1.2 Acute Leukaemia Flashcards Preview

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Flashcards in 1.2 Acute Leukaemia Deck (29):
1

define leukaemia:

A spectrum of diseases resulting from a malignant neoplastic proliferations of haemopoietic or lymphoid cells. It results from an acquired mutation in a single stem cell, the progeny of which form a clone of leukaemic cells

2

define acute leukaemia

Malignant transformation in the HSC or early progenitor which causes accumulation of blast cells (early HSC) in the bone marrow.

3

What is the dominant feature of acute leukaemia?

Bone marrow failure

4

What is cytopenia?

reduction in the number of blood cells

5

Define chronic leukaemia

A slowly progressive proliferation of haemopoietic or lymphoid cells. The leukaemic clone often retains some functional capabilities and the clinical disease is indolent. Over time, the disease process becomes more aggressive

6

Who normally gets AML?

adults >60 (most common leukaemia in adults)
M:f 5:3

7

Who normally gets ALL?

Highest incidence in childhood with = M:F

8

What are the features of acute leukeamia?

Bone marrow failure

9

What are the features of bone marrow failure?

Bone marrow failure
Leukopenia (low WCC - fever, infection, mouth ulcers)

Thrombocytopenia (low platelets): bleeding, ecchymoses, petechiae

Anaemia (low RCC): fatigue, SOB on exertion, exacerbation of CCF/IHD

10

What are the features of bone marrow failure?

Leukopenia (low WCC - fever, infection, mouth ulcers)

Thrombocytopenia (low platelets): bleeding, ecchymoses, petechiae

Anaemia (low RCC): fatigue, SOB on exertion, exacerbation of CCF/IHD

11

What are the extramedullary infiltration features of acute leukaemia?

Gingival hyperplasia
Hepatosplenomegaly and lymphadenopathy
Spinal cord compression and paraparesis
Headache and seizures
Nerve palsies
Skin rashe/infiltration

12

What tests can be used to classify leukaemia?

Morphology of cells
Immunophenotyping pattern
Cytogenetics
Molecular testing
Disease behaviour and treatment response

13

What are the AML subtypes with recurrent genetic abnormalaties?

AML with t(8;21) RUNX1-RUNX1T1 


AML with inv(16) CBFβ-MYH11 


AML with t(15;17) PML- RAR α

14

What are the AML subtypes with normal cytogenetics?

AML with mutated NPM1 


AML with FLT–3ITD 


AML with mutated CEBPA

15

What are the three main classifications of AML?

AML with recurrent genetic abnormalities

AML with normal cytogenetics

Therpay related AML

16

What are the 3 main classifications of ALL?

B lymphoblastic leukaemia/lymphoma NOS

B lymphoblastic leukaemia/lymphoma with recurrent genetic abnormalities

T Lymphoblastic leukaemia/lymphoma

17

What is the usual FBC results of someone with leukaemia?

Low Hb, Low platelets, High WCC

18

What will you see in a bone marrow biopsy of leukaemia?

Loss of normal architecture
Loss of fat cells
Deep infiltrate of leukaemic blast cells
Deep blue, basophilic neuclei

19

What will you see in immunophenotyping of AML?

CD33+
CD13+
CD14+
myeloperoxidase +
CD7+/-
HLA-DR+

20

What will you see in immunophenotyping of ALL?

B cell lineage (90%)
CD10+
CD 19+
TdT+
surface or cytoplasmic Ig
T cell lineage (10%)
CD2,3,4,8+/-

21

What are the common genetic mutations of AML?

FLT-3, NPM1, CEBPA

22

What is graft vs. leukaemia

Donor T cells eliminate host malignant T cells

23

What is graft vs, host disease and what are the complications

Occurs when the donor immune cells recognise host cells as foreign and begins to attack them. This can lead to skin rash, diarrhoea, thickening of skin and liver abnormalities

24

What is graft vs, host disease and what are the complications

Occurs when the donor immune cells recognise host cells as foreign and begins to attack them. This can lead to skin rash, diarrhoea, thickening of skin and liver abnormalities

25

What is graft vs. leukaemia

Donor T cells eliminate host malignant T cells (good)

26

What is graft vs, host disease and what are the complications

Occurs when the donor immune cells recognise host cells as foreign and begins to attack them. This can lead to skin rash, diarrhoea, thickening of skin and liver abnormalities

27

What are the general treatment principles in acute leukaemia?

Chemotherapy
Supportive care
Bone marrow transplant
Palliation

Good prognosis AML and ALL have reasonable cure rate with chemo alone

Poor prognosis need bone marrow transplant as well

28

What are the general treatment principles in acute leukaemia?

Chemotherapy
Supportive care
Bone marrow transplant
Palliation

Good prognosis AML and ALL have reasonable cure rate with chemo alone

Poor prognosis need bone marrow transplant as well

29

What are the types of B lymphoblastic leukaemia with recurrent genetic abnormalities?

t(9;22) BCR-ABL
t(12;21) TEL-AML-1
Hyperploidy
Hypoploidy