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Medicine Phase 2a Haematology > Leukemia > Flashcards

Leukemia Flashcards

(48 cards)

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1
Q

What are the 4 types of leukemia

A

Acute lymphoblastic
Chronic lymphocytic
Acute myeloid
Chronic myeloid

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2
Q

What is acute lymphoblastic leukemia

A

Acute malignant transformation of a clone of lymphoid progenitor cells

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3
Q

Clinical presentation of acute lymphoblastic leukemia

A 
Bone marrow failure: Anaemia, Bleeding, Infection
Bruising
SoB
Purpura
Malaise
Weight loss
Night sweats

Bone pain
(Hepatoslenomegaly more chronic)
Fatigue
Dizziness
Palpitations
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4
Q

Pathophysiology of acute lymphoblastic leukemia

A

Uncontrolled proliferation of precusor B or T cells
-> Accumulation of leukaemic cells in bone marrow, peripheral blood and other tissues.
Also a reduction in red cells, platelets and neutrophils

Often spreads to CNS

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5
Q

Genetic Aetiology of acute lymphoblastic leukemia

A

Down’s syndrome 20x risk

Pregnancy

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6
Q

Environmental Aetiology of acute lymphoblastic leukemia

A

Chemicals (benzene compounds)
Drugs (alkylating agents)
Ionising Radiation exposure

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7
Q

Epidemiology of ALL

A

Most common cancer in children

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8
Q

Diagnosis of ALL

A

Peripheral blood film - anaemia and thrombocytopenia

Bone marrow aspirate - Leukaemic blast cells

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9
Q

Treatment of ALL

A

Chemotherapy
Intrathecal methotrexate
Follow up maintenance

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10
Q

What chemotherapy drugs are given in the treatment of ALL

A

Vincristine, Dexamethasone, Asparaginase and Daunorubicin

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11
Q

Prognosis of ALL in children compared with adults

A 
Children = excellent prognosis (1 in 5 die)
Adults = poorer prognosis, only 30% cured
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12
Q

Which leukemia would show smudge cells in histological analysis

A

Chronic Lymphocytic Leukemia

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13
Q

Which leukaemia would show auer rods in histological analysis?

A

Acute myeloid leukemia

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14
Q

Which leukaemia has a propensity to involve the CNS?

A

Acute Lymphoblastic leukemia

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15
Q

What is chronic lymphocytic leukaemia

A

Chronic malignant transformation of a clone of mature lymphoid cells

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16
Q

Early clinical presentation of chronic lymphocytic leukaemia

A

Asymptomatic (indolent), but isolated lymphocytosis is frequent

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17
Q

Clinical presentation of chronic lymphocytic leukaemia when symptomatic

A 
Bone marrow failure
Nontender lymphadenopathy
Hepatosplenomegaly
Malaise
Weight loss
Night sweats

Anaemia
Bleeding and Infection due to bone marrow failure
Rubbery lymph nodes

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18
Q

Pathophysiology of chronic lymphocytic leukaemia

A

Uncontrolled proliferation and accumulation of mature B (or T) cells.
Autoimmune haemolysis can occur causing anaemia

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19
Q

Aetiology of chronic lymphocytic leukaemia

A

Genetic: Mutation (11q or 17p deletion for example)

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20
Q

Epidemiology of CLL

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A

Most common leukaemia in the western world

21
Q

Diagnostic tests of CLL

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A

FBC - Anaemia, raised White cell

Blood film - smudge cells

22
Q

Treatment of CLL

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A

Incurable

Chlorambucil (with or without) prednisolone) -> decreases blood count -> Decreases lymphadenopathy and splenomegaly

23
Q

What is the most common cancer in children?

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A

Acute lymphoblastic leukaemia

24
Q

What is the most common cancer in the Western world

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A

Chronic lymphocytic leukaemia

25
What is Acute Myeloid leukaemia
Acute malignant transformation of a clone of myeloid progenitor cells
26
Clinical presentation of Acute Myeloid leukaemia
Fatigue, dizziness and palpitations. Anaemia, bleeding and infection due to bone marrow failure. Hepatosplenomegaly Malaise, weight loss, night sweats
27
Pathophysiology of Acute Myeloid leukaemia
Accumulation of leukaemia cells in bone marrow, peripheral blood and other tissues. Additionally a reduction in red cells, platelets and neutrophils. Rapidly progressing
28
Aetiology of Acute Myeloid leukaemia
``` Exact cause unknown Risk factors include: Myeloproliferative disease Alkylating agents Ionising radiation exposure Down's syndrome ```
29
Epidemiology of Acute Myeloid Leukaemia
Most common leukaemia in adults | Most common in older adults and elderly
30
Diagnostic tests of Acute Myeloid Leukaemia
Peripheral blood film - anaemia, thrombocytopenia, AUER RODS (diagnostic) Bone Marrow Aspirate - Leukaemia blast cells
31
Low risk Treatment of AML
Chemotherapy in intervals to allow marrow recovery
32
Intermediate treatment of AML
Chemotherapy followed by allogenic bone marrow transplant
33
High risk treatment of AML
Only curable with allogenic BM transplantation
34
What is Chronic Myeloid Leukaemia
Chronic malignant transformation of a clone of myeloid cells
35
Clinical presentation of Chronic Myeloid Leukaemia
Insidious onset, fever, malaise, weight loss, (night) sweating. Bone marrow failure, anaemia. Massive splenomegaly. Untreated, this lasts 3-4 years before progressing
36
Pathophysiology of Chronic Myeloid Leukaemia
Insidious onset lasts 3-4 years ->Blast transformation -> Acute myeloid leukaemia -> death
37
Aetiology of CML
``` Ionising radiation is risk factor Genetic: 95% of cases: Philadelphia chromosome: reciprocal translocation (t(;22)), creating fusion gene (BCR-ABL) with tyrosine kinase activity which alters cell growth ```
38
Diagnostic tests of CML
FBC - anaemia, raised WBCs | Cytogenetics - Philadelphia stage
39
Treatment of CML
Imatinib (tyrosine kinase inhibitor) If in acute stage = chemotherapy Allogeneic stem cell transplantation in <60 possible
40
Sequelae of CML
AML | Myelofibrosis
41
Leukaemia complications
``` Death Increased risk of infection Haemorrhage: pulmonary, intracranial Depression Complication of chemotherapy ```
42
Investigations
Bloods - FBC, WCC, platelets, U and Es, LFTs, ESR, CRP Bone marrow biopsy, lymph node biopsy Radiology - x-ray, ultrasound scan, CT scan, MRI
43
How are ALL and AML classified
French-American-British (FAB) classification
44
Conservative treatment of leukaemia
Patient education | Refer to Macmillan nurses
45
Medical treatment of ALL
Induce remission and maintenance To induce remission: Dexamethasone, Vincristine, Anthracycline antibiotics, Cyclophosphamide Maintenance: Methotrexate, Mercaptopurine, Cytarabine, Hydrocortisone
46
Medical treatment of AML in patients <60
Chemotherapy with an anthracycline and cytarabine or methotrexate
47
Medical treatment of AML in patients >60
Palliative anthracycine, cytarabine or mitoxantrone
48
What would you add to therapeutic regime if M3 type AML (Acute Promyelocytic leukemia - APML)
All-trans retinoic acid

Medicine Phase 2a Haematology (16 decks)

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