Leukaemia

Question 1

Leukemia

Answer 1

Malignancy of blood cells

Question 2

Types

Answer 2

AML
CML
ALL
CLL

Question 3

Acute vs chronic leukemia

Acute - impaired […], resulting in large numbers of […] in the bone marrow;

Chronic - excessive proliferation of […]. Cell differentiation is […].

Answer 3

Acute - cell differentiation, malignant precursor cells

Chronic - mature malignant cells, unaffected.

Question 4

Myeloid vs lymphocytic

myeloid leukaemia commonly arises from a myeloid precursor cell, such as […]. Lymphocytic leukaemia arises from a lymphoid precursor, such as […].

Answer 4

neutrophils
B-cells

Question 5

AML - most common acute leukemia in […]
Features
- Bone marrow failure (anaemia, bleeding, infections)
- Signs of […] - hepatomegaly, […], and […] hypertrophy

Answer 5

adults
infiltration
splenomegaly, gum hypertrophy

Question 6

Diagnosis of AML
- Leucocytosis may be present, but WBCs can also be normal
- […] is required, may show […] rods (cytoplasmic inclusion bodies)

Answer 6

Bone marrow biopsy, Auer

Question 7

AML mx

Answer 7

chemotherapy regimens or bone marrow transplant

Question 8

AML Prognosis
- […] months without treatment
- […] survival rate in 3 years

Answer 8

2
20%

Question 9

ALL - most common cancer in […]

Answer 9

childhood

Question 10

ALL - Features
- symptoms caused by marrow failure (anaemia, bleeding, infection)
- bone pain (infiltration)
Signs include
- painless […]
- hepatosplenomegaly,
- CNS involvement (e.g. […] palsy)
- […] infiltration (resulting in painless […] […] enlargement).

Answer 10

lymphadenopathy
cranial nerve VII, meningism
testicular infiltration unilateral testicular

Question 11

ALL diagnosis
- […] and […] cells on blood film and bone marrow analysis

Answer 11

leucocytosis and blast cells

Question 12

Mx - ALL

Answer 12

chemo

Question 13

Prognosis ALL - in children […] to […] cure rate

Answer 13

70-90%

Question 14

CML - most common is […] patients, with […] slightly more affected.

It is classically associated with the […] chromosome.

Answer 14

middle-aged, males
Philadelphia - part of chromosome 9 moves to chromosome 22 - BcrAbl

Question 15

CML features
- weight […], tiredness, fever, and […].
Common signs include massive […] (>75%), bleeding (due to thrombocytopenia), and […].

Answer 15

loss, sweating (night sweats?)
splenomegaly, gout

Question 16

Diagnosis CML
- Blood tests: […], in particular raised […] cells which include: neutrophils, monocytes, basophils, and eosinophils.
Bone marrow analysis shows similar findings.

Answer 16

leucocytosis, myeloid

Question 17

Mx - CML

Answer 17

Chemo

Question 18

Prognosis - CML

Answer 18

5-6 years survival

Question 19

CLL is most common in […] patients over the age of […]. It is caused by the proliferation of functionally incompetent malignant […] cells.

Answer 19

male, 60, B

Question 20

CLL features
Typically presents […]. However, patients may present with non-tender […], hepatosplenomegaly, or […] (weight loss, night sweats, and fever).
Features of marrow failure (infection, anaemia, and bleeding) are […] common than in the acute leukaemias.

Answer 20

asymptomatically, lymphadenopathy
B symptoms
less

Question 21

CLL diagnosis

The most common initial blood result is an incidental […].

Subsequent blood film shows […] cells, which are cells damaged as they lack a cytoskeletal protein.

[…] is then used to measure particular markers expressed by the malignant cells.

Other tests include bone marrow biopsy.

Answer 21

lymphocytosis
smudge
Flow cytometry

Question 22

CLL mx

Answer 22

chemo

Question 23

CLL prognosis

Answer 23

1/3 of cases don’t progress, 1/3 of cases progress slowly, and 1/3 of cases progress actively.