Leukemia Flashcards
What is the only way to cure CLL?
Allograph
How is flow cytometry used outside of diagnosis?
Follow up detection of clearance of leukaemic cells
What is the first line therapy of CLL?
FCR
F - Fludarabine
C - Cyclophosphamide
R - Rituximab
How is CML monitored?
Measure bcr-abl transcript in blood
What are the second generation tyrosine kinase inhibitors? When are they used?
Dasatinib
Nitolinib
Resistant to imatinib
Cytologically, what is unique about APML?
Faggot cells with lots of auer rods
What is the common leukaemia in adults?
CLL
What is the first line therapy for CML?
Tyrosine kinase inhibitors - Imatinib
Virtually eliminated the need for transplantation
How is leukaemia diagnosed on bone marrow?
Blasts make up >20% of nucleated cells
What are the three stages of CML?
Chronic
Accelerated
Blast
How does risk effect treatment in AML?
Good risk don’t require transplant
Adverse risk require transplant
How do you stratify intermediate risk patients from cytogenetics?
Molecular testing
What are symptoms of acute leukemia?
Symptoms of anaemia - lethargy, SOB, pallor, presyncope
Neutropenia - fever, rigors, infections
Thrombocytopenia - bruising, bleeding
B symptoms - fevers, sweats, weight loss
Lymphadenopathy, hepatosplenomegaly
Symptoms of hyperleucocytosis
How are leukemia classified?
Acute vs chronic
Myeloid vs lymphoid
What are auer rods classic of?
Acute myeloid leukaemia
How is CLL diagnosed with Ix?
Morphology on blood film and marrow
- Small mature lymphocytes, smear cells
- Cytopenia
Immunophenotype
- cells expressing CD5
What is the natural history of CML?
Chronic phase: asymptomatic, up to 5 years
Accelerated: symptoms develop, cytopenias, hepatosplenomegaly
Blast phase: acute leukaemia, full range of myelo-development present on blood film
What is the diagnostic feature of CML?
9;22 philadelphia chromosome and BCL-ABL protein
The philadelphia chromosome and BCR-ABL phenotype is in which type of leukaemia?
CML
When is CLL treated?
Only when they become symptomatic
(LNs, cytopenias, B symptoms)
What is the critical drug used in ALL?
L-asparaginase
What are the mainstays of treatment on AML in Aus?
Cytarabine and anthracycline
1x Induction (high dose)
2x Consoliation (lower dose)
Why do you do cytogenetics in CLL?
You want to know the genetype as
Because 17p deletion doesn’t response to FCR treatment
And deletion of 13p has an indolent course
How does treatment of APML differ from other acute leukaemia?
It’s medical emergency
DIC common
Which cohort of people get CLL?
Elderly
How do you investigate acute leukemia?
FBE and film
Bone marrow biopsy
Immunophenotyping
Cytogenetics
Molecular studies
What is the etiology of leukemia?
Mostly unknown
Other risk factors:
- Previous cytotoxic theray eg adriomycin
- Ionizing radiation
- Chemical exposure
- Infections - adult T cell leukemia lymphoma and HTLV-1 (not common in Aus)
- Genetic - trisomy 21
- Rare familial syndromes
Which cytogenetic type has the worst prognosis in CLL?
17p deletion
Or other TP53 mutation (that isn’t a 17p deletion)
How are chronic leukaemias usually diagnosed?
On screening FBE for other conditions
How do you manage APML acutely?
Correct coagulopathy with platelets, cryoprecipitiate and fibrinogen
And all trans retinoic acid (ATRA) and arsenic as soon as possible - this very curative (98%, 5 yearly survival)
When is blasts in the peripheral blood normal?
Never
