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AML Flashcards

1
Q

What is leukaemia?

A

A cancer in the white blood cell producing cells of the bone marrow

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2
Q

What are the types of leukaemia?

A
  • Acute lymphoblastic leukaemia
  • Acute lymphocytic leukaemia
  • Acute myeloid leukaemia
  • Chronic myeloid leukaemia
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3
Q

What is lymphoblastic/lymphocytic mean?

A

That the abnormal cancerous cells arise from a lymphoid stem cell

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4
Q

What does myeloid mean?

A

That the abnormal cancerous cell originated from a myeloid stem cell

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5
Q

When should you refer a patient for immediate specialist assessment for suspicion of leukaemia?

A

If a child or young person has unexplained petechiae or hepatosplenomegaly

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6
Q

In what period of time should a very urgent blood test for leukaemia be performed?

A

Within 48 hours

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7
Q

When should you offer a very urgent FBC for suspicion of leukaemia in children and young people?

A

In children and young people with any of following signs and symptoms of leukaemia;

  • Pallor
  • Persistent fatigue
  • Fever
  • Persistent infection
  • Generalised lymphadenopathy
  • Persistent or unexplained bone pain
  • Bruising
  • Bleeding
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8
Q

When should you offer a very urgent FBC for suspicion of leukaemia in adults?

A

As with children and young people, and also hepatosplenomegaly

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9
Q

How many adults does acute lymphoblastic leukaemia affect in the UK?

A

About 800/year

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10
Q

How does the incidence of ALL compare to other cancers?

A

It is the most common cancer in children and young people under the age of 35, and in older adults over 75

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11
Q

How does the incidence of ALL compare between the genders?

A

It is slightly more common in males than females

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12
Q

What is ALL a cancer of?

A

WBCs

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13
Q

What is the mechanism of disease in ALL?

A

The process by which cells divide in an orderly and controlled way becomes out of control, and signals to stop the production of white blood cells are ignored

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14
Q

Do the dividing cells in ALL mature into normal lymphocytes?

A

Many do not

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15
Q

What is the result of many of the dividing cells not maturing into normal lymphocytes?

A

Too many immature blood cells (lymphoblasts) are produced

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16
Q

What is the problem with the lymphoblasts in ALL?

A

They are unable to fight infection, and fill up the bone marrow so there is insufficient space to make other blood cells

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17
Q

What are the types of ALL?

A
  • B-lymphoblastic leukaemia

- T-lymphoblastic leukaemia

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18
Q

What is the most common type of ALL?

A

B-lymphoblastic leukaemia

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19
Q

Where is the typing of ALL important?

A

In determining treatment

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20
Q

What is the typing of ALL based on?

A

What type of blood cell has become cancerous

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21
Q

What are the risk factors for ALL?

A
  • Radiation exposure
  • Genetic conditions
  • Exposure to chemicals
  • Infection
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22
Q

When can radiation exposure increase the risk of ALL?

A

When the person has been exposed to very high radiation levels, e.g. following a nuclear accident

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23
Q

Why is radiation exposure not much of a concern in the UK?

A

Because very few people in the UK will have been exposed to sufficient levels of radiation to increase their risk

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24
Q

Does living near a power plant increase the risk of ALL?

A

There is very little evidence for this

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25
Q

Give 2 examples of genetic conditions that increase the risk of ALL?

A
  • Down’s syndrome

- Fanconis anaemia

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26
Q

What chemicals can increase the risk of ALL?

A

Industrial chemicals, e.g. benzene and other solvents

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27
Q

How is infection linked to the development of ALL?

A

ALL develops because of changes to certain types of immature blood cells. What causes these changes is unknown, but infection may be involved

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28
Q

Are there any specific infections that have been found to cause leukaemia?

A

No

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29
Q

What are the symptoms of ALL?

A
  • Fatigue, dizziness, and palpitations
  • Severe and usual bone and joint pain
  • Recurrent and severe infections
  • Fever without obvious infection
  • LUQ fullness and early satiety
  • Dyspnoea
  • Headache, irritability, or altered mental status
  • Haemorrhagic or thrombotic complications
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30
Q

What are the most common sites of recurrent and severe infection in ALL?

A
  • Oral
  • Throat
  • Skin
  • Perianal
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31
Q

What causes LUQ fullness and splenomegaly in ALL?

A

Splenomegaly

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32
Q

What causes dyspnoea in ALL?

A

Anaemia, or large mediastinal mass

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33
Q

In which kind of ALL might dyspnoea due to a large mediastinal mass present?

A

T-cell leukaemia

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34
Q

What causes headache, irritability, or altered mental status in ALL?

A

CNS involvement

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35
Q

What causes haemorrhagic or thrombotic complications in ALL?

A

Thrombocytopenia or DIC

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36
Q

Give 3 examples of haemorrhagic or thrombotic complications of ALL

A
  • Menorrhagia
  • Frequent nosebleeds
  • Spontaneous bruising
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37
Q

What are the signs of ALL?

A
  • Pallor
  • Tachycardia and a flow murmur
  • Non-specific signs of infection
  • Petechiae
  • Abdominal distention
  • Lymphadenopathy
  • Testicular enlargement
  • Gum hypertrophy
  • Leukaemia cutis
  • Cranial nerve palsy
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38
Q

What causes petechiae in ALL?

A

Thrombocytopenia

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39
Q

What might petechiae progress to in ALL?

A
  • Purpura

- Ecchymoses

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40
Q

What causes abdominal distention in ALL?

A
  • Hepatomegaly

- Splenomegaly

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41
Q

What is leukaemia cutis?

A

google it (im on a train)

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42
Q

What are the differential diagnoses of ALL?

A
  • Infection
  • Myeloproliferative or lymphoproliferative disorders
  • Myelodysplasia
  • Aplastic anaemia
  • Idiopathic thrombocytopenia
  • Lymphoma
  • Metastatic cancer
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43
Q

Give 2 examples of infections that may be differentials for ALL?

A
  • EBV

- Parvovirus 19

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44
Q

What investigations should be done in ALL?

A
  • Blood tests
  • Bone marrow biopsy
  • Immunophenotyping
  • Lumbar puncture
  • General health checks
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45
Q

What blood tests should be done in ALL?

A
  • FBC
  • Blood film
  • Clotting
  • LDH
  • Liver and renal function
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46
Q

What may be found on FBC in ALL?

A
  • Anaemia, Hb may be below 5g/L
  • Thrombocytopenia, to varying degrees
  • WBC may be high, normal, or low, but there is usually neutropenia
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47
Q

What may be found on blood film in ALL?

A

Likely to show blast cells, but can be normal if blast cells are confined to bone marrow

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48
Q

What may be found on clotting in ALL?

A

DIC

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49
Q

What indicates DIC on a clotting screen?

A
  • Elevated prothrombin time
  • Reduced fibrinogen level
  • Presence of fibrin degradation produces
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50
Q

What happens to LDH in ALL?

A

Usually raised

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51
Q

Why do you need to do liver and renal function in ALL?

A

Should be checked before initiating chemotherapy

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52
Q

What does the WHO classification require for a diagnosis of ALL, regarding bone marrow and/or peripheral blood?

A

20% or greater amount of blasts in bone marrow and/or peripheral blood

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53
Q

What is the standard procedure for obtaining a bone marrow sample in ALL?

A

Aspiration

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54
Q

When may core biopsy be done in ALL?

A

If aspiration does not yield sufficient cells

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55
Q

What is the purpose of immunophenotyping in ALL?

A

Helps reveal subtype

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56
Q

How can a positive confirmation of lymphoid rather than myeloid origin be achieved in ALL?

A

By flow cytometric demonstration of lymphoid antigens

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57
Q

Why is immunophenotyping important in ALL?

A

Therapeutically, it is important to differentiate between T-cell, mature B-cell, and B-cell precursor phenotypes

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58
Q

What can ALL be classified into (think ive already asked this lol)?

A
  • B-cell ALL

- T-cell ALL

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59
Q

What can B-cell ALL be further classified into?

A
  • Early pre-B cell ALL
  • Common ALL
  • Pre-B ALL
  • Mature B-cell ALL
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60
Q

What can T-cell ALL be further classified into?

A
  • Pre-T ALL

- Mature T-cell ALL

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61
Q

What does treatment for ALL typically consist of?

A
  • Remission induction
  • Consolidation (or intensification)
  • Maintenance (or continuation) therapies
  • CNS prophylaxis
  • Management of relapse
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62
Q

What is the exception to the typical treatment for ALL?

A

Mature B-cell ALL

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63
Q

How is mature B-cell ALL managed?

A

Short-term intensive chemotherapy

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64
Q

What is involved in the general supportive treatment of ALL?

A
  • Replacement therapy of blood cells

- Antibiotic and antifungal agents

65
Q

Why is replacement therapy of blood cells important in ALL?

A

Pre-existing deficiency due to ALL can be profoundly aggravated by chemotherapy

66
Q

What is the purpose of antibiotics and antifungal treatment in ALL?

A

Treat opportunistic infection

67
Q

What are the goals of induction therapy in ALL?

A
  • Eliminate more than 99% of initial burden of leukaemic cells
  • Rapidly restore normal haemopoiesis
  • Restore previous performance status
68
Q

When should treatment be started for ALL?

A

Immediately

69
Q

What might be given before induction therapy in ALL?

A

Pre-phase therapy

70
Q

What is given in pre-phase therapy in ALL?

A

Corticosteroids, either alone or in combination with a chemotherapy drug, and often with allopurinol and hydration

71
Q

How long is pre-phase therapy given for in ALL?

A

5-7 days

72
Q

What are most remission induction regimes centred on in ALL?

A

Multiple chemotherapy agents (vincristine, corticosteroids, and anthracycline, with or without cyclophosphamide and cytarabine)

you dont have to know the specific regime just know they give loads of chemo at once

73
Q

How good are current treatment regimes for induction in ALL?

A

Achieve complete remission rates of 80-90%

74
Q

When is maintenance therapy initiated in ALL?

A

Once normal haemopoiesis is achieved

75
Q

What does maintenance therapy usually consist of in ALL?

A

Daily chemotherapy (6-metacaptopurine) and weekly methotrexate

76
Q

How is 6-metacaptopurine administered?

A

Orally

77
Q

What treatment duration is recommended for maintenance therapy in ALL?

A

2.5-3 years

78
Q

Why is CNS prophylaxis given in ALL?

A

Because patients frequently have meningeal leukaemia at the time of relapse

79
Q

What is the incidence of meningeal leukaemia in the absence of CNS prophylaxis?

A

50-75% in one year

80
Q

What are the treatment modalities for CNS prophylaxis in ALL?

A
  • CNS irradiation
  • Intrathecal methotrexate
  • Intrathecal triple therapy
  • Systemic high-dose therapy with either methotrexate and/or cytarabine
81
Q

What is included in intrathecal triple therapy for CNS prophylaxis in ALL?

A
  • Methotrexate
  • Steroids
  • Cytarabine
82
Q

What does stem cell transplantation allow for in ALL?

A

Intensification of chemotherapies and radiotherapies

83
Q

How does stem cell transplantation allow for intensification of chemotherapies and radiotherapies?

A

It replaces destroyed stem cells

84
Q

Describe the prognosis of relapse of ALL?

A

Very poor

85
Q

What is the result of relapse of ALL having a very poor prognosis?

A

Most patients are referred for trial ‘salvage’ therapies

86
Q

What are the factors predicting a good outcome after salvage therapies in ALL relapse?

A
  • Young age

- Short duration of first remission

87
Q

What is the outcome of ALL related to?

A

The age of the patient

88
Q

What are the cure rates of childhood ALL?

A

80-90%

89
Q

What are the cure rates of ALL in elderly/frail patients?

A

<10%

90
Q

What preventative strategies can be used in ALL?

A

There are no widely accepted preventative strategies for ALL.
Some studies suggest that breast-feeding confers protection for childhood ALL, but this remains controversial

91
Q

What is acute myeloid leukaemia (AML)?

A

A malignant disease of the bone marrow

92
Q

What happens in AML?

A

The precursors of blood cells are arrested in an early stage of development

93
Q

What do most AML subtypes show, in terms of blasts?

A

More than 30% blasts of a myeloid lineage in blood, bone marrow, or both

94
Q

What does the mechanism of maturation arrest in an early stage of development in AML involve?

A

The activation of abnormal genes through chromosomal translocations and other genetic abnormalities

95
Q

What is the effect of the maturation arrest in an early stage of development in AML?

A

Reduces the normal blood cells

96
Q

What does failure of apoptosis in AML lead to?

A

Accumulation in various organs, especially the liver and spleen

97
Q

How common is AML, compared to other leukaemias?

A

It is the most common leukaemia in adults

98
Q

At what age does AML occur?

A

It can occur at any age, but the incidence increases with age, and the median age of onset is 67

99
Q

What are the subtypes of AML?

A
  • AML with characteristic genetic abnormalities
  • AML with multi-lineage dysplasia
  • AML and MDS, therapy related
  • AML not otherwise categorised
100
Q

Who does the subtype of AML with multi-lineage dysplasia include?

A

Patients who have had prior myelodysplastic syndrome (MDS) or myeloproliferative disease that transforms into AML

101
Q

What does the subtype of AML and MDS, therapy related include?

A

Patients who had had prior chemotherapy and/or radiation

102
Q

What are the risk factors for AML?

A
  • Other haematological disorders
  • Radiation
  • Congenital disorders
  • Exposure to benzene
  • Survivors of cancer chemotherapy
103
Q

What other haematological disorders increase the risk of AML?

A
  • Myelodysplastic syndrome
  • Aplastic anaemia
  • Myelofibrosis
104
Q

What congenital disorders increase the risk of AML?

A
  • Bloom’s syndrome
  • Down’s syndrome
  • Fanconi’s anaemia
  • Neurofibromatosis
105
Q

What is the presentation of AML related to?

A

Bone marrow failure or organ infiltration

106
Q

How does the presentation of AML differ between children and older people?

A

Children or young adults may present with acute symptoms over a few days to weeks, whereas older people may present with fatigue over weeks or months

107
Q

What are the symptoms of AML?

A
  • Dizziness and shortness of breath on exertion
  • Fever
  • Early satiety and fullness in LUQ
  • Bone pain
108
Q

What feature of the fever may be present with AML?

A

Failure to respond to antibiotics

is that a feature? idk

109
Q

What causes the early satiety and fullness in LUQ in AML?

A

Splenomegaly

110
Q

What are the emergency presentations of AML?

A
  • Haemorrhage into lungs, GI tract, or CNS

- Leukostasis

111
Q

What cause leukostasis in AML?

A

Extremely high WBC

112
Q

What are the most common sites for infiltration of AML?

A
  • Liver
  • Spleen
  • Gums
113
Q

Why is knowing the most common sites of infiltration of AML clinically important?

A

Should look for signs in those locations

114
Q

What examination features may be present in AML?

A
  • Pallor
  • Signs of infection, e.g. fever, pneumonia
  • Hepatomegaly and splenomegaly
  • Petechiae on lower limbs
  • Gingivitis, with swollen, bleeding gums
115
Q

What does the diagnosis of AML require?

A

The examination of peripheral blood and bone marrow specimens

116
Q

What tests are done on the peripheral blood and bone marrow specimens in AML?

A
  • Morphology
  • Cytochemistry
  • Immunophenotyping
  • Cytogenetics
  • Molecular genetics
117
Q

What investigations are done in AML?

A
  • Blood testing
  • Bone marrow aspiration
  • Allotyping
  • Cytochemical testing
118
Q

What blood tests should be done in AML?

A
  • FBC
  • Clotting screen
  • LDH
  • Liver and renal function
119
Q

What may be found on FBC in AML?

A
  • Variable degree of anaemia and thrombocytopenia
  • Total WBC may be normal, high, or low, and sometimes extremely high
  • Neutrophils usually depleted
120
Q

What condition is commonly found on clotting screen in AML?

A

DIC

121
Q

What findings on clotting screen are suggestive of DIC?

A
  • Prolonged thrombin time
  • Low level of fibrinogen
  • Fibrin degradation products
122
Q

What happens to LDH in AML?

A

Usually raised

123
Q

Why do you need to check liver and renal function in AML?

A

Must be checked before initiating chemotherapy

124
Q

What is the importance of bone marrow aspiration in AML?

A

It is the diagnostic procedure

125
Q

What findings on bone marrow aspiration are required for a diagnosis of AML?

A

More than 20% blasts in the peripheral blood

126
Q

Who should be HLA typed at diagnosis of AML?

A

Patients potentially suitable for allogenic stem cell transplantation, and their first-degree family members

127
Q

What is the purpose of cytochemical staining in AML?

A

It allows for classification of AML into its subtypes

128
Q

What can cytogenetic studies provide in AML?

A

Important information about prognosis

129
Q

What is the usually accepted criteria of therapeutic response in AML?

A
  • Blast clearance in the bone marrow to <5% of all nucleated cells
  • Morphologically normal haematopoiesis
  • Return of peripheral blood cell counts to normal levels
130
Q

Where is treatment for AML co-ordinated?

A

Specialist centres

131
Q

On what basis is AML treatment delivered?

A

Two phases

132
Q

What are the phases of AML treatment?

A
  • Induction

- Post-remission consolidation (intensification)

133
Q

Is stem cell transplantation an option in AML?

A

Yes

134
Q

What are the other aspects of care in AML?

A
  • Blood product replacement
  • Antibiotics for infection
  • Allopurinol to reduce uric acid levels
135
Q

What might patients with excessive leukocytosis require before commencing chemotherapy for AML?

A

Emergency leukophoresis

136
Q

What is the prognosis of AML dependant on?

A
  • Age
  • Cell type
  • Burden of disease
  • Pre-existing medical conditions
137
Q

What social factor affects the prognosis of AML?

A

Prognosis is worse with socio-economic deprivation

138
Q

What % of people with AML develop secondary malignancies?

A

13%

139
Q

What rates of complete remission can be achieved in younger patients?

A

80%

140
Q

What is the 5-year survival of AML in younger patients?

A

40%

141
Q

What are the remission rates of AML in over 60’s?

A

60%

142
Q

What is the limitation of remission in over 60’s?

A

Remissions are usually transient

143
Q

What is the median survival of AML in over 60’s?

A

5-10 months

144
Q

What pre-existing medical conditions are associated with a poorer prognosis from AML?

A
  • Diabetes
  • CHD
  • COPD
145
Q

What is chronic lymphocytic leukaemia?

A

A monoclonal expansion of B-lymphocytes with accumulation of abnormal lymphocytes

146
Q

Where do abnormal lymphocytes accumulate in chronic lymphocytic leukaemia?

A
  • Blood
  • Bone marrow
  • Spleen
  • Lymph nodes
  • Liver
147
Q

How do the lymphocytes in CLL appear morphologically?

A

Normal

148
Q

What is abnormal about the lymphocytes in CLL?

A

They are immature and non-reactive

149
Q

What is the result of the lymphocytes being immature and non-reactive in CLL?

A

Results in immunological compromise

150
Q

How common is CLL compared to other leukaemias?

A

It represents about 1/4 of all leukaemias seen in clinical practice

151
Q

When does CLL present?

A

It is largely a disease of older people

152
Q

What causes CLL?

A

Unknown

153
Q

What are the known risk factors for CLL?

A
  • Age

- Radiation exposure

154
Q

Are people in the UK exposed to radiation levels high enough to increase the risk of CLL?

A

No, it occurs after nuclear accidents etc

155
Q

Describe the presentation of CLL?

A

Variable, with insidious onset

156
Q

Are most people symptomatic at presentation of CLL?

A

No

157
Q

How are people diagnosed with CLL asymptomatically?

A

Following routine blood tests

158
Q

What are the symptoms of CLL?

A
  • Susceptibility to infection
  • Symmetrically enlarged lymph nodes
  • Abdominal discomfort from an enlarged spleen
  • Bleeding or petechiae in skin or mucous membranes

X - Cancer Care COPY (36 decks)

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