Leukaemia

Question 1

kinetics of normal haemopoiesis

Answer 1

self renewal 
proliferation
differentiation 
maturation
apoptosis

Question 2

what enzyme do mature neutrophils express

Answer 2

myeloperoxidase

Question 3

what cell surface antigen to red blood cells express

Answer 3

glycophorin A

Question 4

what is malignant haemopoiesis characterised by

Answer 4

increased numbers of often dysfunctional cells

loss of normal haemopoietic reserve

Question 5

what is needed for haemopoeisis to be classified as malignant

Answer 5

one or more of:

• increased proliferation
• lack of differentiation
• lack of maturation
• lack of apoptosis

Question 6

what is acute leukaemia

Answer 6

abnormal proliferation and maturation

• bone marrow over run by mononuclear cells = loss of variation
• cells unable to mature

Question 7

what is a driver mutation

Answer 7

mutation that gives a selective advantage to a clone through either increasing its survival or reproduction
causes clonal expansions

Question 8

what is a passenger mutation

Answer 8

mutation that has no consequence to the cell or growth advantage

Question 9

most common childhood cancer

Answer 9

acute lymphoblastic leukaemia

Question 10

what is a ‘clone’

Answer 10

population of cells derived from a single parent cell

Question 11

clonal features of

• normal haemopoeisis
• malignant haemopoiesis

Answer 11

normal = polyclonal
malignant = monoclonal

Question 12

what are haematological malignancies based on

Answer 12

1. speed of presentation
   - acute or chronic
2. based on site
   - medullary (marrow) / extramedullary
   - blood (leukaemia) / lymph node (lymphoma)
3. lineage:
   - myeloid
   - lymphoid

Question 13

types of haematological malignancy

Answer 13

acute myeloid leukaemia
acute lymphoblastic leukaemia

chronic myeloid leukaemia
chronic lymphocytic leukaemia

Question 14

what is a myeloma

Answer 14

plasma cell malignancy in marrow

Question 15

which type of leukaemia can involve both blood/bone marrow and lymph nodes

Answer 15

chronic lymphocytic leukaemia

Question 16

features of acute leukaemia

Answer 16

rapidly progressive clonal malignancy of marrow/blood with maturation defects

defined as excess of ‘blasts; in either the peripheral blood or bone marrow

decrease/loss of normal haemopoietic reserve

Question 17

types of acute leukaemia

Answer 17

acute myeloid leukaemia (AML)

acute lymphoblastic leukaemia (ALL)

Question 18

What is acute lymphoblastic leukaemia (ALL)

Answer 18

malignant disease of lymphocytes- arrest in maturation of lymphoblasts + proliferation
most common childhood cancer

Question 19

presentation of ALL

Answer 19

anaemia/infection/bleeding – due to marrow failure

High WCC and involvement of extra-medullary areas e.g.CNS

bone pain

Question 20

who is acute myeloid leukaemia more common in

Answer 20

elderly >60

neoplastic proliferation of myeloblasts

Question 21

presentation of acute myeloid leukaemia

Answer 21

anaemia/infections/bleeding – marrow failure

Question 22

investigation for acute leukaemia

Answer 22

blood count + blood film
coagulation screen
bone marrow aspirate

Question 23

blood results of an acute leukaemia

Answer 23

LOW Hb, platelets + neutrophils

Question 24

what is required to differentiate AML from ALL

Answer 24

immunophenotyping

Question 25

what feature on blood film would make you think of acute myeloid leukaemia

Answer 25

AEUR RODS | red staining needle like bodies

Question 26

immunomarker for stem cell precursors

Answer 26

CD34

Question 27

immunomarker for myeloid precursors

Answer 27

CD33

Question 28

treatment for ALL

Answer 28

lasts up to 2-3 years | -different phases of treatment

Question 29

treatment for AML

Answer 29

normally intensive - 2-4 cycles of chemotherapy - prolonged hospitalisation

Question 30

problems of marrow suppression

Answer 30

anaemia neutropenia -- infections thrombocytopenia -- bleeding

Question 31

side effects of chemo treatment

Answer 31

``` N+V hair loss tumour lysis syndrome liver/renal dysfunction infection infertility ```

Question 32

which chemotherapy drug has a risk of cardiomyopathy

Answer 32

anthracyclines

Question 33

what needs to be done as soon as a neutropenic fever develops

Answer 33

empirical treatment with broad spectrum antibiotics

Question 34

childhood cure rate of ALL

Answer 34

>85-90%

Question 35

Potential curative treatment for leukaemia

Answer 35

allogenic stem cell transplantation (donor stem cells)

Question 36

what is Philadelphia chromosome

Answer 36

genetic abnormality in chromosome 22 of leukaemia cancer cells

Question 37

what leukaemia is Philadelphia chromosome particular seen in

Answer 37

chronic myeloid leukaemia

Question 38

aetiology of chronic lymphocytic leukaemia

Answer 38

clone of mature B cells (memory cells)

Question 39

aetiology of chronic myeloid leukaemia

Answer 39

clonal proliferation of myeloid cells