Acute leukaemia

What are the two main types of acute leukaemia?

AML (Acute Myeloid Leukaemia) and ALL (Acute Lymphoblastic Leukaemia)

What is the key pathological feature of acute leukaemia?

Rapid proliferation of immature blast cells causing bone marrow failure

What are common presenting symptoms of acute leukaemia?

• Fatigue

• anaemia

• infections

• bleeding

• bruising

• bone pain

• splenomegaly

• weight loss

What are ALL-specific presenting features?

• B symptoms (fever, night sweats, weight loss)

• lymphadenopathy

• testicular swelling

What are the key diagnostic tests for acute leukaemia?

• FBC

• blood film

• bone marrow biopsy

• flow cytometry - CD markers to classify AML v ALL

• cytogenetics molecular

• PCR

What are major risk factors for AML?

• Older age

• smoking

• radiation

• chemical exposure

• inherited syndromes ( Fanconi anaemia, Bloom syndrome, Li‑Fraumeni)

• prior chemotherapy

• MDS or MPN

What determines AML treatment intensity?

Risk category based on cytogenetics and molecular markers plus patient fitness

When is allogeneic transplant used in AML?

High risk disease or relapsed AML

Why is APML a medical emergency?

Severe coagulopathy and high bleeding risk

What is first-line treatment for APML?

ATRA started immediately

What is differentiation syndrome features?

• Weight gain

• fever

• pulmonary infiltrates

• effusions

• treated with steroids

What are key risk factors for ALL?

• Down syndrome

• Fanconi anaemia

• Bloom syndrome

• Li Fraumeni

• prior chemotherapy radiation

What is the age distribution of ALL?

Most common paediatric cancer with a second peak in older adults

What are the core components of ALL treatment?

• Induction

• consolidation

• interim maintenance

• delayed intensification

• maintenance

What are key toxicities of vincristine?

Peripheral neuropathy and constipation

Why is TPMT or NUDT15 testing needed?

To guide mercaptopurine dosing and avoid toxicity

Low TMPT requires dose reductions

What defines laboratory tumour lysis syndrome?

Two or more of high uric acid high potassium high phosphate low calcium

What is TLS prophylaxis in acute leukaemia?

Allopurinol or rasburicase for high risk and aggressive hydration

What is the mechanism of action of FLT3 inhibitors?

They inhibit FLT3-mutated signalling reducing proliferation of FLT3-positive AML blasts

What subtype of ALL is Nelarabine used for?

T-cell ALL particularly in relapsed or refractory disease

What is the purpose of PEG-asparaginase in ALL treatment?

It depletes asparagine leading to leukemic cell death

What are key toxicities of PEG-asparaginase?

• Pancreatitis

• thrombosis

• hepatotoxicity

• hypersensitivity

What is the role of Blinatumomab in ALL?

A BiTE antibody linking CD3 T-cells to CD19 B-cells to induce cytotoxicity

What is the indication for CAR-T therapy in ALL?

Relapsed or refractory B-cell ALL

What supportive antifungal therapy is preferred in ALL and why?

Liposomal amphotericin B or caspofungin because azoles interact with vincristine

What is the purpose of dexamethasone eye drops during HDAC therapy?

To prevent chemical conjunctivitis caused by high-dose cytarabine

What is the main toxicity concern with daunorubicin?

Cardiotoxicity with a lifetime cumulative dose limit

What is the purpose of hydroxycarbamide in AML management?

Used for cytoreduction while awaiting diagnostic results or before induction therapy