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Clinical lectures: Yr2 > Leukaemia: AML, ALL, CML, CLL > Flashcards

Leukaemia: AML, ALL, CML, CLL Flashcards

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1
Q

Define leukaemia?

A

Group of malignant cancers characterised by overproduction of immature and abnormal mature leukocytes, which suppress formation of other blood cells

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2
Q

Leukaemia is a cancer of what blood cell lineage?

A

Leukocytes (WBCs)

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3
Q

How does leukaemia characteristically affect formation of other blood cell lineages?

A

Suppresses formation of other blood cell types

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4
Q

Why is leukaemia classed as either myeloid or lymphoid?

A

Classed as myeloid (originates from myeloid cell lineage)

or

lymphoid (originates from lymphoid cell lineage)

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5
Q

How many main types of leukaemia are there, and what are they called?

A

4 main types:

Acute Myeloid Leukaemia (AML)

Chronic Myeloid Leukaemia (CML)

Acute Lymphoblastic/Lymphocytic Leukaemia (ALL)

Chronic Lymphoblastic/Lymphocytic Leukaemia (CLL)

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6
Q

Why is leukaemia classed as either acute or chronic?

A

Classed as acute (predominantly originates from immature cells)

or

chronic (predominantly originates from mature cells)

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7
Q

Define CLL, in terms of classification?

A

Chronic Lymphoblastic/Lymphocytic Leukaemia (CLL): Characterised by clonal proliferation of mature B-lymphocytes

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8
Q

What is the most common type of leukaemia?

A

CLL

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9
Q

At what age does CLL typically present?

A

Over 70 yrs old

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10
Q

Describe the speed of progression of CLL?

A

Usually progresses slowly

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11
Q

Does a patient with CLL typically present as symptomatic or asymptomatic, and why?

A

Asymptomatic

Because it generally progresses slowly

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12
Q

In the clinical presentation of symptomatic CLL, what are the 4 characteristic findings?

A

Lymphadenopathy

Splenomegaly

Symptoms of anaemia eg. pallor, TATT

Symptoms of thrombocytopenia eg. easily bruises or bleeds

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13
Q

How is CLL usually initially diagnosed during investigation?

A

Incidental lymphocytosis finding on FBC

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14
Q

If a patient has lymphadenopathy but no lymphocytosis on the FBC, can this still be diagnosed as CLL?

A

No, CLL must have lymphocytosis finding

Diagnosed as a Small Lymphocytic Lymphoma (SLL), which is a low-grade Non-Hodgkin lymphoma

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15
Q

What are the 2 hallmark findings for CLL on a blood film?

A

Lymphocytosis (lymphocytes with large nucleus and very thin cytoplasm border)

Smudge/smear cells (ruptured lymphocytes with irregular cytoplasm border)

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16
Q

What is immunophenotyping?

A

Lab test that uses a monoclonal antibody with an attached fluorescent maker to identify different antigens

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17
Q

What lab investigation is used to confirm CLL diagnosis?

A

Immunophenotyping

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18
Q

What is the hallmark finding of CLL, on immunophenotyping?

A

Co-expression of CD5 (T-cell antigen) and CD19 (B-cell antigen)

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19
Q

When do you start treatment for a patient with CLL?

A

Only treat patient when they become symptomatic, otherwise watch and wait

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20
Q

What are the most common medications used to treat CLL?

A

Combination of cytotoxic chemotherapy and monoclonal antibodies

eg. Rituximab + fludarabine + cyclophosphamide

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21
Q

What new drug class can be used to treat CLL, and give 2 examples?

Study These Flashcards
A

B-cell signaling inhibitor tablets

e.g. ibrutinib, venetoclax

22
Q

Define CML, in terms of classification?

Study These Flashcards
A

Chronic Myeloid Leukaemia (CML): Characterised by clonal proliferation of mature granulocytes

23
Q

What is the pathophysiology of CML?

Study These Flashcards
A

Philadelphia chromosome translocation between chromosomes 9 and 22 causes BCR-ABL protein (tyrosine kinase) to switch on myeloid cell production

24
Q

Does a patient with CML typically present as symptomatic or asymptomatic, and why?

Study These Flashcards
A

Usually asymptomatic, as the chronic phase progresses slowly

25
Compare the clinical presentation of symptomatic CML to CLL?
Similar presentation of splenomegaly, lymphadenopathy, anaemia, thrombocytopenia, neutropenia symptoms and signs CML presents also with night sweats and weight loss
26
How is CLL usually initially diagnosed during investigation?
Incidental lymphocytosis finding on FBC
27
Other than neutrophilia, what are 4 findings on a FBC of a patient with CML?
Thrombocytosis or thrombocytopenia Eosinophilia Basophilia Anaemia
28
What is the blood film hallmark for CML?
Neutrophilia
29
Which 2 lab investigations are used to confirm a CML diagnosis?
FISH Bone marrow aspirate
30
What will the FISH investigation show to confirm CML?
Philadelphia translocation
31
What will the bone marrow aspirate show to confirm CML?
Excess myeloid cells
32
What is the FISH investigation, and why is it useful for diagnosing CML?
FISH (Fluorescent In-Situ Hybridisation) identifies specific chromosome translocations by providing fusion signal (yellow coloured) Will identify Philadelphia translocation
33
How does the bone marrow aspirate from a patient with CML correlate to their progression?
Shows state of progression between chronic and acute phase
34
When do you start treatment for a patient with CML?
Immediately after diagnosis Otherwise could progress to AML
35
What is the first-line drug class for CML treatment, and how long must the patient take these for?
Tyrosine Kinase Inhibitors (TKI) eg.imatinib Taken daily for rest of life
36
How can TKIs treat CML, and how is this monitored?
Patient aims to have very low BCR-ABL protein as TKI blocks it Monitored using PCR of blood
37
Define ALL, in terms of classification?
Acute Lymphoblastic/Lymphocytic Leukaemia (ALL): Characterised by clonal proliferation of lymphoblasts (lymphocyte precursors)
38
Define AML, in terms of classification?
Acute Myeloid Leukaemia (AML):Characterised by clonal proliferation of myeloblasts (myeloid cell precursors)
39
Compare the epidemiologies of ALL and AML?
ALL: More common in children AML: More common in adults and elderly
40
Compare the clinical presentation of ALL and AML?
Both present with symptoms of pancytopenia: Lethargy, fever and infections, easily bleed and bruise, symptoms of anaemia ALL patients can sometimes present with hepato-splenomegaly
41
Compare the speed of onset of ALL and AML?
Speed of onset is usually fast, as history is short
42
Why is hepato-splenomegaly less common in acute leukaemia than chronic leukaemia?
Hepato-splenomegaly is an adaptation so can take time to occur
43
What must a blood film show to confirm an acute leukaemia diagnosis?
Over 20% blast cells
44
Why is blood film not reliable to distinguish between ALL and AML?
Lymphoid and myeloid blasts both have high nuclear:cytoplasmic ratio and distinct nucleoli
45
What lab investigation is used to distinguish between ALL and AML?
Immunophenotyping
46
What blood film finding can indicate AML instead of ALL?
Auer rods
47
What is meant by cancer remission, and is this absolute?
Cancer is not detected Patients still have risk of cancer returning: Relapse
48
What is the correlation between curative chemotherapy for acute leukaemias and patient age?
The more elderly a patient is, the less likely they are to tolerate curative chemotherapy
49
Give one benefit and one disadvantage of intensive chemotherapy?
Chance of cure but is very toxic and has life-threatening complications associated
50
Give one benefit and one disadvantage of low-intensity chemotherapy?
Prolongs life but not curative, still is toxic
51
When palliative care is the chosen treatment for acute leukaemia, what is the main focus?
Symptom control with minimal time in hospital

Clinical lectures: Yr2 (63 decks)

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