Leukaemia

• What are the four main types of leukaemia?

  Acute myeloid leukaemia (AML), Acute lymphoblastic leukaemia (ALL), Chronic myeloid leukaemia (CML), Chronic lymphocytic leukaemia (CLL)
• What is the main difference between acute and chronic leukaemia?


  Acute leukaemia results from impaired cell differentiation, while chronic leukaemia results from excess proliferation of mature malignant cells.
• From what type of precursor cells does myeloid leukaemia arise?


  Myeloid leukaemia commonly arises from myeloid precursor cells, such as those that produce neutrophils.
• What type of precursor cells does lymphocytic leukaemia arise from?


  Lymphocytic leukaemia arises from lymphoid precursor cells, such as B or T cells.
• What is the most common acute leukaemia?

  Acute myeloid leukaemia (AML)
• Who is predominantly affected by AML?


  AML predominantly affects adults, especially older adults.
• What environmental factor is associated with the development of leukaemia?

  Ionising radiation, such as that from a nuclear disaster, is associated with the development of leukaemia.
• What are the clinical features of AML?


  • Bone marrow failure: anaemia, bleeding, infections
  • Signs of tissue infiltration: hepatomegaly, splenomegaly, gum hypertrophy
  • Rare central nervous system involvement
• What blood test findings are commonly associated with AML?


  Blood tests commonly show leucocytosis, but white cells can also be normal or low.
• What is a key diagnostic procedure for AML?


  A bone marrow biopsy is key to the diagnosis of AML.
• What are the characteristic findings in a bone marrow biopsy for AML?


  • Hypercellular marrow
  • Presence of blasts (usually >50%)
  • Sometimes Auer rods
• How is AML classified according to the FAB classification?


  AML can be classified into eight subtypes (M0–M7) based on its morphological appearance.
• What is the role of cytochemistry in diagnosing AML?


  Cytochemistry, such as Sudan Black and nonspecific esterase, helps identify specific cell types in AML.
• What are the management strategies for AML?


  • Chemotherapy regimens
  • Bone marrow transplantation
  • Prophylactic antimicrobials
  • Blood products and growth hormone therapy
  • Cryopreservation for fertility preservation
• What is the purpose of initial induction chemotherapy in AML?


  Initial induction chemotherapy aims to remove the bulk of leukaemic cells to achieve <5% blasts in the marrow.
• What is the 'graft-versus-leukaemia' effect?


  The 'graft-versus-leukaemia' effect refers to the immunogenic response from donor cells that helps destroy remaining leukaemic cells.
• What is a common complication of bone marrow transplantation?


  Graft-versus-host disease is a common complication of bone marrow transplantation.
• What is the prognosis for AML without treatment?


  Death typically occurs within 2 months without treatment.
• What are key survival factors in AML?


  Key survival factors include age, poor cytogenetics, and response to the first dose of induction chemotherapy.
• What are the complications associated with AML treatment?


  • Secondary malignancy
  • Cardiorespiratory complications
  • Endocrine dysfunction
  • Infertility
  • Avascular necrosis of the hip
  • Neuropsychological effects
• What is the peak incidence age for ALL?


  The peak incidence for ALL is at age 4–5 years.
• What is the main cause of ALL?


  ALL is caused by the abnormal proliferation of lymphoid progenitor cells.
• What are the common clinical features of ALL?


  • Symptoms of marrow failure: fatigue, abnormal bleeding/bruising, infections
  • Organ infiltration: bone pain
  • Signs: painless lymphadenopathy, hepatosplenomegaly, CNS involvement, testicular infiltration
• What is a common diagnostic finding in ALL?


  Leucocytosis is a common finding in ALL.
• What is the significance of immunophenotyping in ALL?


  Immunophenotyping helps differentiate whether the origin of ALL is a T or B cell.
• What is the treatment strategy for ALL?


  ALL is treated with combination chemotherapy that induces remission and then consolidates with stronger chemotherapy.
• Why are CNS prophylactic agents given to ALL patients?


  CNS prophylactic agents are given because the CNS is a sanctuary site for leukaemia cells.
• How is the response to treatment monitored in ALL?


  Response is monitored by blast count in the bone marrow and assessment of minimal residual disease (MRD).
• What is the cure rate for children with ALL?


  The cure rate for children with ALL is 70–90% with chemotherapy alone.
• What are poor-risk prognostic factors in ALL?


  Poor-risk factors include age <1 year or >10 years, male sex, high WCC, CNS disease, and poor cytogenetic features.
• What is the median age for CML patients?


  The median age for CML patients is 40–50 years.
• What is the Philadelphia chromosome associated with?


  The Philadelphia chromosome is classically associated with chronic myeloid leukaemia (CML).
• What are the common clinical features of CML?


  • Weight loss
  • Tiredness
  • Fever
  • Sweating
  • Massive splenomegaly
  • Bleeding due to thrombocytopenia
  • Gout
• What are the typical blood test findings in CML?


  Blood tests commonly show leucocytosis, raised myeloid cells, and possible anaemia.
• What is the diagnostic marker for CML?


  The BCR–ABL/Philadelphia chromosome is the diagnostic marker for CML.
• What is the incidence of CML in the population?


  The incidence of CML is 1 per 100,000 of the population.
• What is the typical age distribution for CML patients?


  CML is most common in middle-aged patients, with a median age of 40–50 years.
• What is a common symptom of splenomegaly in patients?


  It occurs in more than 75% of patients.
• What condition can cause bleeding in patients with CML?

  Thrombocytopenia
• What metabolic condition is associated with CML?


  Gout