Oncology - Leukaemia Flashcards

1
Q

Definition

A

Acute lymphoblastic leukaemia = proliferation of lymphoblasts, most commonly of the B cell lineage.
- MC cancer in children and associated with Down Syndrome
- t(12;21) MC cytogenic abnormality in children

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2
Q

Epidemiology

A
  • Bimodal age distribution: 4-5 years and 50 +
  • Previous chemotherapy
  • Radiation exposure
  • Down syndrome: X 20
  • Benzene exposure: painters, petroleum, rubber, manufacturers
  • Family history
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3
Q

Pathophysiology

A

Genetic aberrations result in the excessive proliferation of lymphoblasts which accumulate in the bone marrow leading to bone marrow failure, with subsequent anaemia and thrombocytopenia . Lymphoblasts ‘leak’ into the blood and can invade a number of tissues, including the testicles, meninges, and kidneys.

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4
Q

Signs

A
  • Lymphadenopathy
  • Hepatosplenomegaly
  • Pallor
  • Flow murmur due to anaemia
  • Parotid infiltration
  • Testicular swelling: due to testicular involvement
  • Central nervous system (CNS) involvement e.g. meningism, and cranial nerve palsy
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5
Q

Symptoms

A
  • Fatigue
  • Loss of appetite
  • Easy bruising, prolonged bleeding and mucosal bleeding: due to thrombocytopaenia
  • Bone pain: due to bone marrow infiltration
  • Weight loss
  • Recurrent infections: due to neutropaenia
  • Fever: present in half of patients
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6
Q

Treatment

A

Pre-phase: 5 - 7 days of treatment shortly after diagnosis
- Treat with corticosteroids +/- additional chemotherapy agent

Induction: 4 - 8 week therapy to induce remission, defined as < 5% blast cells in bone marrow
- e.g. corticosteroids , vincristine or doxorubicin (chemotherapy)
- + Imatinib if Philadelphia chromosome-positive
- Intrathecal therapy if there is CNS involvement

Consolidation: Up to 1 year of high-dose chemotherapy , which is started after complete remission
- The aim of treatment is to eliminate clinically undetectable residual leukaemia, hence preventing relapse

Maintenance:
- 2 years of mercaptopurine and methotrexate therapy
- The aim of treatment is to eliminate minimal residual disease (leukemic cells not present on microscopy but cell surface markers still present)

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7
Q

Treatment Second Line

A

Bone marrow transplantation: may be used as consolidation therapy in people at high risk of relapse, or for treating relapse when it occurs

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8
Q

Complications

A

2’ to chemo:
- Myelosuppression and neutropaenic sepsis
- Tumour lysis syndrome
2’ to ALL
- Myelosupression and neutropaenic sepsis
- Extramedullary involvement: CNS, testicular and renal involvement
- Infertility: due to lymphoblastic invasion

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