Acute Leukaemia

Question 1

What is acute leukaemia?

Answer 1

The accumulation of early MYELOID or LYMPHOID precursors in the BONE MARROW and other tissues

Question 2

What is leukaemia usually the result of?

Answer 2

Mutations in haemopoietic stems cells

• Cannot differentiate into mature blood cells

Question 3

What are the two main types of leukaemia?

Answer 3

Lymphoid leukaemia

Myeloid leukaemia

(further divided into various subgroups)

Question 4

What are the features of blast cells in AML?

Answer 4

• High nucleus:cytoplasm ratio

- presence of granule

Question 5

What are the feature of blast cells in ALL?

Answer 5

Higer nucleus:cytoplasm ration (very little cytoplasm)

• smaller than AML blasts
• rounder

Question 6

What are the clinical features of acute leukaemia? What are the specific

Answer 6

Anaemia - hypochromic, microcytic

Infection (immunocompromised e.g. candida, perianal infection - E coli, strep faecalis)

Early bruising/haemorrhage - thrombocytopenia

Organ infiltration by leukaemia cells e.g. spleen, liver, meninges, testes, skin

Question 7

How is acute leukaemia diagnosed?

Answer 7

Morphology - look at cells!

Immunological markers**

Cytogenetics

Question 8

How are acute myeloid leukaemia classified? What are the two classification systems and what do they look at?

Answer 8

French American and British (FAB) - morphological features - see different points in maturation

WHO - risk adapted

Question 9

How does immunological markers work?

Answer 9

Monoclonal antibodies with fluorochrome attached added

Attached to cell surface antigens

Fluorochrome absorbs light and releases wavelength

• Indicates presence of antigens which = diagnostic

Question 10

What is trisomy 9:22? (T(9;22))

Answer 10

Philadelphia chromosome - driver for chronic myeloid leukaemia

Question 11

What cytogenetic abnormalities are associated with a good and bad prognosis of Acute leukaemia?

Answer 11

T(15:17) (T8:21) = good prognosis

Mysomy -5, -7 = bad

Question 12

What type of chromosomal abnormalities are associated with ALL?

Answer 12

Abnormalities in number of chromosomes

Question 13

What are the poor prognostic factors for ALL?

Answer 13

• Increasing age (>10yrs)
• High white cell count (>50)
• Male
• Cytogenetic abnormalities (discussed)
• T cell - ALL (worse than B-cell ALL)

Question 14

What genetic mutations are associated with a good and poor diagnosis?

Answer 14

NPM1 = good

FLT3 - bad

Question 15

What is the management for AML?

Answer 15

Chemotherapy - 4 courses - 2 intensive, 2 consolidation (obtain remission)

Bone marrow transplant in young patient

Question 16

What is the management for ALL?

Answer 16

Induction and intensive consolidation chemotherapy

Prophylaxis of meningeal leukaemia with methotrexate

Bone marrow transplant in bad risk patients

Question 17

What is neutropenic sepsis? How is it diagnoses>

Answer 17

Intensive chemotherapy will destroy patient neutrophils

Pyrexia with neutrophil count being less than 1 x19^9

Question 18

How is neutropenic sepsis managed?

Answer 18

Rapid administration of broad spectrum IV antibiotics

Protective isolation

Prophylactic antibiotics

Use of GCSF