(which one is to do with chilblains in elderly males)
Most due to specific gene mutations.
Acute lymphoblastic leukaemia (ALL):
commonest form in childhood <5yrs; rapid course massive infiltration of bone marrow by immature lymphoid cells generalised infections and weakness; bleeding; anaemia; bone pain 50% cure rate with chemotherapy; marrow transplantAcute myelogenous leukaemia (AML): • most common form; more common in elderly • heterogenous disorder • acute course; fatal in 2 months if untreated; 20% 3 year survival with chemotherapy • infection is major complicationChronic myeloid leukaemia (CML): • 15% of leukaemia’s; annual incidence in UK of 1/100 000 • usually between ages 30-80yrs (peak at 55yrs) • slow onset of non-specific symptoms (tiredness, weight loss, breathlessness, abdominal pain, lethargy, anorexia, sweating, abdominal fullness, bruising); 90% have splenomegaly • 90% have Philadelphia (Ph1) chromosome (a shortened chromosome 22) • management – chemotherapy (hydrozyurea most widely used); alpha interferon • prognosis – 15% die in first 12 months; median survival is about 45 months (chilblains)Chronic lymphocytic leukaemia (CLL): • 25%; most >50yrs; M2x>F;
• 85-95% are B-cell origin
• insidious onset – up to 25% diagnosed incidentally; present with anaemia, painful lymphadenopathy, infections, fatigue and weakness
• Staging:
• A – no anaemia or thrombocytopenia; < 3 areas of enlarged lymph glands • B - no anaemia or thrombocytopenia; > 3 areas of enlarged lymph glands
• C – anaemia and/or thrombocytopenia
• Management – Stage A – no specific treatment; Stage B – chemotherapy if symptomatic, local radiotherapy to lymph nodes; Stage C – transfusion for anaemia


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