Acute Leukaemia

Question 1

what is acute leukaemia

Answer 1

haematopoietic blast cells constitute >20% bone marrow cells

Question 2

what is the most common type of malignancy in childhood

Answer 2

ALL

Question 3

when does AML occur

Answer 3

at all ages

Question 4

clinical features

Answer 4

short hx symptoms due to bone marrow failure- anaemia, abnormal bruising/bleeding, infection; weating, fever, weight loss, malaise

Question 5

what signs are present

Answer 5

lymphadenopathy and hepatosplenomegaly freq especially in ALL

Question 6

what is common in promyelocytic AML

Answer 6

DIC

Question 7

lab features

Answer 7

anaemia, thrombocytopenia, neutropenia. leucocytosis. infiltration by blast cells.

Question 8

good prognostic features in ALL

Answer 8

female, 2-9 years, low WCC, absent extramedullary disease, 4 weeks remission speed, 1 week clearance peripheral blood blasts, negative minimal residual disease in bone marrow at 1-3m

Question 9

good prognostic indicators in AML

Answer 9

remission after one course chemo.

Question 10

what can AML be a result of (iatrogenic)

Answer 10

chemo treatment eg for lymphoma

Question 11

what is AML associated with

Answer 11

myelodysplastic states, radiation, syndromes. progresses rapidly

Question 12

what rods are diagnostic of AML

Answer 12

auer rods

Question 13

what is the first stage of treatment

Answer 13

remission induction- high dose intensive combination chemo - reduce or eradicate leukaemic cells from bone marrow, re establish normal haemopoiesis. post induction chemo- initially intensive then for ALL less- maintenance chemo

Question 14

what is remission

Answer 14

normal FBC,

Question 15

treatment AML

Answer 15

anthracycline- daunorubicin, cytosine arabinoside.

Question 16

prognosis AML

Answer 16

80% 85% with 2 courses. 30-50% cured 15-55yrs

Question 17

treatment ALL

Answer 17

remission induction with vincristine, dexamethasone and L-asparaginase; often with daunorubicin or cyclophosphamide.

Question 18

what is maintenance and how long for in AML

Answer 18

mercaptopurine daily, weekly methotrexate, monthly vincristine and dexamethasone. for further 2-3 years

Question 19

what system is commonly involved in ALL

Answer 19

CNS- so give intrathecal methotrexate and high dose systemic chemo

Question 20

when can stem cell transplant be used

Answer 20

allogeneic stem cell transplantation in adults

Question 21

prognosis ALL

Answer 21

80% children cured

Question 22

what is tumour lysis syndrome

Answer 22

metabolic abnormalities due to the massive destruction of cells. hyperkalaemia, incr urate, decr calcium, renal injury

Question 23

treatment tumour lysis syndrome

Answer 23

fluid intake and allopurinol

Question 24

side effects cancer treatment

Answer 24

tumour lysis syndrome, hyperviscosity, DIC, neutropenic sepsis

Question 25

what happens in hyperviscosity

Answer 25

if WCC >100x10^9/l thrombi in brain, lungs, heart.

Question 26

treat hyperviscosity

Answer 26

lower WCC with hydroxycarbamide, transfusion

Question 27

what is neutropenic sepsis

Answer 27

neutrophils

Question 28

treatment neutropenic sepsis

Answer 28

piperacillin-tazobactam (tazocin)

Question 29

what treatment can you give in promyelocytic leukaemia

Answer 29

trans retinoic acid