Leukaemias, Lymphomas & Myelomas

Questions and Answers

Which type of leukaemia is characterized by cancer of the lymphoid tissue?

Chronic lymphoid leukaemia (CLL) (correct)

Acute myeloid leukaemia (AML)

Chronic myeloid leukaemia (CML)

Acute lymphoblastic leukaemia (ALL) (correct)

What regulates normal cell proliferation by promoting progression of the cell cycle?

Oncogenes

Growth factors (correct)

Tumor suppressor genes

Proto-oncogenes (correct)

What is the primary risk associated with genetic alterations in proto-oncogenes?

Uncontrolled cell growth (correct)

Decreased cell division

Increased cell death

Inhibition of cell growth

Which of the following statements regarding leukaemia is accurate?

Leukaemia results in raised circulating white blood cell count. Signup and view all the answers

Which type of malignancy arises from plasma cells in the bone marrow?

Myeloma Signup and view all the answers

What does the term 'incidence' refer to in the context of disease?

Rate of new cases in a specified time period Signup and view all the answers

What is the typical number of new leukaemia cases diagnosed annually in the UK as of 2018?

9,900 Signup and view all the answers

How do tumor suppressor genes influence cell cycle progression?

They inhibit or slow down cell cycle progression. Signup and view all the answers

What was the mortality rate of leukemia in the UK in 2019?

7.6 cases per 100,000 people Signup and view all the answers

Which type of leukemia is characterized by the gradual increase of myeloid cells?

Chronic Myeloid Leukemia Signup and view all the answers

What is the genetic condition associated with an increased risk of leukemia?

Down's syndrome Signup and view all the answers

What does AML stand for in the context of leukemia?

Acute Myeloid Leukemia Signup and view all the answers

Which of the following is not a known cause of leukemia?

High cholesterol levels Signup and view all the answers

How is leukemia primarily categorized?

As Acute and Chronic forms Signup and view all the answers

What is a common symptom of Acute Myeloid Leukemia (AML)?

Malaise and fever Signup and view all the answers

What is the incidence rate of Acute Myeloid Leukemia (AML) in the UK as of 2018?

4.9 cases per 100,000 people Signup and view all the answers

What factor is associated with an increased risk of developing Acute Myeloid Leukemia?

Advancing age Signup and view all the answers

Which type of leukemia is known to affect lymphoid cells?

Acute Lymphoblastic Leukemia Signup and view all the answers

What is a common feature in the blood film of AML patients?

Greater than 20% blast cells Signup and view all the answers

Which type of anemia is commonly associated with AML?

Normocytic, normochromic anemia Signup and view all the answers

What is a common consequence of thrombocytopenia in AML?

Bleeding tendencies or DIC Signup and view all the answers

How does AML typically manifest in patients?

Acute malaise, fever, and sweats Signup and view all the answers

What happens in the bone marrow of patients with AML?

Over-production of myeloid blast cells Signup and view all the answers

What is the typical outcome of chemotherapy in younger patients with AML?

Complete remission in 80-90% of cases Signup and view all the answers

What does remission in AML indicate?

Fewer than 5% blast cells in the bone marrow Signup and view all the answers

What is a notable risk associated with neutropenia in AML?

Increased risk of bacterial and fungal infections Signup and view all the answers

What is the significance of myeloperoxidase (MPO) positivity in AML?

Indicates the presence of myeloid lineage cells Signup and view all the answers

What does a 5-year survival rate represent in AML prognosis?

Overall measure of patient longevity post-diagnosis Signup and view all the answers

What systemic complications are commonly associated with Multiple Myeloma?

Renal failure and hypercalcemia Signup and view all the answers

What condition is characterized by the deposition of abnormally folded proteins in Multiple Myeloma patients?

Amyloidosis Signup and view all the answers

Which of the following blood test findings is indicative of anemia in Multiple Myeloma?

Normocytic, normochromic, or macrocytic cells Signup and view all the answers

What is often seen in blood tests associated with Multiple Myeloma that suggests metabolic imbalance?

Hypercalcemia Signup and view all the answers

In patients with Multiple Myeloma, what is essential for their prognosis?

Good palliative care and management strategies Signup and view all the answers

What is typically the survival rate for Multiple Myeloma patients after 10 years with treatment?

29% Signup and view all the answers

What is the typical characteristic of anaemia in Chronic Myeloid Leukaemia (CML)?

Normocytic, normochromic anaemia Signup and view all the answers

Which of the following manifestations is most commonly associated with Chronic Lymphoid Leukaemia (CLL)?

Painless enlargement of lymph nodes Signup and view all the answers

What is the effect of lymphocyte over-production on the bone marrow in CLL?

Lymphocytosis with a high lymphocyte count Signup and view all the answers

Which test is specifically used to detect the Philadelphia chromosome in Chronic Myeloid Leukaemia (CML)?

FISH (Fluorescence In Situ Hybridization) Signup and view all the answers

What is the preferred initial therapy for Chronic Myeloid Leukaemia (CML)?

Tyrosine kinase inhibitor imatinib Signup and view all the answers

In which demographic is Chronic Lymphoid Leukaemia (CLL) most common?

Elderly, typically >50 years Signup and view all the answers

Which of the following is a characteristic finding in the neutrophil alkaline phosphatase score in CML?

Invariably low Signup and view all the answers

What is the approximate 5-year survival rate for patients diagnosed with Chronic Myeloid Leukaemia (CML)?

Approximately 50% Signup and view all the answers

What type of cells predominantly monoclonally proliferate in Chronic Lymphoid Leukaemia (CLL)?

B-lymphocytes Signup and view all the answers

Which statement best describes the typical clinical course of CLL?

Initially indolent without immediate treatment needs Signup and view all the answers

What is the primary age range affected by Hodgkin's Lymphoma?

15-35 years Signup and view all the answers

Which hematological finding is most commonly associated with Hodgkin's Lymphoma?

Normochromic, normocytic anemia Signup and view all the answers

Which diagnostic procedure is essential for confirming Hodgkin's Lymphoma?

Lymph node biopsy Signup and view all the answers

What is the primary factor that determines the prognosis of Hodgkin's Lymphoma?

Stage of the disease Signup and view all the answers

Which of the following is a common symptom associated with Non-Hodgkin's Lymphoma?

Asymmetrical and painless lymphadenopathy Signup and view all the answers

What is the typical incidence of Non-Hodgkin's Lymphoma in the UK as of 2018?

22.8:100,000 Signup and view all the answers

In contrast to Hodgkin's Lymphoma, how does Non-Hodgkin's Lymphoma typically present?

With less fever and night sweats Signup and view all the answers

Which cell marker is associated with Reed-Sternberg cells in Hodgkin's Lymphoma?

CD15 Signup and view all the answers

What type of anaemia may occur as a hematological finding in Non-Hodgkin's Lymphoma?

Normocytic, normochromic anaemia Signup and view all the answers

What is a significant late side effect of treatment for Hodgkin's Lymphoma?

Secondary malignancy Signup and view all the answers

What age range does Acute Lymphoblastic Leukemia (ALL) peak in incidence?

0-4 years Signup and view all the answers

What is the most common subtype of Acute Lymphoblastic Leukemia (ALL)?

B-cell Signup and view all the answers

What percentage of childhood leukemias does Acute Lymphoblastic Leukemia (ALL) account for?

80% Signup and view all the answers

What is a common physical manifestation observed in patients with ALL?

Hepatosplenomegaly Signup and view all the answers

What genetic abnormality is commonly associated with Chronic Myeloid Leukemia (CML)?

BCR-ABL fusion gene Signup and view all the answers

What is the typical age range for peak onset of Chronic Myeloid Leukemia (CML)?

65-85 years Signup and view all the answers

Which of the following symptoms is associated with bone marrow failure in ALL?

Anemia Signup and view all the answers

What is a common consequence of the BCR-ABL fusion gene in CML?

Uncontrolled proliferation of myeloid stem cells Signup and view all the answers

What is a common symptom of ALL involving the central nervous system (CNS)?

Headaches Signup and view all the answers

What is the typical prognosis for children diagnosed with ALL when treated with standard chemotherapy?

Majority of children are curable Signup and view all the answers

Study Notes

Overview of Haematological Malignancies

Leukaemia: Cancer of white blood cells (WBCs).
- Types include Acute Myeloid Leukaemia (AML), Acute Lymphoblastic Leukaemia (ALL), Chronic Myeloid Leukaemia (CML), Chronic Lymphoid Leukaemia (CLL), and others.
Lymphoma: Cancer of lymphoid tissues.
- Divided into Hodgkin's Lymphoma and Non-Hodgkin's Lymphoma.
Myeloma: Cancer of clonal plasma cells in the bone marrow (B-cells).

Regulation of the Cell Cycle

Normal cell proliferation regulated by growth factors.
Proto-oncogenes promote cell cycle progression (analogous to a gas pedal).
Tumor suppressor genes inhibit cell cycle progression (similar to a brake pedal).

Genetic Alterations and Malignancies

Haematological malignancies arise from genetic alterations in single marrow or lymphoid cells.
Oncogenes: Mutated proto-oncogenes cause uncontrolled cell growth.
Tumor Suppressor Genes: Mutations lead to compromised inhibition of cell growth.
Clonal populations form through successive mitotic divisions of an abnormal cell.

Incidence and Prevalence

Incidence: Rate of new cases over a given period, often expressed per 100,000.
Prevalence: Total number of people with a condition.

Leukaemia Facts

Characterized by uncontrolled growth of blood cells in the bone marrow, resulting in elevated white cell counts and bone marrow failure.
2018 UK Stats:
- 9,900 annual diagnoses.
- Incidence: 15.8 cases per 100,000.
- Mortality: 7.6 cases per 100,000 (2019).
More prevalent in adults than children; most common childhood cancer.

Causes of Leukaemia

Most cases have unknown causes.
Known factors:
- Previous chemotherapy (alkylating agents).
- Radiation exposure.
- Chemicals like benzene and formaldehyde.
- Genetic conditions (e.g., Down's syndrome, myelodysplasia).

Types of Leukaemia

Acute Leukaemia: Little or no maturation of cells; >20% blast cells present.
Chronic Leukaemia: Many maturing cells; gradual disease progression.

Acute Myeloid Leukaemia (AML)

Characterized by abnormal proliferation of myeloid stem cells and immature white cells.
Median diagnosis age: ~60 years.
2018 UK Incidence: 4.9 cases per 100,000.

Symptoms and Diagnosis of AML

Common symptoms: malaise, fever, sweats, anemia, infections (neutropenia), and bleeding (thrombocytopenia).
Blood tests show >20% blast cells; leukocytosis, leukopenia, or normal WBC count possible.
Anemia is typically normocytic and normochromic.

Prognosis of AML

Successful chemotherapy can lead to remission (less than 5% blast cells).
Cure rates: ~80-90% in younger patients, ~45% overall.
5-year survival rate is significant for assessing treatment effectiveness.

Acute Lymphoblastic Leukaemia (ALL)

Results from proliferation of lymphoid stem cells, producing numerous lymphoblasts.
Peak incidence between ages 0-4; accounts for 80% of childhood leukemia cases.
2018 UK Incidence: 1.1 cases per 100,000.

Symptoms of ALL

Abrupt onset with symptoms like bone and joint pain, anemia, hepatosplenomegaly, and potential CNS involvement.
Prognosis better in children; adults have lower cure rates.

Chronic Myeloid Leukaemia (CML)

Involves uncontrolled proliferation of myeloid stem cells, mainly producing neutrophils.
Peak onset ages: 65-85; more common in males.
2018 UK Incidence: 1.3 cases per 100,000, linked to Philadelphia chromosome.

Symptoms and Diagnosis of CML

Common symptoms: fatigue, weight loss, splenomegaly, gout, easy bruising.
Blood tests show elevated WBC counts, often >50 x 10^9/L, with normocytic anemia, thrombocytosis, or thrombocytopenia.
Positive for BCR-ABL fusion gene linked to CML.

Chronic Lymphoid Leukaemia (CLL)

Characterized by uncontrolled B-lymphocyte proliferation.
Typically affects older adults (>50 years).
2018 UK Incidence: 5.7 cases per 100,000; often asymptomatic and can result in lymphocytosis.

Prognosis of CLL

Often indolent; early chemotherapy may not be needed.
Around 70% 5-year survival; patients may die from other causes.

Lymphoma Overview

Hodgkin's Lymphoma: Malignant B-cells, characterized by Reed-Sternberg cells; inc. 3.3 cases per 100,000 (2018).
Non-Hodgkin's Lymphoma: Comprises a greater variety of lymphoid tumors; highest incidence among hematological cancers at 22.8 cases per 100,000 (2018).

Key Features of Hodgkin's vs Non-Hodgkin's Lymphoma

Hodgkin's: Age peaks at 15-35 and over 50; good prognosis (~80% 10-year survival).
Non-Hodgkin's: More variable presentation, often presents as painless lymphadenopathy.

Key Diagnostic Procedures

Lymph node biopsy for lymphoma diagnosis.
FISH for detection of Philadelphia chromosome in CML cases.

Final Remarks

Understanding the type and characteristics of leukaemia and lymphomas is crucial for effective diagnosis and treatment.

Gastrointestinal Involvement in Non-Hodgkin's Lymphoma

Abdominal symptoms can arise from splenic or hepatic enlargement and GI tract involvement.

Hematological Findings in Non-Hodgkin's Lymphoma

Normocytic, normochromic anemia is common; autoimmune hemolytic anemia may also occur.
Advanced disease can lead to neutropenia and thrombocytopenia from bone marrow involvement.

Diagnostic Procedures

Lymph node biopsy is essential for diagnosis.
Cytogenetic tests, such as chromosome mapping, may be performed for further analysis.

Prognosis of Non-Hodgkin's Lymphoma

The 10-year survival rate is approximately 55%.

Response to Chemotherapy in Non-Hodgkin's Lymphoma

Indolent types respond well to chemotherapy, but a complete cure is rare.

Cure for Aggressive Non-Hodgkin's Lymphoma

Aggressive forms may be cured through chemotherapy combined with rituximab.

Stem Cell Transplants

Stem cell transplants are increasingly utilized in the treatment of Non-Hodgkin's Lymphoma.

Definition of Multiple Myeloma

Multiple Myeloma is characterized as cancer of clonal plasma cells in the bone marrow, originating from B-cells.

Characteristics of Ab-secreting B-cells

These cells produce a paraprotein, a homogeneous immunoglobulin detectable in serum and/or urine.

Rare before age 40, with peak incidence at ages 85-89.

Incidence of Multiple Myeloma in the UK

Reported incidence is 9.6 cases per 100,000 population (2018 data).

Gender and Ethnicity Predominance

Males are more affected than females.
African Americans show higher incidence rates than Caucasians.

Common Presenting Symptoms of Multiple Myeloma

Bone pain is the most common symptom, often leading to fractures.
Associated symptoms may include anemia, thrombocytopenia, and leukopenia.

Systemic Complications in Multiple Myeloma

Complications may include renal failure and hypercalcemia.

Amyloidosis in Multiple Myeloma

Amyloidosis involves deposition of misfolded proteins, causing additional clinical issues.

Effect on Bone Marrow

Plasma cells accumulate in the bone marrow, leading to overcrowding and increased plasma cell count (usually exceeding 20%).

Diagnostic Indicators in Blood Tests for Multiple Myeloma

Detection of paraprotein in serum and/or urine is a key diagnostic indicator.

Hematological Findings in Blood Tests for Multiple Myeloma

Anemia may present as normocytic, normochromic, or macrocytic.
Pancytopenia, a reduction in all blood cells, can occur.

Metabolic Imbalance in Blood Tests

Hypercalcemia, elevated blood calcium levels, may be indicative of Multiple Myeloma.

Prognosis of Multiple Myeloma

A complete cure is often elusive.
Treatment typically involves chemotherapy followed by stem cell transplant, with a 10-year survival rate of about 29%.
Good palliative care is crucial for pain management.

Summary of Hematological Cancers

Leukaemia is classified into types such as Acute Myeloid Leukaemia (AML), Acute Lymphoblastic Leukaemia (ALL), Chronic Myeloid Leukaemia (CML), and Chronic Lymphoid Leukaemia (CLL).
Lymphoma includes Hodgkin's and Non-Hodgkin's lymphoma.
Myeloma refers to the cancer of clonal plasma cells in the bone marrow derived from B-cells.

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Description

Test your knowledge on leukemia, its types, and related concepts. This quiz covers the characteristics of various leukemias, the regulation of cell proliferation, and the implications of genetic alterations. Perfect for students studying hematology or oncology.