Leukaemia

Haematological malignancy causing uncontrolled proliferation of abnormal haematopoietic progenitor cells, which:

• Replaces normal bone marrow with dysfunctional leukocytes
  Leads to bone marrow failure, characterised by:
  • ↓ Haematopoiesis
  • Immunocompromise
• Classified based on the type of haematological progenitor cell affected:
  • Acute Myeloid Leukaemia
    Uncontrolled proliferation of myeloid precursors. Rapidly progressive leukaemia which are further divided into:
    • AML with characteristic genetic abnormalities
      Generally good prognosis. Includes:
      • Several known translocations
      • Acute promyelocytic leukaemia (APML)
        Associated with DIC.
    • AML with multi-lineage dysplasia
      Typically progresses from myelodysplasia and has poor prognosis.
    • Therapy-related AML
      AML following chemotherapy or radiotherapy.
  • Acute Lymphoblastic Leukaemia
    Uncontrolled proliferation of lymphoid precursors.
    • Usually seen in childhood
    • Good prognosis
    • CNS involvement is common
  • Chronic Lymphocytic Leukaemia
    Slow-growing accumulation of mature but abnormal lymphocytes.
    • Common in elderly
    • 8-12 year median survival
    • May transform to diffuse large B cell lymphoma
      This has a very poor prognosis.
  • Chronic Myeloid Leukaemia
    Accumulation of mature but abnormal lymphocytes that is divided into three phases, which advance as additional mutations accrue:
    • Chronic phase
      May last several years, with minimal symptoms.
    • Accelerated phase
      More rapid proliferation with ↑ symptoms.
    • Blast crisis
      Proliferation of immature blasts, resembling acute leukaemia.
  • Ambiguous lineage
    Evidence of either both lymphoid and myeloid cells, or where there are not enough categories to accurately classify it.

Epidemiology and Risk Factors

Pathophysiology

Haematological Progenitors

Aetiology

Clinical Features

Presentation typically with:

• Fatigue
• Lymphadenopathy
• Hepatosplenomegaly
• Marrow failure
  • Anaemia
  • Bleeding
  • Immunocompromise

Assessment

History:

Exam:

Investigations

Bedside:

Laboratory:

Imaging:

Other:

Diagnostic Approach and DDx

Diagnosis confirmed with:

• Blast cells
• Immunophenotyping
• Cytogenetic analysis
• Molecular genetic analysis

Management

• Chemotherapy

Resuscitation:

Specific therapy:

• Pharmacological
  • Chemotherapy
    • Consists of three phases:
      • Induction chemotherapy
        Achieve remission by ↓ cells to undetectable levels.
      • Consolidation chemotherapy
        Eliminate residual undetectable disease.
      • Maintenance therapy
        Prolong remission. Used in ALL and APML.
    • Intrathecal chemotherapy used if CNS is involved
  • Total body radiotherapy
• Procedural
  • Radiotherapy
• Physical

Supportive care:

Disposition:

Preventative:

Marginal and Ineffective Therapies

Anaesthetic Considerations

Complications

Prognosis

Key Studies

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References

1. Bersten, A. D., & Handy, J. M. (2018). Oh’s Intensive Care Manual. Elsevier Gezondheidszorg.