Leukemia Flashcards Preview

Hugh's MD2 Core Conditions and Presentations > Leukemia > Flashcards

Flashcards in Leukemia Deck (31):
1

What is the only way to cure CLL?

Allograph

2

How is flow cytometry used outside of diagnosis?

Follow up detection of clearance of leukaemic cells

3

What is the first line therapy of CLL?

FCR

F - Fludarabine

C - Cyclophosphamide

R - Rituximab

4

How is CML monitored?

Measure bcr-abl transcript in blood

5

What are the second generation tyrosine kinase inhibitors? When are they used?

Dasatinib

Nitolinib

Resistant to imatinib

6

Cytologically, what is unique about APML?

Faggot cells with lots of auer rods

7

What is the common leukaemia in adults?

CLL

8

What is the first line therapy for CML?

Tyrosine kinase inhibitors - Imatinib

Virtually eliminated the need for transplantation

9

How is leukaemia diagnosed on bone marrow?

Blasts make up >20% of nucleated cells

10

What are the three stages of CML?

Chronic

Accelerated

Blast

11

How does risk effect treatment in AML?

Good risk don't require transplant

Adverse risk require transplant

12

How do you stratify intermediate risk patients from cytogenetics?

Molecular testing

13

What are symptoms of acute leukemia?

Symptoms of anaemia - lethargy, SOB, pallor, presyncope

Neutropenia - fever, rigors, infections

Thrombocytopenia - bruising, bleeding

B symptoms - fevers, sweats, weight loss

Lymphadenopathy, hepatosplenomegaly

Symptoms of hyperleucocytosis

14

How are leukemia classified?

Acute vs chronic

Myeloid vs lymphoid

15

What are auer rods classic of?

Acute myeloid leukaemia

16

How is CLL diagnosed with Ix?

Morphology on blood film and marrow

- Small mature lymphocytes, smear cells

- Cytopenia

 

Immunophenotype

- cells expressing CD5

17

What is the natural history of CML?

Chronic phase: asymptomatic, up to 5 years

Accelerated: symptoms develop, cytopenias, hepatosplenomegaly

Blast phase: acute leukaemia, full range of myelo-development present on blood film

18

What is the diagnostic feature of CML?

9;22 philadelphia chromosome and BCL-ABL protein

19

The philadelphia chromosome and BCR-ABL phenotype is in which type of leukaemia?

CML

20

When is CLL treated?

Only when they become symptomatic 

(LNs, cytopenias, B symptoms)

21

What is the critical drug used in ALL?

L-asparaginase

22

What are the mainstays of treatment on AML in Aus?

Cytarabine and anthracycline

1x Induction (high dose)

2x Consoliation (lower dose)

23

Why do you do cytogenetics in CLL?

You want to know the genetype as

Because 17p deletion doesn't response to FCR treatment

And deletion of 13p has an indolent course

24

How does treatment of APML differ from other acute leukaemia?

It's medical emergency

DIC common

25

Which cohort of people get CLL?

Elderly

26

How do you investigate acute leukemia?

FBE and film

Bone marrow biopsy

Immunophenotyping

Cytogenetics

Molecular studies

27

What is the etiology of leukemia?

Mostly unknown

Other risk factors:

- Previous cytotoxic theray eg adriomycin

- Ionizing radiation

- Chemical exposure

- Infections - adult T cell leukemia lymphoma and HTLV-1 (not common in Aus)

- Genetic - trisomy 21

- Rare familial syndromes

28

Which cytogenetic type has the worst prognosis in CLL?

17p deletion 

Or other TP53 mutation (that isn't a 17p deletion)

29

How are chronic leukaemias usually diagnosed?

On screening FBE for other conditions

30

How do you manage APML acutely?

Correct coagulopathy with platelets, cryoprecipitiate and fibrinogen

And all trans retinoic acid (ATRA) and arsenic as soon as possible - this very curative (98%, 5 yearly survival)

31

When is blasts in the peripheral blood normal?

Never