100 - Acute Myeloid Lymphoma Flashcards
AML (____) is a neoplastic disease characterized by an _____ of the blood, BM and other tissues by ___, ___, ___ cells from the hematopoietic system
Acute myeloid leukemia Infiltration Proliferative Clonal Unsorted
AML is the most common leukemia in ___ with median age at diagnosis of ___ survival of __ years in 27%
Adults
67
5
Most cases of AML are ___. Myeloid leukemia with genetic predisposition are linked to several syndromes of BM failure such as: ____,____. and biological disorders such as dyskeratosis congenital
Idiopathic
Fanconi anemia
Schwachman diamond
AML is also found in higher rates in patient with ___
Trisomy 21
In order to diagnose AML there need to be > ___ blasts in the BM/blood, unless there following genetic alteration exist: (3)
20% t(15:17) t(8:21) inv(16) t:(16:16)
The mutation ____ is linked with very good prognosis with ___ cure rate
t(15:17)
85%
The mutations ____ and ____are linked with good prognosis with ___ cure rate
t(8:21)
inv(16)
55%
In AML without cytogenic abnormalities there is an ___ with ___ cure rate
Intermediate outcome risk
40%
The worse prognosis is for ___ and ___ genetic changes.
t(6:9)
inv(3)
Old age is a ___ prognosis in AML, and predicts a more ___ disease and difficulty to withstand therapy
Bad
Resistant
There is a lower response criteria when symptoms such as ___, ___, ___ are present ___ months before the diagnosis
Anemia
Leukopenia
Thrombocytopenia
3
Complete remission after blood and BM examination is achieved according to the following: (5)
Neutrophils >=1000 Platelets>=100,000 without blasts in circulation BM blasts <5% No auer rods No extramedullary leukemia
The common clinical symptoms in AML include: (5)
- Fatigue
- Lethargy
- Anorexia and weight loss
- Fever
- Abnormal hemostasis
Less common clinical symptoms in AML include: (5)
Bone pain Lymphadenopathy Non specific cough Headache Sweating
What is myeloid sarcoma (rare)?
A tumor mass consisting of myeloid blasts occuring at anatomic sites other than bone marrow (skin, LN, GI, sot tissue, testis)
Most AML patients will present with non severe ___. usually normocytic normochromic with a decrease in ___.
Anemia
Reticulocytes
It is recommended to treat most AML patients with anemia and thrombocytopenia with ____ even if the decrease is not severe
Blood products
The median of white count in AML patients is ___. Older patients will present with ____ counts
15K
Lower
In AML patients 25-40% of patients will present with leukocytes count of ____
5K
In AML patients 20% of patients will present with leukocytes count of ____
> 100,000K
____ are not always present, but when they do the diagnosis is certain
Auer rods
In AML patients 75% of patients will present with platelets count of ____
<100,000
In AML patients 25% of patients will present with platelets count of ____
<25,000
50% of AML patients present a slight elevation in ___ when diagnosed. In 10% of patients it will sink in the kidneys, rarely leading to ____
Uric acid
Renal Failure
In AML chemotherapy may lead to substantial ____, therefore all patients will be treated with ___ or ___ when chemo starts.
Hyperuricemia
Alopurinol
Rasburicase
What are the two stages when treating AML?
- Induction
2. Post remission (consolidation)
One of the most important factors when choosing the suitable treatment in AML is ___. When
Age
60
What is the induction therapy drugs for AML patients <60?
Cytarabine
+
Anthracycline (daunorubicin, idarubicin, mitoxantrone)
Young AML patients who did not get to the point of remission after induction will go through:
A second round of induction
Consolidation therapy in young AML patients include:
Intense chemotherapy for 2+4 cycles + BM transplantation (allogenic autologous)
Consolidation therapy in old AML patients include:
Reduced chemotherapy
Allogenic BM transplantation if possible
Supportive therapy in AML patients include central line and the following: (2)
- Platelets infusion keeping the levels > 10K
2. RBC infusion keeping Hgb levels > 7-9
APL has long term prognosis of ___
85%
10% of patients who receive the normal protocol die because of ___ due to particles released from the ___ in the blasts
DIC
Auer rods
APL leukemic cells are: ___
t(15:17)
The drug of choice in APL is:___ which does not cause ___
Tretinoin
DIC
Post remission treatment = __
consolidation
Without consolidation therapy, all AML patients will experience __
relapse
The goal of consolidation therapy is to __ all of the residual __ cells
eradicate
lukemia
Young patients are recommended to go through intensive chemotherapy consolidation therapy:
high dose cytarabine for 2+4 cycles \+ BM transplantation (HSCT) allogenic / autologous
Old patients are recommended to go through reduced chemotherapy consolidation therapy. ___ transplantation should be considered in patients < __ without ___ illness and __ match
Allogenic
75
background
HLA
The leading mortality cause in AML patients is __. All patients will develop __ during the treatment, but only half will have __
infection
fever
infection
Neutropenic patients should be treated with __ and __ when going through __ and __ therapy. Patients with positive __/__ should be treated with prophylaxes __
Abx antifungal induction consolidation VZV herpes antiviral
The recommended monotherapy Abx are: 3
Imipenem-cilastatin
meropenem
piperacillin
cephalosporine
If a neutropenic AML patient suffers from fever under treatment for 4-7 days, we should consider __ treatment: 3
antifungal
caspofungin
voriconazole
liposomal amphotericin B
A neutropenic AML patient with fever should continue Abx and/or antifungal until the source of __ is found or the patients is no longer __
infection
neutropenic
