Leukaemia

Question 1

Leukaemia

Answer 1

cancer of a particular line of stem cells in the bone marrow

Question 2

4 types

Answer 2

AML
CML
ALL
AML

Question 3

pancytopenia

Answer 3

low platelets
low RBC
low WBC

Question 4

most common leukaemia in children under 5

Answer 4

ALL

Question 5

typical features

Answer 5

fatigue
fever
failure to thrive
pallor 
petechiae/abnormal bruising
LN
hepatosplenomegaly

Question 6

petchiae differentials

Answer 6

leukaemia
meningococcal septicaemia
vasculitis 
NAI
ITP
HSP

Question 7

diagnosis

Answer 7

FBC
blood film 
lactate dehydrogenase
bone marrow biopsy
LN biopsy 
CXR, lumbar puncture, CT/MRI/PET

Question 8

blood film

Answer 8

abnormal cells and inclusions

Question 9

definitive diagnosis

Answer 9

bone marrow biopsy

Question 10

bone marrow aspirate

Answer 10

liquid sample full of cells from bone marrow

Question 11

bone marrow trephine

Answer 11

solid core sample of bone marrow and better assessment of cells and structure

Question 12

where is bone marrow biopsy usually taken from?

Answer 12

iliac crest

Question 13

what happens in ALL?

Answer 13

malignant change in lymphocyte precursor cells

acute proliferation of (usually) B lymphocytes

Question 14

why is there pancytopenia in ALL?

Answer 14

B lymphocytes take over bone marrow and replace other cells

Question 15

what is ALL often associated with?

Answer 15

downs syndrome

ionising radiation in pregnancy

Question 16

ALL blood film

Answer 16

blast cells

Question 17

ALL genetic association

Answer 17

philadelphia chromosome 30% adults but only 5% children

Question 18

who is usually affected by CLL?

Answer 18

adults over 55

Question 19

CLL symptoms

Answer 19

often asymptomatic

infections, anaemia, bleeding and weight loss

Question 20

what can CLL cause?

Answer 20

warm autoimmune haemolytic anaemia

Question 21

what can CLL transform into?

Answer 21

high grade lymphoma

richter’s transformation

Question 22

blood film CLL

Answer 22

smear or smudge cells

Question 23

3 phases of CML

Answer 23

chronic phase
accelerated phase
blast phase - crisis

Question 24

how are those with CML often diagnosed?

Answer 24

asymptomatic raised WCC

Question 25

characteristic cytogenic change CML

Answer 25

philadelphia chromosome

Question 26

philadelphia chromosome

Answer 26

chr 9 and 22 translocation | CML

Question 27

treating CML - what drug has revolutionalised treatment?

Answer 27

imatinib | BCR-ABL tyrosine kinase inhibitor

Question 28

most common acute leukaemia in adults

Answer 28

ALL

Question 29

what can ALL progress from?

Answer 29

myeloproliferative disorder polycythaemia ruby vera myelofibrosis

Question 30

blood film AML

Answer 30

blast cells | auer rods in cytoplasm

Question 31

how long is asymptomatic phase of CML?

Answer 31

5 years

Question 32

complications of chemotherapy

Answer 32

``` failure stunted growth in children infections infertility tumour lysis syndrome neuro/cardiotoxicity ```

Question 33

what causes tumour lysis syndrome?

Answer 33

release of uric acid from cells destroyed by chemo

Question 34

impact of uric acid in TLS

Answer 34

crystals in interstitial tissue and tubules in kidney - AKI

Question 35

treating tumour lysis syndrome

Answer 35

allopurinol or rasburicase potassium and phosphate monitoring calcium monitoring

Question 36

Is CNS involvement common in ALL?

Answer 36

yes

Question 37

3 classifications of ALL

Answer 37

morphological - FAB cytogenic - philadelphia immunological

Question 38

ALL treatment

Answer 38

remission consolidation CNS prophylaxis maintenance

Question 39

ALL cure rate children

Answer 39

70-90%

Question 40

only cure for CML

Answer 40

stem cell transplant -HLA matched

Question 41

treating CLL

Answer 41

fludarabine rituximab cyclophosphamide

Question 42

staging for CLL

Answer 42

binet staging | rai stage

Question 43

binet staging

Answer 43

``` A = fewer 3 LN B = >3 LN C = anaemia and low platelets ```