A Brief of leukaemia's Dr Amin Islam MB, MRCP UK, FRCPath UK Consultant Haematologist www.janaanhealth.org GP Refresher course 25th April 2017 Robina Parker Education Centre SUH NHSFT .

leukaemia's An overview Common symptoms Presentations When to refer Common types Diagnosis Treatments prognosis

Common symptoms Sudden or Gradual onset, Non specific abdominal discomfort due to splenomegally Symptoms of anaemia's Petechial rash due to thrombocytopepnia Jaundiced due to ineffective erythropoiesis Infections such as pneumonia Chest symptoms due to either infection or life threatening pulmonary leucostasis in AML Pyrexia and occasional neurological symptoms

Common presentation Majority acute leukaemia's are picked up by the laboratory Confirmed by consultant haematologist Usually have blood test for being unwell or hospital admissions etc Occasionally dramatic with multi organ failure and DIC Chest and neurological events CML usually non specific and abdominal symptoms CLL asymptomatic mainly blood test for others

When to refer Majority acute leukaemias are picked up in the lab and patient/GP contacted urgently Chronic High WCC counts with film comments suggestive Children with non specific any cytopenia, bone pains and blood film comments to refer Lymphocytes >5 and persistent CLL common for adults usually >60 yrs Any blood film suggest to contact please discuss

Types of leukaemia's Acute Commonest AML denov MDS-AML Rare ALL in children rare in adults Chronic CLL very common >70 yrs up to 10% CML 3-4 cases in southend per year

Rare types T and B PLL ATLL associated with HTLV1 virus

Diagnosis Blood film usually specific Immunophenotyping to confirm the types Molecular and cytogenetic to risk stratify cytogenetic has prognostic values Bone marrow test CSF and MRI if neurological involvement rarely needed

Few examples: CLL

CLL and massive splenomegally

Treatment FCR bloods

Blood test July 2015

April 2017

Bad cytogenetic in CLL

CML presentation bloods

25th august 2015 routine diabetic check up

23rd March 2017, unwell AE resus

CXR hypoxic

Had emergency leukopheresis

MDS initial Eprex and transfusion

29th october 2017

AML Bone marrow all blast

Fallied High dose MAC/ARAC Now on AZACYTIDINE

T PLL

No response with Campath Responded with pentostatin

treatments AML Intensive chemotherapy at Barts DA 3+7 We are trying to get AML intensive back to southend collaboration with Barts Non intensive MAC locally in southend or palliative best supportive care majority elderly

ALL rare in adult Intensive at Barts with UK ALL protocols Children at GOS ALL protocol for children's Elderly Best supportive care

CLL FCR is standard BR for elderly or RP Relapse setting Ibrutinib and idelalisib options Clinical trials option available

T cell Campath Ideally treated at RMH or Barts Poor prognosis

Prognosis Excellent in childhood ALL>97 cured AML according to molecular and cytogenetics Overall 50% long term survival Elderly Outcome poor overall Some countries 10% elderly survive at 5 years

aml

ALL

CLL

CML