Acute leukaemia

Question 1

Test tube of blood from normal person vs that of a patient with leukaemia

Answer 1

leukaemia patients tube has huge “pussy” layer of white blood cells in between RBC’s and serum, this layer is hard to see in the normal blood tube

Question 2

The categories of blood cancers

Answer 2

• leukaemias
• myeloproliferative neoplasms (polycythemia, too many RBC’s, blood is thick and sticky = headaches and lethargy) (key locular changes that cause increased proliferation of the different myeloid blood lineages but they differentiate and mature in a normal way
• Lymphomas (Hodgkins and Non- Hodgkins)
• Myelomas (colonel proliferation of cancer cells that replace bone marrow, release cytokines that inc bone marrow lysis)

Question 3

Progression of leukaemia

Answer 3

proliferation of immature bone marrow cells
Expand and replace normal bone marrow cells
Abnormal leukaemic cells spill over into blood

Question 4

the difference between chronic and acute leukaemia

Answer 4

acute - abnormal cells are blasts that remain very immature and cannot carry out their normal functions. number of blasts increases rapidly, and the disease gets worse quickly.
chronic some blast cells are present, cells are more mature and can carry out some of their normal functions. number of blasts increases less rapidly than in acute leukemia. As a result, chronic leukemia gets worse gradually.
arise in either of the two main types of white blood cells–lymphoid cells or myeloid cells. When leukemia affects lymphoid cells, it is called lymphocytic leukemia. When myeloid cells are affected, the disease is called myeloid or myelogenous leukemia.

Question 5

The 4 main types of leukaemia and the most common associable demographic

Answer 5

Acute lymphocytic leukemia (ALL) predominantly children

Acute myeloid leukemia (AML) predominantly adults

Chronic lymphocytic leukemia (CLL) most often affects adults over the age of 55.

Chronic myeloid leukemia (CML) occurs mainly in adults. A very small number of children

Question 6

Risk factors for leukaemia

Answer 6

Congenital / inherited (most leukaemia not familial / inherited but some congenital disorders increase the risk e.g. Downs syndrome)
Viral Infections (proven with animal models, one rare virus in Africa can cause it)
Radiation (post atomic bombs and chernobyl, and a result of therapeutic radiation treatment for other cancers, especially when used in conjunction with chemo)
Chemical / DNA damaging drugs

Question 7

Example of targeted therapy

Answer 7

Philadelphia chromosome found in CML and some cases of acute leukaemia 
Imantinib developed (competes with ATP binding site and blocks phosphorylation of downstream tyrosine residues)
Life expectancy of those with CML is now almost the same as that of the general population

Question 8

How does leukaemic bone marrow look different

Answer 8

Heaps of small pink staining cancer cells, no more fat cells

Question 9

Signs and symptoms due to bone marrow failure

Answer 9

Anaemia, fatigue, dyspnoea (laboured breathing), cheast pain
Exacerbation of underlying respiratory and cardiac conditions
Neutropenia -infection of wounds, slow to heal –> failure of production of normal cells
Thrombocytopenia - bruising and bleeding

Question 10

Leukemia full blood count diagnosis

Answer 10

low Hb/ anaemia
White cells increased due to circulating blasts (leukaemia cells), neutrophils low
Severe thrombocytopenia - often less than 20x10^9(150-400)

Question 11

What else do you do to diagnose leukaemia

Answer 11

Bone marrow biopsy 
aspirate
trephine 
from posterior iliac crest 
If >20% blasts then BAD 

Specialised testing

• Immunophenotype
• Chromosomes (some chromosome changes have a good prognosis, others bad)
• Molecular studies

Question 12

Acute leukaemia: therapy

Answer 12

Intensive transfusion support 
- Red cells 
- Platelets 
Management of infection 
- ID and lab support, antibiotic therapy 
Vascular access 
- tunnelled venous catheters 
Patient and family support

Question 13

Chemotherapy for acute leukaemia

Answer 13

Induction therapy - to induce remission
Consolidation - to mop up residual leukaemia cells
Maintenance therapy (only in ALL) - to keep patient in remission

Question 14

Types of haematopoietic stem cell transplantation

Answer 14

Autologous - own stem cells taken out in remission (mainly for lymphomas and myelomas)
Allogenic - matching sibling or unrelated donor
Stem cells = bone marrow, peripheral blood or cord blood