Leukaemia Symposium

Question 1

What is cancer?

Answer 1

Transformed cell phenotype: uncontrolled proliferation; failure to undergo apoptosis
Genetic: oncogenes, tumour suppressor genes
Epigenetic: dysregulated gene expression; aberrant DNA methylation

Question 2

Acute Myeloid Leukaemia

Answer 2

Uncontrolled proliferation of primitive cells in the bone marrow
Causes of bone marrow failure: anaemia, infections, bleeding
Blasts identified on blood film

Question 3

How is it treated?

Answer 3

Chemotherapy - combination regimes; myelo-ablative cycles of treatment
Supportive therapy: antibiotics/antifungals; transfusions of blood and platelets
Allogenic stem cell transplantation: allograft from sibling/matched unrelated donor (Anthony Nolan)

Question 4

Risk of neutropenic sepsis

Answer 4

Medical emergency
Gram negative bacteria are most dangerous
Blood cultures and blind antibiotic therapy if fever >38 degrees
- 1st line: Tazocin (piperacillin/tazobactam) +/- Gentamicin
- 2nd line – switch to meropenem +/- Teicoplanin (for Gram +ve)
- 3rd line – add anti-fungal e.g. ambisome (amphotericin)
Resuscitate patient with IV fluids if hypotensive
May require inotropic support on ITU

Question 5

Graft vs Host disease

Answer 5

Caused by donor/host mismatches in major and minor HLA loci
Prevented by using: T cell depletion of infused donor cells, and immunosuppression of recipient
Clinical manifestations: skin rash, diarrhoea, deranged liver function
Graft vs leukaemia is how the stem cell transplant cures leukaemia
Donor lymphocyte infusions post treatment can treat relapse by augmenting GVL effect