Leukaemia Symposium Flashcards
What is cancer?
Transformed cell phenotype: uncontrolled proliferation; failure to undergo apoptosis
Genetic: oncogenes, tumour suppressor genes
Epigenetic: dysregulated gene expression; aberrant DNA methylation
Acute Myeloid Leukaemia
Uncontrolled proliferation of primitive cells in the bone marrow
Causes of bone marrow failure: anaemia, infections, bleeding
Blasts identified on blood film
How is it treated?
Chemotherapy - combination regimes; myelo-ablative cycles of treatment
Supportive therapy: antibiotics/antifungals; transfusions of blood and platelets
Allogenic stem cell transplantation: allograft from sibling/matched unrelated donor (Anthony Nolan)
Risk of neutropenic sepsis
Medical emergency
Gram negative bacteria are most dangerous
Blood cultures and blind antibiotic therapy if fever >38 degrees
- 1st line: Tazocin (piperacillin/tazobactam) +/- Gentamicin
- 2nd line – switch to meropenem +/- Teicoplanin (for Gram +ve)
- 3rd line – add anti-fungal e.g. ambisome (amphotericin)
Resuscitate patient with IV fluids if hypotensive
May require inotropic support on ITU
Graft vs Host disease
Caused by donor/host mismatches in major and minor HLA loci
Prevented by using: T cell depletion of infused donor cells, and immunosuppression of recipient
Clinical manifestations: skin rash, diarrhoea, deranged liver function
Graft vs leukaemia is how the stem cell transplant cures leukaemia
Donor lymphocyte infusions post treatment can treat relapse by augmenting GVL effect