Introduction to Myeloid and Lymphoid Leukaemia Flashcards
(23 cards)
‘Leukaemia’
group of blood cancers associated with an increase in white blood cells
Acute Leukaemia types (2)
-acute myeloid leukaemia
-acute lymphoblastic leukaemia
Acute leukaemia (3)
Rapidly progressive clonal malignancy of the marrow/blood with maturation defect(s)
Defined as an excess of ‘blasts’ (≥20%) in either the peripheral blood or bone marrow
Decrease/loss of normal haemopoietic reserve
Acute Lymphoblastic Leukaemia - ALL (2)
a malignant disease of primitive lymphoid cells (resulting in an excess of lymphoblasts)
most common childhood cancer (30-40 cases/million)
Acute Lymphoblastic Leukaemia clinical presentation (5)
due to marrow failure (anaemia, infections, bleeding)
leukaemic effects:
-high count with obstruction of circulation
-involvement of areas outside the marrow + blood (extra-medullary) e.g. CNS, testis
bone pain
Acute Myeloid Leukaemia- AML (4)
AML is a malignant disease of primitive myeloid cells (an excess of myeloblasts)
More common in the older age group (>60 years)
Age-adjusted incidence of 4-5 in 100,000
May be ‘de novo’ or secondary
Acute Myeloid Leukaemia clinical presentation (4)
Presentation can be similar to ALL (marrow failure – anaemia, infections, bleeding)
Subgroups of AML may have characteristic presentation :
=Coagulation defect - DIC in acute promyelocytic leukaemia
=Gum infiltration
Investigations for Acute Leukaemia (6)
Morphology (Blood count and film)=
-Reduction in normal
-Presence of abnormal cells (not always seen)
-abnormal cells (‘blasts’) with a high nuclear: cytoplasmic ratio, ‘open’ chromatin, nucleolus
Coagulation screen – ‘DIC’
Bone marrow aspirate
Treatment of acute leukaemia
Supportive care – blood products, antibiotics
Definitive anti-leukaemic therapy - multi-agent chemotherapy
Allogeneic stem cell transplantation in some, after chemotherapy
ALL treatment (5)
-can last up to 2-3 years
-Different phases of treatment of varying intensity
-Targeted treatments in certain genetic subsets
-CNS-directed treatment
-Immunotherapy
AML treatment (4)
-Intensive chemotherapy (3-4 cycles)
-Prolonged hospitalisation
-Less intensive therapy(non curative)
-Targeted treatments in subsets (see Misc info Moodle, if interested)
Problems of marrow suppression (disease or treatment-related) (4)
- Anaemia
- Neutropenia, Infections, Severity, Duration
- Thrombocytopenia, Bleeding, Purpura, Petechiae
Gram NEGATIVE bacteria can cause fulminant life-threatening sepsis in neutropenic patients
Complications of anti-leukaemic treatment (6)
-Nausea and vomiting
-Hair loss
-Liver, renal dysfunction
-Tumour lysis syndrome (during first course of treatment)
-Late effects (eg loss of fertility, cardiomyopathy with anthracyclines)
-INFECTION
Infections (3)
Bacterial: empirical treatment with broad spectrum antibiotics (particularly covering Gram negative organisms) as soon as neutropenic fever
Fungal (e.g. aspergillus if prolonged neutropenia and persisting fever unresponsive to anti-bacterial agents)
Pneumocystis jirovecci pneumonia (more relevant in ALL therapy)
Chronic Leukaemia types (2)
-chronic myeloid leukaemia
-chronic lymphocytic leukaemia
Chronic myeloid leukaemia- CML (5)
Clonal stem disorder – primitive compartment
Philadephia chromosome (BCR-ABL1 re-arrangement)
In ‘chronic’ phase, excessive proliferation with maturation
Excessive production of granulocytes and precursors
Can undergo ‘blast transformation’ when it resembles acute leukaemia
Chronic lymphocytic leukaemia -CLL (5)
A clonal (malignant) lymphoproliferative disorder of the mature B lymphoid compartment
The most prevalent type of adult leukaemia in some parts of the world
Median age of diagnosis of CLL is ~ 72 yrs
Slower pace of disease than acute leukaemia and ‘low-grade’, less primitive cells
Frequently involves lymph nodes, liver and spleen
Chronic lymphocytic leukaemia clinical presentation (9)
Often none (even with white counts of 500 x 109/L)!
-Non-specific (night sweats, fever, fatigue, weight loss)
Related to lymph node or spleen enlargement
Related to bone marrow infiltration (cytopenia)
Infections (immunocompromised)
Autoimmune cytopenia !
Autoimmune haemolysis !
=[Direct antibody (Coomb’s) test positive]
=Autoimmune thrombocytopenia (ITP)
Diagnosis Chronic Leukaemia (5)
Morphology
Immunophenotyping – for clonal B cell population expressing markers of CLL
Genetic testing including TP53 gene mutations
Immunoglobulin levels, Direct antibody test (DAT)
CT – chest, abdomen and pelvis
Management Chronic Leukaemia
Supportive care – as with acute leukaemia (blood products, antibiotics)
Anti CLL therapies
Still considered incurable in most but good disease control with modern therapies with treatment options at progression
Kinase inhibitors (2)
Chemotherapy increasingly replaced by targeted treatments (kinase inhibitors, Bcl-2 inhibitors and monoclonal antibodies) in high income countries
Some treatments can inhibit platelet function (implications pre- surgery/dental work) + be associated with cardiac arrhythmias
