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CSB048 - TREATMENT 2 > Hematological > Flashcards

Hematological Flashcards

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1
Q

Physiology of Blood

A

Transportation - transports oxygen from lungs to cells and carbon dioxide from cells to lungs
Regulation - homeostasis of all body fluids
Protection - blood can clot, which protects against excessive blood loss

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2
Q

Components of blood

A

Blood plasma and formed elements

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3
Q

Types of blood

A

Red - contain haemoglobin to carry oxygen
Platelets - assists in clotting
White blood cells - fights infections, disease and foreign bodies 2 main types - neutrophils and lymphocytes

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4
Q

WBC Function

A

Monocytes - in blood are mobile and phagocytic, others become macrophages
Lymphocytes - t cell responsible for immunity and B cell with antibody production
Granulocytes - neutrophils protect against foreign materials

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5
Q

Hematological malignancies

A

Leukaemia’s
Multiple Myeloma
Polycythaemia Rubra Vera

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6
Q

Leukaemia types

A

ALL - Acute lymphoblastic leukaemia (common in children)
AML - Acute Myeloid leukaemia (mainly adults but can occur in children and adolescents)
CLL - Chronic lymphocytic leukaemia (affects adults)
CML - Chronic myeloid leukaemia (can occur at any age but uncommon below age of 20)

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7
Q

Leukemia and RT

A

Treating leukaemia that has spread to CNS
Or to the testicles
to treat symptoms caused when swollen internal organs, such as the spleen, press on other organs
May be used before stem cell transplant
Used to relieve bone pain

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8
Q

Treatment for Leukemia depends on

A

the stage of the disease • the location of the cancer • the severity of symptoms

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9
Q

Standard treatment for acute leukaemia

A

• Remission induction (3-8 weeks) - no abnormal leukaemic cells
• Consolidation (Intensification of treatment to kill resistance cells, can last 6-9months)
• Maintenance (continuing treatment) - low dose treatment

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10
Q

Disease Classification

A

Classification based on age, white cell count and cryogenetics of the leukaemia cells
Standard risk - majority of ALL patients
High Risk - all adolescents and younger children with higher leukocyte counts at presentation
Very High Risk - 1-2% with B cell
Special risk patients - Philadelphia chromosome or slow response to induction treatment

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11
Q

ALL Epidemiology and cause

A

Bone marrow makes too many lymphocytes, gets worse quickly
40% occurs between 2-5 years
Male/female 1:1
Less common than AML

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12
Q

ALL Aetiology

A

Down syndrome
Environmental agents - viruses
Radiation exposure

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13
Q

ALL Signs and symptoms adults

A

Peripheral lymphadenopathy
Splenomegaly
Liver palpable
Bone marrow failure - infection due to leucopoenia, bruising and bleeding
Petechiae (flat, pinpoint spots under skin caused by bleeding)
Fever
Shortness of breath
Loss of appetite or weight loss

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14
Q

ALL signs and symptoms Children

A

oral and pharyngeal ulceration, anaemia, infection, bone pain, few weeks of malaise, fever , haemorrhages in eye, lymph node enlargement, usually pale, bones tender. Meningeal involvement if: headache, stiff neck, vomitting

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15
Q

Adverse prognostic features in childhood ALL

A

Adverse cytogenic markers, CNS disease, early marrow relapse, testicular relapse, t-cell phenotype, philadelphia chromosome
Above 12yrs, prognosis worse (35% in adults) and 70% in children
Total white cell count - more than 20000 poorer prognosis

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16
Q

Diagnosis for ALL

A

Physical exam and patient history
Full blood count
Peripheral blood smear
Cytogenic analysis
Erythrocyte sedimentation rate
Immunophenotyping
Liver function
Radiography
Bone marrow biopsy and aspiration

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17
Q

ALL Clinical Management - children

A

Curative
Multidrug therapy
CNS targeted treatment - common as chemo cannot enter this area due to barrier
Remission Induction - Vincristine, Doxorubicin
Consolidation - Methotrxate - drugs are myelosuppressive
Maintenance - Methotraxate - 2 years, any lower -> increased relapse
87% survival at 5 years
CNS Prophylaxis - intrathecal methotrexate, cranial irradiation

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18
Q

ALL treatment Side Effects

A

Low neutrophil and platelet count - infections, bleeding
Bone marrow suppression
Hair loss
Kidney damage - increase fluid intake

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19
Q

ALL RT options and dose

A

Cranial Irradiation
Opposing lateral fields
18Gy in 8-10#
More recently 12Gy

Testicular relapse
24-26Gy in 12-13#
Child in frog-leg position with soles of the feet touching

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20
Q

ALL Relapse

A

20-25% will relapse
High risk disease -> higher rate of relapse
Relapsed ALL more resistant to treatment than original disease -> leukaemic cells become drug resistant

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21
Q

ALL Relapse Treatment

A

Repeat remission induction programme
Increased intensity

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22
Q

ALL Adult clinical management

A

Remission Induction - more intense to children
Consolidation
Maintenance - testicular relapse not common, cranial irradiation not given

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23
Q

ALL Prognostic factors for Adults

A

Age over 60 years
Late achievement of complete response
B-cell ALL
Philadelphia chromosome

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24
Q

AML epidemology

A

Rare- accounts for 0.8% of all tumpours in australia
Men slightly higher incidence
More common in adults over age of 60
3.7 in 100,000 in australia don’t survive

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25
AML Aetiology
Damage to one or more of the genes that normally control blood development Increased incidence in population exposed to radiation after hiroshima and nagasaki May occur after exposure to chemicals such as formaldehyde Downs syndrome, myelodysplastic syndrome Radiation
26
AML Signs and symptoms
Anaemia, low platelet count - causing bruising and bleeding, low white cell count - persistent infection, fever because of a lack of white blood cells Aching joints and bones, unusual bleeding - caused by a reduction in the number of platelets Feeling generally unwell and run down - this may be caused by anaemia or repeated infections
27
AML Investigations
Full blood count Biochemistry - checking abnormalities in liver function Chromosome analysis - bone marrow sample Radiograph
28
AML prognosis
Not as good for ALL Approx 40% of all patients are cured Increased by successful transplantation to 50%
29
AML Clinical Management
Remission Induction - Intensive supportive care, Danorubicin Maintenance therapy - drugs for remission with other agents - etoposide Consider allogeneic or autologus transplant as late intensification in CR
30
AML prognostic factors
Age over 60 years High WBC Poor performance status Patients who developed AML after myelodysplastic syndrome
31
CML cause
Myeloid cells found in bone marrow and circulating blood Characterised by excess granulocytes Progress slowly in chronic phase (4-6years), then rapid (3-9 months) Difficult to detect in early stage Only cure is stem cell transplant
32
CML Epidemiology
249 people diagnosed each year in australia (very rare) Can occur at any age but is more common in adult over 50 Slightly higher in males
33
CML Aetiology and prognosis
Not known 90% of cases characterised by philadelphia chromosome Exposure to radiation Median survival = 4 years
34
CML Signs and symptoms
Massive splenomegaly Tiredness and pale skin due to anaemia Excessive bleeding or bruising at various sites Petechiae Periods heavier Itching Abdominal distension Lymphadenopathy Thrombocytopenia Bone pain Fever Very high white cell count Weight loss
35
CML investigations
Blood count - increased number of basophils Bone marrow biopsy Ultrasound for hepatomegaly and splenomegaly Bone marrow sampling Philadelphia chromosome test
36
CML Phases
Chronic phase - stable, most people diagnosed in this phase Accelerated phase - the disease is developing more quickly Blast phase - much of the bone marrow has been replaced by many immature cells Phase is determined by number of blast cells in bone marrow and severity of symptom
37
CML Stages
Relapsed chronix myeloid leukaemia Complete remission Molecular remission
38
CLL
Very similar characteristics to Non-hodgkins lymphoma Results from injury to DNA of single cell in bone marrow - uncontrolled growth of B-lymphocytic cells in blood Leukaemic cells that accumulate in marrow do not impede blood production as much as ALL
39
CLL Epidemiology
Accounts for 0.8% of all cancers diagnosed Almost 80% of all new cases occur in people over the age of 60 years Commonly in men
40
CLL Aetiology
No known factors Family history Not associated with radiation exposure
41
CLL Signs and symptoms
Peripheral lymphadenopathy Splenomegaly Hepatomegaly Anaemia Tiredness Shortness of breath on physical activity Sweats, fever, weightloss Recurrent infections
42
CLL Diagnosis
FBC, Bone marrow biopsy
43
CLL Prognosis
Remission is usually achieved easily but cure is rare Patients can live many years in remission Median survival = 8 years
44
CLL Clinical Management
No cure, Early stage - watch and wait, Late stages - chemo regimes Chlorambucil Prednisolone
45
Hairy Cell Leukemia symptoms
Tiredness, weight loss, infections, anaemia, frequent infections, enlarged spleen
46
Multiple Myeloma
B-lymphocyte neoplasm Results in large numbers of immature plasma cells - that infiltrate the bone marow and can be found in blood
47
Multiple Myeloma Epidemiology
- Uncommon under 50s - Twice as common in males - Annual incidence is 4/100000 - Increased rates of incidence - Carriers of BRCA1 and BRCA2 Family clusters
48
Multiple Myeloma aetiology
Radiation exposure
49
Multiple myeloma signs and symptoms
Acute back pain, weakness, anorexia and weight loss, bacterial infections, bone lesions, hypercalcemia, renal failure
50
Multiple myeloma investigations
FBC, Biochemistry, Urine test, bone marrow biopsy, radiographs and scans
51
Multiple Myeloma clinical management
Not curable but possible to relieve symptoms Palliative radiotherapy or chemo Asymptomatic patients not treated unless disease progressing RT- Cord Compression, bone pain, whole brain
52
Polycythaemia Rubra Vera
Uncommon bone marrow disease Most common in men between 50-65 years of age Myelo-proliferation - over production of red blood cells Can also effect other blood cell types
53
Polycythaemia Rubra Vera signs and symptoms
Increased peripheral cell volume - leading to marrow exhaustion Headaches Dizziness Tinnitus Tiredness Visual disturbances Cyanosis Pruritus Palpable spleen (75%) Hepatomegaly (30%)
54
Polycythaemia Rubra Vera prognosis
3yr 50% survival after diagnosis in absence of treatment 10 yr 50% survival with treatment Patient eventually dies of marrow failure, thrombosis, haemorrhage or heart failure
55
Treatment of Primary disease
Chemotherapy given with curative intent - melphalanor Cyclophosphamide Younger/fitter patient given more intensive chemo Majority carried out using patient's own stem cells
56
Chemo Delivery
Hickman line - decreases needle punctures needed for IV medication Can be used for longer Port-a-catheter - implanted beneath the skin, cannot be pulled, less infection
57
Bone Marrow Transplantation
Hematopoietic Stem Cell Transplant 2 types - autologous - patient receives own stem cells allogeneic - patient receives cells from a relative or matched donor
58
TBI dose
Total body irradiation Dose fractionation: 14.4Gy in 8# over 4 days 12 Gy in 6# over 3 days
59
Patient Care
- Mouth sores - bleeding - Infection - Infertility - Pneumonitis - Relapse - Second cancer - Diarrhea - Hair loss Post transplant lymphoprliferative disorder (PTLD)
60
classification of AML
using FAB
61
TBI
effective as biological effect is equally distributed requires multi-disciplinary team due to accurate calculation of dose Limited to public hospitals Patient positioned upright, several m from source, with custom blocks for shielding Using opposed, parallel, horizontal field setup Can be half sitted - due to long treatment time, if the patient is tall Can also be lying on the side, arms by side to reduce dose to lung Simulated in treatment position Need to measure - patient height, separation, SSN, head, umbilicus, thighs, ankle Shielding for lung Prescribed to umbiicus or midline gantry 90 degrees, collimator is 40x40 Plastic screen helps allow dose to skin High scatter CT based 3DCRT and IMRT, helical tomography SAD to be considered during placement of lung shielding Head compensator - layers of lead, harden photon beam and increase scatter dose Compensators - to account for different separations of different body parts

CSB048 - TREATMENT 2 (12 decks)

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