Acute Leukaemia

Front 1

What are the 2 types of acute leukaemia?

Back 1

ALL (Acute LymphoBLASTIC Leukaemia)
AML (Acute MYELOID Leukaemia)

Front 2

How can we categorize the clinical features of acute leukaemia?

Back 2

1. Marrow failure
2. Infiltration of other organs
3. Systemic consequences of malignancy

Front 3

What are the signs and symptoms of marrow failure?

Back 3

1) Anaemia (normocytic)
- fatigue, dyspnoea, faintness, palpitations, headache, pallor
2) Infection
- look in throat, skin, perianal
3) Bleeding
- brusing, gingival bleeding, palatal and retinal haemorrhages, epistaxis, menorrhagia

Front 4

What are the signs and symptoms of infiltration into other organs?

Back 4

- Hepatosplenomegaly
- Bone pain

ALL
- Meninges - headache or CN palsies
- Testis - painful testicular mass

AML
- Skin and gum (hypertrophy)

Front 5

What are the systemic symptoms of malignancy?

Back 5

- Fever
- Fatigue
- Weight Loss
- Night Sweats

Front 6

What are 8 investigations performed for Acute Leukaemia and why?

Back 6

1) FBC - to assess pancytopaenia
2) Coags - to assess DIC (due to leukaemia or 2' sepsis)
3) UEC - may have abnormal renal function 2' to hyperuricaemia and sepsis
4) LFTs - infiltration of the liver may cause abnormal LFTs
5) Immunophenotyping - antigens on cell surface distinguish between ALL and AML
6) Cytogenetics - to find the chromosomal abnormality, which is the most important prognostic indicator
7) CXR - a mediastinal mass may be present in T-cell ALL
8) LP - if neuro SSx to look for CNS involvement in ALL

Front 7

What are the treatment options for Acute Leukaemia?

Back 7

1) Supportive care
2) Chemotherapy
3) Allogenic Stem Cell Transplant

Front 8

Outline what is involved in supportive care

Back 8

1. Inpatient care in a specialist unit
2. Placement of a long term central venous catheter
3. (RBC) PRC transfusions to maintain Hb>80
4. (Plt) Platelet transfusions to maintain Plt>10
5. (Neut) Broad spectrum IVABs in febrile neutropaenia

Front 9

Outline the chemotherapy for AML and ALL

Back 9

AML
1. Cytosine arabinoside
2. Daunorubicin/Idarubicin (anthracyclines)
3. Etoposide

ALL
1. Prednisolone
2. Ara-C
3. Vincristine
4. Methotrexate

Remission induction (2 cycles)
Consolidation (2 cycles)

Front 10

Who gets bone marrow transplant?

Back 10

- High risk patients with standard/poor risk cytogenetics
- Have to be under 45 to be able to tolerate (but changing with new methods)