Leukaemia (Pathology)

Question 1

Leukaemia is cancer of

Answer 1

Cancer of blood or bone marro

Question 2

Leukaemic blood shows increased

Answer 2

Immature white blood cells

Question 3

Most acute leukemias in children are

Answer 3

Acute lymphoblastic leukemia

Question 4

Most acute leukemias in adults are

Answer 4

Acute myeloblastic leukemia

Question 5

Leukaemia arises from __________ mutations in ____________ or ________ progenitor cells

Answer 5

Somatic mutations in mulipotent (primitive) or in some cases differentiated

Question 6

Mutations leading to leukemia generally result from

Answer 6

chromosomal translocation

Question 7

Chromosomal translocation leads to

Answer 7

fusion of genes encoding for fusion proteins that disrupt the normal pathways of maturation and differentiation, predisposing to malignant transformation

Question 8

Immature cells in peripheral blood is referred to as

Answer 8

left shift - eg band cells, myelocytes, promyelocytes, myeloblasts etc., cells which should be in the bone marrow

Question 9

Acute leukaemia is

Answer 9

proliferation/accumulation of blasts (immature blood cells), compromosing normal marrow function - clinical course is rapid and fatal

Question 10

Chronic leukaemia is

Answer 10

accumulation of maturer white cells with gradual compromise of marrow function; course is indolent with or w/o treatment

Question 11

What are the common chronic leukaemias?

Answer 11

Chronic lymphocytic
Chronic myeloid
Hairy cell
Chronic myelomonocytic

Question 12

What is the commonest chronic leukaemia?

Answer 12

chronic lymphocytic leukaeima (CLL)

Question 13

Leukaemia is characterized/classified based on

Answer 13

clinical features (nonspecific)
morphology
cytochemistry (less now)
immunophenotype
cytogenetics - will become routine
molecular - more common

Question 14

T/F pathogenesis of acute myeloid leukaemia is related to one genetic event

Answer 14

False; it is a complex interplay of genetic events that contributes to AML pathogenesis

Question 15

What are the haematological investigations in leukaemia?

Answer 15

FBE, bone marrow (morphology)

Question 16

What are the biochemical investigations in leukaemia?

Answer 16

Renal and LFTs
Serum Ca
Uric acid
LDH

Question 17

What are the imaging investigations in leukaemia?

Answer 17

Plain Xray, CT for hepatosplenomegaly and lymphadenopathy, cardiac function

Question 18

What are the principles of treatment?

Answer 18

Observation (chronic; not acute)
Chemo
Transplantation
Radiotherapy
Targeted chemo
Supportive tx

Question 19

Autologous transplant is when stem cells are taken from

Answer 19

the patient’s own peripheral blood (used to be bone marrow)

Question 20

Allogenic transplant is when stem cells are taken from

Answer 20

siblings or unrelated donors

Question 21

Supportive tx in leukaemia involves

Answer 21

management of blood counts (chemo drops neutrophils, platelets etc), susceptibility to infections (ABs), platelet transfusions etc., social and emotional support for patients and their families

Question 22

Transplantation is derived from

Answer 22

peripheral blood (autologous), bone marrow, in some situations resort to cord blood

Question 23

Tx response is monitored by

Answer 23

looking for remission: normal morphology and immunophenotype on flow cytometry, no cytogenic abnormalities, reduced molecular abnormalities

Question 24

Partial remission is defined as

Answer 24

more than 50% reduction of the disease

Question 25

What is the outcome of childhood ALL?

Answer 25

80% cure rate

Question 26

What is the outcome of adult AML/ALL?

Answer 26

20-40% 5yr survival rate

Question 27

What is the outcome of CML?

Answer 27

80-90% 10yr survival

Question 28

What is the outcome of CLL?

Answer 28

5-10yrs