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Stage 2: Cancer and Clinical Genetics > Acute Leukaemias > Flashcards

Acute Leukaemias Flashcards

1
Q

What is the most common childhood cancer (0-4 years)?

A

Acute lymphocytic leukaemia (ALL)

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2
Q

What are the 4 types of leukaemia?

A

1) Acute lymphocytic leukaemia (ALL)
2) Acute myeloid leukaemia (AML)
3) Chronic lymphocytic leukaemia (CLL)
4) Chronic myeloid leukaemia (CML)

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3
Q

What cells do lymphocytic leukaemias (lymphoid neoplasms) derive from?

A

Lymphoid stem cell (i.e. cells which when mature become lymphocytes & NK cells)

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4
Q

What cells do myeloid neoplasms incl. leukaemias derive from?

A

Myeloid stem cell (i.e. cells which when mature become RBCs, platelets & neutrophils/eosinophils/basophils)

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5
Q

What is leukaemia?

A

Uncontrolled proliferation of immature blood cells causing anaemia, thrombocytopenia and leukopenia

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6
Q

What is infiltration in leukaemia?

A

When immature WBCs spill out from the bone marrow into other organs

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7
Q

What are risk factors for acute lymphocytic leukaemia?

A

1) Down’s syndrome

2) XR in pregnancy

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8
Q

What are the symptoms of acute lymphocytic leukaemia?

A

1) BM failure - infection, anaemia (pallor, SOB), bleeding e.g. gums, epistaxis
2) Infiltration - hepato/splenomegaly, lymph nodes, CNS symptoms, bone pain

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9
Q

What is a complication of acute lymphocytic leukaemia?

A

SVCO (superior vena cava obstruction)

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10
Q

How do you diagnose all leukaemia?

A

Bone marrow biopsy

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11
Q

What initial investigations might you do in someone with suspected leukaemia?

A

FBC, blood film

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12
Q

What would you see on blood film (and BM biopsy) in acute lymphocytic leukaemia?

A

Blasts

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13
Q

Why does acute lymphocytic leukaemia cause SVCO?

A

Enlarged thymus due to T cell ALL

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14
Q

What are symptoms of SVCO?

A

Dysphagia and dyspnoea

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15
Q

What are symptoms of bone marrow failure?

A
  • Fatigue
  • Bleeding/bruising (thrombocytopenia)
  • Becoming full quickly - due to hepato and splenomegaly, stomach can’t expand
  • Lymphadenopathy (painful lymph nodes)
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16
Q

When does acute lymphocytic leukaemia typically present?

A

Childhood

17
Q

What is the commonest acute leukaemia in adults/elderly?

A

Acute myeloid leukaemia

18
Q

What are risk factors for acute myeloid leukaemia?

A
  • Down’s syndrome
  • Myelodysplastic syndrome
  • Myeloproliferative syndrome
19
Q

How do acute leukaemias typically present and therefore how do you treat them?

A

Medical emergency - supportive treatment e.g. transfusion, IV fluids (prevents TLS) ± abx prophylaxis

20
Q

How do you treat acute leukaemias?

A

Combination chemo (intensive e.g. cytarabine) ± BMT (sibling matched allogenic) with ciclosporin (to reduce graft vs host disease)

21
Q

How does acute myeloid leukaemia present acutely?

A

Leukocytosis (large WCC in bone marrow)

22
Q

What would you see on blood film in acute myeloid leukaemia?

A

Auer rods - in progranulocytes (platelets precursor)

23
Q

What are symptoms of acute myeloid leukaemia?

A
  • BM failure - infection ± DIC (APML), anaemia, bleeding

- Infiltration - hepato/splenomegaly, gum hypertrophy, skin involvement

24
Q

What are complications of acute myeloid leukaemia?

A
  • Infection
  • Tumour lysis syndrome (TLS) - risk in all leukaemias
  • Leukostasis (extremely elevated blast cell count and symptoms of decreased tissue perfusion)
25
Q

What is the WCC in acute leukaemia?

A

Total cell count is high - but lots of immature cells rather than mature

26
Q

Is acute lymphocytic leukaemia easier to cure in children or adults?

A

Children

27
Q

How can you tell the difference between lymphoid and myeloid leukaemia?

A

Blood film or biopsy - NOT symptoms

28
Q

What is acute promyelocytic leukaemia?

A

A subtype of acute myeloid leukaemia - 10% (chromosomal translocation 15;17)

29
Q

When is TLS most likely to occur?

A

Within a week of starting treatment

30
Q

What is a life threatening risk of acute leukaemia?

A

Neutropenic sepsis (complication of neutropenia)

31
Q

What are symptoms of TLS?

A
  • Hypocalcaemia
  • Hyperkalaemia
  • Hyper-uricaemia
  • Calcium phosphate imbalance
32
Q

How do you diagnose APML?

A
  • Increased PT, APTT, D-dimers

- Decreased fibrinogen, platelets, TT

33
Q

What clotting defect happens in APML?

A

DIC (massive clotting and bleeding)

34
Q

How do you treat APML?

A

ATRA (all-trans retinoic acid - chemotherapy) + arsenic

Correct coagulopathy

35
Q

Which leukaemia occurs in older adults?

A

AML

Stage 2: Cancer and Clinical Genetics (18 decks)

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