Leukaemia

Question 1

What is leukaemia?

Answer 1

Clonal proliferation of malignant blood cells

Question 2

How does leukaemia happen?

Answer 2

Malignant cells undergo uncontrolled expansion in bone marrow leading to bone marrow failure and the cells circulate in blood and can infiltrate various organs

Question 3

What are the 2 types of leukaemia?

Answer 3

Acute and chronic

Question 4

What is acute leukaemia?

Answer 4

Malignant transformation occurs in haemopoietic stem cell

Defined by presence of over 20% blasts in blood or bone marrow

Question 5

What are 2 types of acute leukaemia?

Answer 5

Acute myloid leukaemia AML (80%)

Acute lymphoblasitc leukaemia ALL (20%)

Question 6

What is chronic leukaemia?

Answer 6

Proliferation of more mature precurser cell. Slower progression with relatively benign cause

Question 7

What are 2 types of chronic leukaemia?

Answer 7

Chronic myloid leukaemia CML

Chronic lymphocytic leukaemia CLL

Question 8

What are the causes of leukaemia?

Answer 8

INHERITED - Downs, klinefelters, immuno deficiencies

ENVIRONMENTAL - radiation, chemo, infection, myeloproliferative disease

Question 9

What is AML?

Answer 9

Acute myloid leukaemia
Most common acute leukaemia in adults, 70 yrs
PRIMARY - de novo
SECONDARY - after another cause, eg chemo

Question 10

What are the clinical features of acute leukaemia (AML and ALL)?

Answer 10

BONE MARROW FAILURE
anaemia
neutropoenia
thrombocytopoenia

ORGAN INFLITRATION
lymadenopathy
hepatomegaly
splenomegaly

Question 11

What investigations would you do for AML?

Answer 11

FBC
blood film - to see myloblasts
bone marrow biopsy

Question 12

What is the treatment for AML?

Answer 12

combination chemo
supportive treatment
bone marrow transplant

Question 13

What is the prognosis of AML dependant on?

Answer 13

Age. Higher cure rate if less than 60 yrs

Question 14

What is ALL?

Answer 14

Acute lymphoblastic leukaemia

Most common leukaemia in children, 2-10 yrs

Question 15

What investigations would you do for ALL?

Answer 15

FBC
blood film - to see lymphoblasts
bone marrow biopsy

Question 16

How would you treat ALL?

Answer 16

combo chemo

bone marrow transplant

Question 17

What is the prognosis for ALL?

Answer 17

70 -80% cure rate in childhood

Question 18

What is the difference between lymphblasts and myloblasts?

Answer 18

Lymphoblasts have less granules than myloblasts

Question 19

What is CML?

Answer 19

Chronic myloid leukaemia
Rare clonal myloproliferative disorder charaterised by an increase in mature myelocytes -esp. neutrophils
Adults, 40- 60 yrs

Question 20

What shows up in CML?

Answer 20

Philadelphia chromosome

Question 21

What are the 3 phases of CML?

Answer 21

Chronic
Accelerated
Blast transformation to acute

Question 22

What are the clinical features of CML?

Answer 22

anaemia
thrombocytopoenia
lymphadenopathy
splenomegaly
hypermetabolim
hepatomegaly

Question 23

What investigations would you do for CML?

Answer 23

FBC
blood film to be myloid cells
bone marrow biopsy
cytogenics for philadelphia chromosome`

Question 24

What treatment would you give for CML?

Answer 24

chemo
splenectomy
bone marrow transplant
tyrosine kinase inhibitors

Question 25

What is CLL?

Answer 25

Chronic lymphocytic leukaemia Clonal lymphoproliferative disease where lymphocytes accumulate in the blood, bone marrow and spleen as a result of longer life expectancy or reduced apoptosis Largely elderly, 70 yrs

Question 26

What are the symptoms of CLL , if it is symptomatic?

Answer 26

lymphadenopathy splenomegaly hepatomegaly immunosuppression

Question 27

What investigations would you do for CLL?

Answer 27

FBC - see increased WBC blood film - increase lymphocytes bone marrow biopsy - see heavy lymphocyte infiltration

Question 28

What is the treatment for CLL?

Answer 28

chemo - if symptomatic

Question 29

What is the prognosis?

Answer 29

Deteriorates if any organ is infiltrated

Question 30

What is a stem cell transplant?

Answer 30

Transplant of multipotent haemopoeitic stem cells, usually derived from bone marrow or peripheral blood

Question 31

What happen when recipient recieves transplant?

Answer 31

Body wants to reject it so they are given radiation or chemo prior to destroy their own immune system

Question 32

What is the difference between an autologous stem cell transplant and an allogenic stem cell transplant?

Answer 32

``` Autologous = patients own stem cells used Allogenic = stem cells from a donor ```

Question 33

What does chemo cause in the oral cavity?

Answer 33

ulcers | reduced saliva