15: Leukemia

Question 0

AML- info

Answer 0

ALL (Nucleus is bigger and less cytosol)
All the chemo for chronic leukemia causes Acute leukemia
Hydroxyurea (myelodyslastic disease rx),
Alkylating agents, Topoisomalase
Chloroquine, Chloramphenicol, Phenylbutazone

Question 1

Leukemia- definition

Answer 1

Abnormality in lymphoid or myeloid lineage

Acute (develop less than 3 month and more than 20% of blastcells in bone marrow or in circulation) or Chronic

Question 2

AML- classification

Answer 2

M0- undifferentiated
M1- without maturation
M2- maturation (MC) (8;21), Auerods
M3- Promyelocytic leukemia (PML)-> hypergranular, auerods, DIC (due to the granule rupture), (15;17), PML/RAr-a fusion gene, ATRA/ Tretinoin/ retinoic acid
M4-> Inversion of Chr16
M5-> Skin infiltration, Gum infiltration, other organ infiltration-> Leukemia cutis-> Leonine facies
Leukemia cutis-> hairy cell leukemia-AML-ALL* (know the order)
etc.. M2,3,4,5 IMP*

Question 3

AML- sx

Answer 3

Thrombocytopenia, easy brusing, epistaxis, bleeding from gum
Keep in mind that there could be bleeding in lung, CNS, PNS
Check Blood/ BM

Question 4

AML- rx

Answer 4

1: Remission induction (goal: achieve complete remission ASAP)
-Daunorubicin & Cytarabin (7 and 3 regimen)
CR: N>1000, PL>100,000, No blasts in circulation, <5% blasts in BM for more than 4 weeks**
-Post remission: Cytarabine alone high dose (Cerebellar, Pulmonary toxicity) or Stem cell transplant
-if no CR is reached, try different agents
-Blood transfusion, platelet transfusion
-M3: Tretinoin + Daunorubicin*

Question 5

CML- cc

Answer 5

t(9;22) -> bcr/abl fusion gene (translocation is not specific but the fusion gene is 100% CML)*-> P210 bcr/abl (protein)-> tyrosin kinase-> suppression of apoptosis
Thrombocytosis**(only seen in this one)
-low LAP score (since those cells are old)
-high LAP score in leukemoid reaction
-smoking in CML increase blastcrisis
-high metabolic state-> Gout (give allopurinol to keep it check)

Question 6

CML- dx

Answer 6

Blood-> excessive myelocytes

Question 7

CML- rx

Answer 7

Imatinib (any pts)
Stem cell transplants (younger pts)
Favorable factors (80% remission)
-Age <30yrs
-Related donor
-HLA-identical match

Question 8

ALL

Answer 8

EBV- Burkits, Hodgkins, Post-BM transplant
Hep C- lymphoplasmocytic lymphoma
HIV- diffuse large T cells
HTLV- adult T-cell leukemia
H. pylori- MALT lymphoma

Question 9

ALL- sx

Answer 9

Lymphadenopathy

Testicular/ CNS involvement

Question 10

ALL- rx

Answer 10

1: Remission induction phase- Vincristine, Predonisone, L-asparaginase
2: Consolidation- 6-mercaptopurine, Methotrexate (Intrathacally for CNS relapse)**
3: Maintenance phase- Methotrexate, Cyclophosphamide, Cytarabine

Question 11

ALL- classification

Answer 11

Pre-B: TDT, CALLA, CD34(+) (70%), good, t(9,22)
T: CD2,3,5,7 (20%) intermediate,
MatureB: CD19, 20, 22 (10%) poor,

Question 12

CLL- info

Answer 12

CLL (CM leukemia)
Trisomy 21
Richard syndrome- CLL gets aggressive
Lymphadenopathy (generalized, extensive)

Question 13

CLL- dx

Answer 13

Absolute leukocytosis

Smugde cells

Question 14

CLL- rx

Answer 14

Fluderabine, Rituximab, Cyclophosphamide**
-> Localized radiotherapy**
Allogenic SC transplant for younger pts

Question 15

Adult T cell leukemia

Answer 15

HTLD1 virus
Flower nuclei
Bonelytic lesion

Question 16

Hairy cell leukemia

Answer 16

TRAP (+)
Huge spleen
no lymphadenopathy
Mycobacteriam avium intracellulare**
Rx: Cladribine**