML (Toronto notes)

Answer 8

rapidly progressive malignancy characterised by failure of myeloid cells to differentiate beyond the blast stage
Median age: 65yo
10-15% childhood leukaemias
Uncontrolled growth of blasts in bm - suppression of normal haemotpoetic cells, appearenace of blasts in peripheral bloods, accumulato of blasts in other sites (e.g. gums, skin), megabolic consequences (tumour lysis syndrome)
Clinically: anaemia, thrombocytopenia, neutropenia, skeletal pain & bone tenderness due to accumulation of blasts in bone marrow, organ infiltration