Leukemia Flashcards
What are the 4 types of leukemia
Acute lymphoblastic
Chronic lymphocytic
Acute myeloid
Chronic myeloid
What is acute lymphoblastic leukemia
Acute malignant transformation of a clone of lymphoid progenitor cells
Clinical presentation of acute lymphoblastic leukemia
Bone marrow failure: Anaemia, Bleeding, Infection Bruising SoB Purpura Malaise Weight loss Night sweats
Bone pain (Hepatoslenomegaly more chronic) Fatigue Dizziness Palpitations
Pathophysiology of acute lymphoblastic leukemia
Uncontrolled proliferation of precusor B or T cells
-> Accumulation of leukaemic cells in bone marrow, peripheral blood and other tissues.
Also a reduction in red cells, platelets and neutrophils
Often spreads to CNS
Genetic Aetiology of acute lymphoblastic leukemia
Down’s syndrome 20x risk
Pregnancy
Environmental Aetiology of acute lymphoblastic leukemia
Chemicals (benzene compounds)
Drugs (alkylating agents)
Ionising Radiation exposure
Epidemiology of ALL
Most common cancer in children
Diagnosis of ALL
Peripheral blood film - anaemia and thrombocytopenia
Bone marrow aspirate - Leukaemic blast cells
Treatment of ALL
Chemotherapy
Intrathecal methotrexate
Follow up maintenance
What chemotherapy drugs are given in the treatment of ALL
Vincristine, Dexamethasone, Asparaginase and Daunorubicin
Prognosis of ALL in children compared with adults
Children = excellent prognosis (1 in 5 die) Adults = poorer prognosis, only 30% cured
Which leukemia would show smudge cells in histological analysis
Chronic Lymphocytic Leukemia
Which leukaemia would show auer rods in histological analysis?
Acute myeloid leukemia
Which leukaemia has a propensity to involve the CNS?
Acute Lymphoblastic leukemia
What is chronic lymphocytic leukaemia
Chronic malignant transformation of a clone of mature lymphoid cells
Early clinical presentation of chronic lymphocytic leukaemia
Asymptomatic (indolent), but isolated lymphocytosis is frequent
Clinical presentation of chronic lymphocytic leukaemia when symptomatic
Bone marrow failure Nontender lymphadenopathy Hepatosplenomegaly Malaise Weight loss Night sweats
Anaemia
Bleeding and Infection due to bone marrow failure
Rubbery lymph nodes
Pathophysiology of chronic lymphocytic leukaemia
Uncontrolled proliferation and accumulation of mature B (or T) cells.
Autoimmune haemolysis can occur causing anaemia
Aetiology of chronic lymphocytic leukaemia
Genetic: Mutation (11q or 17p deletion for example)
Epidemiology of CLL
Most common leukaemia in the western world
Diagnostic tests of CLL
FBC - Anaemia, raised White cell
Blood film - smudge cells
Treatment of CLL
Incurable
Chlorambucil (with or without) prednisolone) -> decreases blood count -> Decreases lymphadenopathy and splenomegaly
What is the most common cancer in children?
Acute lymphoblastic leukaemia
What is the most common cancer in the Western world
Chronic lymphocytic leukaemia
What is Acute Myeloid leukaemia
Acute malignant transformation of a clone of myeloid progenitor cells
Clinical presentation of Acute Myeloid leukaemia
Fatigue, dizziness and palpitations.
Anaemia, bleeding and infection due to bone marrow failure.
Hepatosplenomegaly
Malaise, weight loss, night sweats
Pathophysiology of Acute Myeloid leukaemia
Accumulation of leukaemia cells in bone marrow, peripheral blood and other tissues.
Additionally a reduction in red cells, platelets and neutrophils.
Rapidly progressing
Aetiology of Acute Myeloid leukaemia
Exact cause unknown Risk factors include: Myeloproliferative disease Alkylating agents Ionising radiation exposure Down's syndrome
Epidemiology of Acute Myeloid Leukaemia
Most common leukaemia in adults
Most common in older adults and elderly
Diagnostic tests of Acute Myeloid Leukaemia
Peripheral blood film - anaemia, thrombocytopenia, AUER RODS (diagnostic)
Bone Marrow Aspirate - Leukaemia blast cells
Low risk Treatment of AML
Chemotherapy in intervals to allow marrow recovery
Intermediate treatment of AML
Chemotherapy followed by allogenic bone marrow transplant
High risk treatment of AML
Only curable with allogenic BM transplantation
What is Chronic Myeloid Leukaemia
Chronic malignant transformation of a clone of myeloid cells
Clinical presentation of Chronic Myeloid Leukaemia
Insidious onset, fever, malaise, weight loss, (night) sweating.
Bone marrow failure, anaemia.
Massive splenomegaly.
Untreated, this lasts 3-4 years before progressing
Pathophysiology of Chronic Myeloid Leukaemia
Insidious onset lasts 3-4 years ->Blast transformation -> Acute myeloid leukaemia -> death
Aetiology of CML
Ionising radiation is risk factor Genetic: 95% of cases: Philadelphia chromosome: reciprocal translocation (t(;22)), creating fusion gene (BCR-ABL) with tyrosine kinase activity which alters cell growth
Diagnostic tests of CML
FBC - anaemia, raised WBCs
Cytogenetics - Philadelphia stage
Treatment of CML
Imatinib (tyrosine kinase inhibitor)
If in acute stage = chemotherapy
Allogeneic stem cell transplantation in <60 possible
Sequelae of CML
AML
Myelofibrosis
Leukaemia complications
Death Increased risk of infection Haemorrhage: pulmonary, intracranial Depression Complication of chemotherapy
Investigations
Bloods - FBC, WCC, platelets, U and Es, LFTs, ESR, CRP
Bone marrow biopsy, lymph node biopsy
Radiology - x-ray, ultrasound scan, CT scan, MRI
How are ALL and AML classified
French-American-British (FAB) classification
Conservative treatment of leukaemia
Patient education
Refer to Macmillan nurses
Medical treatment of ALL
Induce remission and maintenance
To induce remission:
Dexamethasone, Vincristine, Anthracycline antibiotics, Cyclophosphamide
Maintenance:
Methotrexate, Mercaptopurine, Cytarabine, Hydrocortisone
Medical treatment of AML in patients <60
Chemotherapy with an anthracycline and cytarabine or methotrexate
Medical treatment of AML in patients >60
Palliative anthracycine, cytarabine or mitoxantrone
What would you add to therapeutic regime if M3 type AML (Acute Promyelocytic leukemia - APML)
All-trans retinoic acid
