8 - Haematological Malignancies (1)

Question 1

What is myeloid leukaemia and aplastic anaemia?

Answer 1

• Myeloid leukaemia - too many stem cells in BM
• Aplastic anaemia - not enough stem cells in BM

Question 2

What blood cells are affected by AML, how fast is the progression, how is it treated and what age group is it most common in?

Answer 2

• Cancer of myeloid precursors
• Rapid progression
• Young patients treated with intensive chemo + bone marrow transplant, older patients have non-intense palliation
• Common in the elderly

Question 3

What blood cells are affected by ALL, how fast is the progression, how is it treated and what age group is it most common in?

Answer 3

• Cancer of lymphoid precursors
• Rapid progression
• Treated with intensive multi-drug chemo and bone marrow transplant for high-risk/ relapse cases
• Common in children

Question 4

What blood cells are affected by CML, how fast is the progression, how is it treated and what age group is it most common in?

Answer 4

• Cancer of mature granulocytes
• Slow progression that may accelerate
• Treated using TKIs
• Common in middle-aged adults

Question 5

What is the Philadelphia chromosome, what type of leukaemia is associated with it and how is it targeted?

Answer 5

• Specific translocation between Ch9 and 22 fusing two genes BCR and ABL creating BCR/ABL
• Associated with CML
• Targeted with TKIs

Question 6

What blood cells are affected by CLL, how fast is the progression, how is it treated and what age group is it most common in?

Answer 6

• Cancer of mature B cells
• Very slow progression
• Monitored and left untreated initially, chemotherapy used when progressed
• Most common type of leukaemia, common in the elderly

Question 7

How are bone marrow biopsies used in the diagnosis of leukaemia?

Answer 7

Aspirate - liquid bone, used in morphology, cytogenetics, flow cytometry and molecular tests

Trephine - core of bone: used in morphology and immunohistochemistry

Question 8

What is morphology used for in the diagnosis of leukaemias and what specific leukaemias is it useful for?

Answer 8

• Identifies abnormal or immature cells
• myeloblasts or auer rods in AML

Question 9

What is flow cytometry used for in the diagnosis of leukaemias and what specific leukaemias is it useful for?

Answer 9

• Immunophenotyping (identification of what WBCs are present)
• Differentiates between AML and ALL

Question 10

What is cytogenetics used for in the diagnosis of leukaemias and what specific leukaemias is it useful for?

Answer 10

• Analysis of chromosomes to detect structural abnormalities
• Useful in CML (Philadelphia chromosome) and helps in personalised medicine for AML

Question 11

What is molecular pathology used for the diagnosis of leukaemias and what specific leukaemias is it useful for?

Answer 11

• PCR used to detect gene mutations and fusion genes
• Philadelphia chromosome in CML and FTL3 and NPM1 mutations in AML