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Introduction To Haematological Malignancies

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Presentation on theme: "Introduction To Haematological Malignancies"— Presentation transcript:

1 Introduction To Haematological Malignancies
By Tiffany Shaw MBChB II July 2002

2 Common Malignancies Acute Chronic Lymphoid Myeloid
Acute lymphoblastic leukemia Chronic lymphocytic leukemia Lymphoma Myeloma Myeloid Acute myeloid leukemia Chronic myeloid leukemia

3 Acute Leukemias -- Definition
A malignant disorder in which haemopoietic blast cells proliferate and constitute > 30% of the bone marrow. Lymphoblasts  Lymphoblastic leukemia Myeloblasts  Myeloid leukemia

4 Acute Leukemias -- PC Bone marrow infiltrated by blasts cells
Bone marrow failure Pan-cytopenia Anaemia  fatigue, SOB on exersion Thrombocytopenia  bleeding / DIC Neutropenia  infections Constitutional symptoms (malaise, anorexia, night sweat, fever) Lymphadenopathy, hepatospenomegaly

5 Acute Leukemias -- Ix Low Hb Low platelets
High WCC (increased blast cells) Low neutrophils Elevated serum uric acid Bone marrow biopsy: infiltration by blast cells

6 Acute Leukemias – Risk Factors
Familial Down’s syndrome Viral infection (EBV  Burkitt’s) Radiation Chemotherapy

7 Acute Leukemias – AML VS ALL
Myeloblastic Any age 1/3 transformation from other myeloproliferative disorders Increased DIC ALL Lymphoblastic Commonly children Primary event More lymphadenopathy and hepatosplenomegaly

8 Acute Leukemias -- Classification
French-American-British Classification Morphology Cytochemistry Immunophenotype Cytogenetics DNA analysis

9 Examples AML Promyelocytic Myelomonocytic Monocytic Erythroid
Megakeryoblastic Undifferentiated …. ect. ALL Small cells Large cells Vacuolated basophillic blast cells

10 Acute Leukemias -- Mx Supportive Rx Anaemia: blood transfusion prn
Bleeding: platelets prn Infection: antibiotics prn Social support + issues

11 Acute Leukemias -- Mx Chemotherapy: Remission-induction phase
Consolidation phase Maintenance phase (for ALL) prednisone, daunorubicin, vincristine, thioguanine, cyclophosphamide…

12 Acute Leukemias -- Mx Bone Marrow Transplantation: High-dose chemo Rx
Removal of stem cells from donor Transplantation into recipient

13 Acute Leukemias -- Prognosis
AML ~ 30-40% cured Varies widely with age, co-morbidity..etc. ALL In children, ~ 70% cured In adults, ~ 30-40%

14 Chronic Myeloid Leukemia
Increase in neutrophils and their precursors Really a myeloproliferative disorder > 95% patients have chromosomal mutation --- Philadelphia chromosome

15 CML -- PC Constitutional symptoms (anorexia, weight loss, fatigue, night sweat) Splenomegaly (hypochondrial pain) Asymptomatic – incidental finding

16 CML -- Ix Increased WCC (neutrophils and precursors)
Later  bone marrow failure (anaemia + thrombocytopenia) Raised serum B12 Raised serum uric acid Bone marrow biopsy  hypercellular with high myeloid:erythroid ratio

17 CML – Course/Progression
Chronic Phase Raised WCC Constitutional symptoms / Asymptomatic Accelerated Phase Anaemia + thrombocytopenia Splenomegaly Bone marrow fibrosis Acute Phase Transformation to acute leukemia (80% AML, 20% ALL)

18 CML -- Mx Chronic Phase Acute Phase Hydroxyurea Interferons Chemo Rx
Bone marrow transplantation Acute Phase Same as acute leukemia

19 Chronic Lymphcytic Leukemia
Increased lymphocytes (B cells) in the blood, bone marrow, lymph nodes, and spleen. Lymphoproliferative disorder

20 CLL -- PC Asymptomatic Lymphadenopathy
Constitutional symptoms (night sweat, weight loss, anorexia) Symptoms of bone marrow failure Splenomagaly

21 CLL -- Ix Lymphocytosis (B cells) Low serum Ig Raised serum uric acid
Bone marrow biopsy  lymphocytic infiltration

22 CLL -- Ix Depends on stage: Stage A B C
< 3 lymph node groups involvement Bloods normal > 3 lymph node groups involvement Bloods abnormal (anaemia + thrombocytopenia)

23 CLL -- Mx Observation (stage A)
Chlorambucil PO (lower lymphocyte count and lymphadenopathy) Corticosteroid Fludarabine IV Other chemo Rx Supportive care

24 CLL -- Prognosis Variable May remain stationary or progress
Some stay asymptomatic for > 10 years Cause of death = bone marrow failure, infiltration of other organs

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