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

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

3. 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

4. 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

5. 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

6. 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

7. Rare types
T and B PLL
ATLL associated with HTLV1 virus

8. 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

9. Few examples: CLL

10. CLL and massive splenomegally

11. Treatment FCR bloods

12. Blood test July 2015

13. April 2017

14. Bad cytogenetic in CLL

15. CML presentation bloods

16. 25th august 2015 routine diabetic check up

17. 23rd March 2017, unwell AE resus

18. CXR hypoxic

19. Had emergency leukopheresis

20. MDS initial Eprex and transfusion

21. 29th october 2017

22. AML Bone marrow all blast

23. Fallied High dose MAC/ARAC
Now on AZACYTIDINE

24. T PLL

25. No response with Campath
Responded with pentostatin

26. 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

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

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

29. T cell
Campath
Ideally treated at RMH or Barts
Poor prognosis

30. 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

31. aml

32. ALL

33. CLL

34. CML