CP7-3 Acute leukaemia and MDS Flashcards
(49 cards)
What cause leukaemia?
Accumulation of early myeloid or lymphoid precursors in the bone marrow, blood or other tissues potentially due to somatic mutation in a single cell within a population of early progenitor cells
What can cause secondary acute leukaemia?
Chemotherapy/radiotherapy for previous malignancy
Other haematological conditions
What is the median age of presentation of patients with acute myeloid leukaemia (AML)?
69
After what age does survival rate of AML become poor?
After 60
What is the trend if AML incidence?
It is increasing
Why is survival rate of AML poorer in older people?
Older people tend to have mutations and abnormalities
What are 3 clinical features of patients with AML?
Anaemia
Increased risk of infection
Easy bruising and haemorrhage as less platelets in blood as not as much being made in bone marrow and proliferation of tumour cells takes up the space/takes over
What organs may become infiltrated with leukaemia cells in AML?
Spleen
Liver
Meninges
Testes
Skin
Gum
What is an example of an acute myeloid leukaemia?
Acute monocytic leukaemia
What are some haematological features might patients with AML present with?
Anaemia
Low of high WCC with circulating leukaemia
Low platelets
How is AML diagnosed by looking at a patients blood?
Morphology of blood cells
Immunological markers
Cytogenetics
What are some known cytogenetic markers for leukaemia?
T(8;21)
Inv(16)
T(15:17)
What factors are important when determining prognosis in AML?
Patients age
Chromosomes and cytology of mutated cells
Molecular features
Extramedullary disease
Disease doesn’t respond to treatment
What are two molecular features that are looked for when determine prognosis in AML?
NPM1
FLT3-ITD - gives a bad prognosis if this is present
How is AML usually treated?
With intensive chemotherapy involving 3-4 cycles of intravenous cytotoxic drugs given centrally
Bone marrow transplant in high risk patients
What are risks of intensive chemotherpay?
Death
Sepsis
Alopecia
Infertility
Tumour lysis
What percentage of patients with AML go into complete remission within cycle 1?
Around 80-85%
What new treatments for AML are being used?
Targeted treatments for specific abnormalities expressed on leukaemia cells
Individualised treatment
Either can be used +/- chemotherapy
What percentage of patients have FLT3 mutation?
Approx 30%
Why does FLT3 lead to a poor prognosis?
As they cause constitutive activation of FLT3 receptors
What are some examples of FLT3 inhibitors that are being developed?
Midostaurin
Quizartinab
Crenolanib
Gantesebib
Gliteritinib
Which patients receive immediate intensive therapy for AML?
if critically ill with rapidly progressive disease that is causing respiratory / neurological / other organ compromise.
What causes poor survival in AML?
high proportion of patients have unfavourable cytogenetics
frequent involvement of more immature leukaemic precursor clones
multidrug resistance
antecedent haem disorder
higher levels of co-morbidity due to epidemiology
When will patients with AML usually relapse for the first time?
Within 18 months of intensive chemotherapy
