MDS + AML

Question 1

myelodysplastic syndrome

Answer 1

• <20% blasts
• bone marrow cells fail to create blood cells
• variable progression to CML
• 76yrs

Question 2

Acute myeloid lymphoma

Answer 2

• heterogenous clonal malignancy
• Immature myeloid cell proliferation
• > 20% blasts
• Bone marrow failure
• 85-89yrs

Question 3

MDS FBC

Answer 3

• low RBC
• Low WBC
• Low platelets
• Dysplastic features on peripheral blood film

Question 4

AML FBC

Answer 4

• white cells can be anything
• RBC + platelets usually low

Question 5

tests for MDA + AML

Answer 5

• blood - FBC + blood film
• bone marrow aspirate and trephine biopsy

Question 6

Appearance of cells on bone marrow aspirate

Answer 6

MDS:
* 10% dysplasia in any cell line
* Blast 0-19%

AML:
* minimum 20% blasts

Question 7

cause of MDS + AML

Answer 7

somatic gene mutations - not inherited so family history isn’t an indicator

Question 8

No one persons MDS is the same as the next

Answer 8

• genetically and clinically heterogenous
• Effect on blood counts and function of blood cells
• How a person feels and their ability to function day to day
• Huge interplay between MDS and the individuals other heath problems
• Disease behaviour and how it affects an individual can evolve over time

Question 9

Treatment of MDS how to decide what it is

Answer 9

• base depends on their life, comorbidities, severity, symptoms etc
• Got to make that decision w the patient
• Aims are to reduce symptoms, reduce progression to AML, improve QOL
• depends on % of blast as to what it is

Question 10

treatment of MDS low blast % vs high blast %

Answer 10

Low blast:
* stimulate marrow to inc blood cells production
* Alleviate symptoms due to low blood counts
* Low toxicity

High blast %
* reduce leukaemia cell burden with chemo / chemo-like medications
* High toxicity

Question 11

MDS supportive treatments

Answer 11

Anaemia:
* red cell transfusions
* Reduce / treat any associated bleeding contributions to anaemia
* Agents to stimulate erythropoietin

Neutropenia:
* treat infections with antibiotics
* G-CSF injections
* Also used to stimulate stem cell production in healthy stem cell donors

Thrombocytopenia:
* platelet infusions
* Tranexamic acid (improve the ability of platelets to reduce bleeding)
* Drugs to stimulate the bone marrows ability to produce platelets

Question 12

European leukaemia net recommendations

Answer 12

recommendations for treatment with quality of life in mind

Question 13

AML prognosis factors

Answer 13

baseline parameters which dictate survival
* type of AML - eg what mutation
* Age - worse if older
* Comorbidities

Question 14

AML treatment first line if theyre not weak ect

Answer 14

• chemo - combo of drugs
  Need to support fertility
  Clinical trial availability
• IV administered
• Anthracycline (daunorubicin)
• Cytabine
• Potential for targeted therapy in some patients eg tyrosine kinase inhibitors in philidelphia gene
• Hickman / PICC line / portacath insertion

Question 15

other treatments if theyre frail

Answer 15

• less intensive but non-curative
• For older / less fit
• Azacytide
• Low dose subcutaneous cytarabine
• Trial drugs eg targeted therapy
• Also supportive measures like transfusions and antibiotics for infection