- cellularity ↑ to 95-100% - ↑ M:E ratio - 20% or more blasts

19) Acute leukemias Flashcards by Samantha Boyer

define acute leukemia

malignant neoplastic proliferation of immature, nonfunctional hematopoietic cells in the BM

caused by clonal expansion from a single cell

How well did you know this?

Not at all

Perfectly

acute leukemia leads to death from —— or ——- if untreated

infection
bleeding

How well did you know this?

Not at all

Perfectly

adults
usually no lymphadenopathy
gum hypertrophy in some types
skin infiltration in some types
no mediastinal mass
DIC in some types
comparatively poor prognosis

AML

How well did you know this?

Not at all

Perfectly

kids
lymphadenopathy
no gum hypertrophy
no skin infiltration
mediastinal mass in some cases
no DIC
comparatively good prognosis

ALL

How well did you know this?

Not at all

Perfectly

——– like to infiltrate tissues from AML

monocytes

How well did you know this?

Not at all

Perfectly

importance of classifying leukemias

anticipating clinical course
long term prognosis
appropriate therapy

How well did you know this?

Not at all

Perfectly

gold standard diagnostic test for leukemia

immunophenotyping/flow

How well did you know this?

Not at all

Perfectly

CD13
CD33

AML

How well did you know this?

Not at all

Perfectly

blast marker

CD34

How well did you know this?

Not at all

Perfectly

acute leukemias which do not show CD34

monocytic
acute promyelocytic

How well did you know this?

Not at all

Perfectly

MPO +
Sudan black +
Specific esterase +

granulocytic AML

How well did you know this?

Not at all

Perfectly

MPO +
Sudan black +
Nonspecific esterase +

monocytic AML

How well did you know this?

Not at all

Perfectly

MPO =
Sudan black =
Esterase =

ALL

How well did you know this?

Not at all

Perfectly

BM changes in AML

cellularity ↑ to 95-100%
↑ M:E ratio
20% or more blasts

How well did you know this?

Not at all

Perfectly

agglomeration of primary granules

auer rods

How well did you know this?

Not at all

Perfectly

auer rods rule out —— and suggest ——

ALL
AML

How well did you know this?

Not at all

Perfectly

bunches of auer rods in a cell

acute promyelocytic leukemia

How well did you know this?

Not at all

Perfectly

4 categories of AML variants as defined by WHO

AML with recurrent genetic abnormalities
therapy-related AML
AML with myelodysplasia-related changes
AML not otherwise specified

How well did you know this?

Not at all

Perfectly

t(8;21)

AML with recurrent genetic abnormalities

How well did you know this?

Not at all

Perfectly

“AML with recurrent genetic abnormalities” falls under past category of…

AML with maturation

How well did you know this?

Not at all

Perfectly

myeloid sarcomas (+/=) in AML with recurrent genetic abnormalities

positive

How well did you know this?

Not at all

Perfectly

AML that may have <20% blasts

AML with recurrent genetic abnormalities

How well did you know this?

Not at all

Perfectly

AML with recurrent genetic abnormalities response to chemo

good

How well did you know this?

Not at all

Perfectly

inv(16)

AML with abnormal eosinophils

How well did you know this?

Not at all

Perfectly

CBFB-MYH11

inv(16) AML with abnormal eosinophils

AML with abnormal eosinophils have -----% eos

how are eos in AML with abnormal eosinophils abnormal?

they have basophilic granules

AML with abnormal eosinophils prognosis

high rate of remission and survival

t(15;17)

acute promyelocytic leukemia

PML-RARA

t(15;17) acute promyelocytic leukemia

best prognosis if treated, worst prognosis if untreated

acute promyelocytic leukemia

variant of acute promyelocytic leukemia harder to recognize and diagnose

microgranular variant

patients with acute promyelocytic leukemia may present with or develop...

DIC

acute promyelocytic leukemia tx

all trans-retinoic acid + chemo causes pros to mature

best to start tx even if this type of leukemia is only suspected

acute promyelocytic leukemia

therapy-related AML usually occurs when?

10 years or so after chemotherapy for another cancer

therapy-related AML prognosis

poor

with therapy-related AML, risk increases with...

treatment age

most common of the 4 variants of AML

AML with myelodysplasia-related changes

AML with history of MDS and no history of chemo or radiation

AML with myelodysplasia-related changes

AML with myelodysplasia-related changes prognosis

poor

usually, MDS does not progress to...

ALL

types of AML not otherwise specified

AML with minimal differentiation AML without maturation AML with maturation Acute myelomonocytic leukemia Acute monoblastic/monocytic leukemia

AML with minimal differentiation (does/does not) have auer rods

does not

AML without maturation (does/does not) have auer rods

does

population for AML with minimal differentiation

infants older adults (majority)

AML with minimal differentiation MPO/SBB SE

MPO/SBB <3% SE =

AML without maturation MPO/SBB SE

MPO/SBB >3% SE +

population for AML without maturation

40s-50s

AML with maturation MPO/SBB SE

MPO/SBB + SE +

AML with maturation (does/does not) have auer rods

does, in a range of granulocytic cells

it's important to distinguish AML ------------- from acute promyelocytic

with maturation

AML with maturation population

all ages

acute myelomonocytic leukemia MPO SE NSE

MPO + SE + NSE +/=

population for acute myelomonocytic leukemia

all ages, median 50yo

acute monocytic leukemia MPO SE NSE

MPO = SE = NSE +/=

monoblasts nuclear lobation irregular nuclear contours

acute monocytic leukemia

may involve bleeding, and involvement of CNS and gums

acute monocytic leukemia

young people get acute mono------ leukemia, adults get acute mono-----

blastic cytic

blast that lacks CD34

monoblast

there is no specific -----blast marker harder to dx

mono

erythroblasts with round nuclei and agranular, possibly vacuolized blue cytoplasm

pure erythroid leukemia

pure erythroid leukemia MPO NSE PAS

MPO = NSE +/= PAS +

CD71 CD117 glycophorin A hemoglobin A

pure erythroid leukemia

profound anemia extremely rare all ages

pure erythroid leukemia

basophilic, agranular blasts with pseudopods/blebs

acute megakaryoblastic leukemia

acute megakaryoblastic leukemia MPO SE NSE PAS

MPO = SE = NSE +/= PAS +

CD41 CD61

acute megakaryoblastic leukemia

associated with Down syndrome very poor prognosis

acute megakaryoblastic leukemia

basophilic precursors with vacuolization

acute basophilic leukemia

acute basophilic leukemia MPO SE NSE PAS

MPO = SE = NSE = PAS +

maybe the rarest acute leukemia

basophilic

hyperhistaminemia lytic lesions cutaneous involvement

acute basophilic leukemia

type of acute leukemia involving fibrosis of BM

acute panmyelosis with myelofibrosis

acute panmyelosis with myelofibrosis involves --------- fibrosis, which is irreversible

collagen

only ------ can distinguish B from T ALLs

flow

(T/B) ALL is more common

acute leukemia with rare Philadelphia chromosome and relationship to CML

B-cell ALL

B-cell ALL prognosis

95% long term survival in children 30-50% in adults

TdT is only positive in -------blasts

lympho

mediastinal mass

T-cell ALL

T-cell ALL is most common in...

adolescent males

T-cell ALL prognosis is (worse/better) than B-cell

worse