15 - Acute Leukemias Flashcards

1
Q

Definition of Acute Leukemia

A
  • Clinical Definition: A life-threatening event caused by the accumulation of immature white bloods cells in the bone marrow requiring immediate therapeutic intervention.
  • Pathologic Definition: Maturation arrest at the level ofhematopoietic precursor cells (myeloblasts or lymphoblasts) defined by the presence of at least 20% blasts in the bone marrow.
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2
Q

Clinical Presentation of

Acute Leukemia

A
  • Symptoms result from displacement of normal hematopoietic elements in the bone marrow
    – Displacement of myelopoietic cells => infections
    – Displacement of megakaryopoiesis => bleeding
    – Displacement of erythropoiesis => anemia
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3
Q

How to diagnose Acute Leukemia?

A
  • Morphology (bone marrow, peripheral blood)
  • Immunophenotyping (mainly flow cytometry)
  • Cytogenetics
  • FISH
  • Molecular Studies (Next Generation Sequencing, PCR etc.)
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4
Q

Comparison between Acute Leukemia
and Myeloproliferative Disease and Myelodysplasia

A
  • Blasts in bone marrow
    and peripheral blood
  • Effective abnormal
    hematopoiesis,
    hypercellular marrow and
    peripheral leukocytosis
  • Ineffective abnormal
    hematopoiesis,
    hypercellular marrow,
    peripheral cytopenia(s)
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5
Q

Two Major Types of Acute Leukemia

A
  • Acute Lymphoid Leukemia (ALL)
  • Acute Myeloid Leukemia (AML)
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6
Q

Myeloid and lymphoid
maturation and differentiation

A
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7
Q

Acute Lymphoblastic Leukemia/Lymphoma of B-Cell Type

A
  • Most common cancer in children (peaks at age 3)
  • Childhood ALL is a therapeutic success story (95% go into full remission, 85% permanently cured)
  • CNS involvement more common in ALL than in AML
  • 90% have structural and numerical chromosomal changes
  • Presents as leukemia and not as tumor
  • Positive for TdT, CD19, CD10, CD22 etc. Negative for surface Ig by definition
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8
Q

Acute Lymphoblastic Leukemia of B-Cell Type

A
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9
Q

Acute Lymphoblastic Leukemia/Lymphoma of T-Cell Type

A
  • Can arise from bone marrow or thymus
  • Most common in adolescent males
  • Aggressive malignancy
  • Thymic masses common
  • Presents as leukemia and/or tumor
  • Positive for TdT
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10
Q

Normal peripheral blood

A
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11
Q

Acute Lymphoblastic Leukemia/Lymphoma of T-Cell Type

A
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12
Q

classification of acute lymphoblastic leukemias

A
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13
Q

Acute Myeloid Leukemia

A
  • As in ALL, symptoms are caused by
    displacement of normal bone marrow cells.
  • Tumor formation is possible
    (myeloid/monocytic sarcoma, extramedullary
    myeloid tumor), e.g. leukemia cutis, gingiva
    involvement
  • CNS involvement less common than in ALL
  • Tumor cells positive for myeloperoxidase
  • Some AMLs may have Auer Rods
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14
Q

acute myeloid leukemia with definining genetic abnormalities and differentiation

A
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15
Q

Acute Myeloid Leukemia M1

A
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16
Q

Acute Promyelocytic Leukemia

A
  • Patient presents with DIC (symptoms caused
    by clotting and bleeding)
  • Normally positive for t(15;17) involving PML-
    RARA
  • Excellent prognosis, treatable with all-trans
    retinoic acid (85% curable)
17
Q

Acute Myeloid Leukemia with
Monocytic Differentiation – M5

A