Haematological malingnacy summaries Flashcards
(34 cards)
There are four main types of acute and chronic leukaemia:
- Acute myeloid leukaemia (AML)
- Acute lymphoblastic leukaemia (ALL)
- Chronic lymphocytic leukaemia
- Chronic myeloid leukaemia
Acute vs Chronic leukaemia
The difference between acute and chronic leukaemia is that:
- Acute leukaemia is a result of impaired cell differentiation, resulting in large numbers of malignant precursor cells in the bone marrow;
- Chronic leukaemia is the result of excessive proliferation of mature malignant cells, but cell differentiation is unaffected.
Myeloid vs Lymphocytic leukaemia
The difference between myeloid leukaemia and lymphocytic leukaemia is that:
- Myeloid leukaemia commonly arises from a myeloid precursor cell, such as neutrophils.
- Lymphocytic leukaemia arises from a lymphoid precursor, such as B-cells.
Acute myeloid leukaemia (AML) background
- AML is the most common acute leukaemia in adults. It is associated with myelodysplastic syndromes.
presentation of AML
Symptoms of bone marrow failure:
- anaemia
- bleeding
- infections
Signs of infiltration, including:
- hepatomegaly
- splenomegaly
- gum hypertrophy.
diagnosis of AML
- Elevated white blood cells (leucocytosis) (can be normal or low)
- Bone marrow biopsy: Auer rods
Management of AML
Chemotherapy regimens or bone marrow transplant.
The chemo drugs used most often to treat AML are a combination of:
- Cytarabine (cytosine arabinoside or ara-C)
- An anthracycline drug, such as daunorubicin (daunomycin) or idarubicin
Phases of treatment:
1) Induction is the first phase of treatment. It is short and intensive, typically lasting about a week. The goal is to clear the blood of leukemia cells (blasts) and to reduce the number of blasts in the bone marrow to normal.
2) Consolidation is chemo given after the patient has recovered from induction. It is meant to kill the small number of leukemia cells that are still around but can’t be seen (because there are so few of them). For consolidation, chemo is given in cycles, with each period of treatment followed by a rest period to allow the body time to recover.
3) Maintenance (or post-consolidation), low doses of chemo (or other treatments) are given for months or years after consolidation is finished.
Acute lymphoblastic leukaemia (ALL)
ALL is the most common cancer of childhood. It is caused by the abnormal clinical proliferation of lymphoid progenitor cells.
These lymphoid precursors infiltrate normal haematopoietic cells of the bone marrow and other organs of the body.
presentation of ALL
Marrow failure
- anaemia including fatigue, abnormal
- bleeding/bruising caused by low platelets
- infections caused by low white cells
Symptoms may also be caused by organ infiltration, such as bone pain.
Signs
- include painless lymphadenopathy,
- hepatosplenomegaly,
- CNS involvement (e.g. cranial nerve palsies, meningism)
- testicular infiltration (resulting in painless unilateral testicular enlargement).
Diagnosis of ALL
Blood results show leucocytosis and blast cells on blood film and bone marrow analysis.
Hand mirror
management of ALL
- Multi-drug chemotherapy
o E.g. Vincristine, doxorubicin, cyclophosphamide, methotrexate - Steroids
- Targeted cancer drugs
o Rituximab – monoclonal antibody - Immunotherapy e.g. CAR T cell therapy
- Radiotherapy
- Stem cell or bone marrow transplants
- Phases of treatment
o Induction
o Consolidation
o Intensification
o Maintenance
chronic myeloid leukaemia
CML is most common in middle-aged patients, with males slightly more affected.
It is classically associated with the Philadelphia chromosome.
Clinical features of CML
CML usually presents with weight loss, tiredness, fever, and sweating.
Common signs:
- include massive splenomegaly (>75%)
- bleeding (due to thrombocytopenia),
- gout
diagnosis of CML
Blood tests commonly show leucocytosis, in particular raised myeloid cells which include:
- neutrophils
- monocytes
- basophils
- eosinophils.
Bone marrow analysis shows similar findings.
Management of CML
CML is commonly treated with chemotherapy regimens
e.g. - Imatinib – tyrosine kinase inhibitors
other TKIs can be tried if one does work
Chronic lymphocytic leukaemia (CLL) pathophysiology
CLL is most common in male patients over the age of 60. It is caused by the proliferation of functionally incompetent malignant B cells.
CLL presentation
CLL typically presents asymptomatically. May present with
- non-tender lymphadenopathy,
- hepatosplenomegaly
- B symptoms (weight loss, night sweats, and fever).
Features of marrow failure are less common than in the acute leukaemias.
- infection
- anaemia,
- bleeding
Diagnosis of CLL
The most common initial blood result is an incidental lymphocytosis. Subsequent blood film shows smudge cells, which are cells damaged as they lack a cytoskeletal protein. Flow cytometry is then used to measure particular markers expressed by the malignant cells. Other tests include bone marrow biopsy.
Management of CLL
CLL is commonly treated with chemotherapy regimens.
Tyrosine Kinase Inhibitors e.g Ibrutinib, acalabrutinib- Bruton’s tyrosine kinase inhibitor. Blocking BTK inhibits the B-cell receptor pathway, which is often aberrantly active in B cell cancers.
Hodgkins lymphoma
are malignant lymphomas characterised by the presence of Reed-Sternberg cells.
RF for Hodgkin lymphoma
Epstein Barr Virus
HIV
Immunosuppression
Cigarette smoking
Hodgkin lymphoma presentation
It typically presents in young adults with cervical or supraclavicular non-tender lymphadenopathy, though the location of diseased nodes can vary. Alcohol-induced pain is a suggestive symptom. There may be symptoms caused by compression of surrounding structures e.g. shortness of breath or abdominal pain. B symptoms (fever, night sweats, and weight loss), occur in 30% of patients. It is important to examine the patient for lymphadenopathy, and to check for hepatomegaly or splenomegaly.
diagnosis of Hodgkin lymphoma
Lymph node biopsy with evidence of Reed Sternberg cells is diagnostic. Blood results can predict a poor prognosis via low haemoglobin and raised LDH, as they indicate high red cell turnover. Staging scans are required to elucidate the extent of disease.
management of Hodgkin lymphoma
- Steroids to reduce lymph node mass
- Radiation +
- Chemotherapy
ABVD
- Adriamycin
- Bleomycin
- Vinblastine
- Dacarbazine
