3.24.14* Goorha - Acute and Chronic Leukemias

Question 1

three types of acute leukemia

Answer 1

AML
T-ALL
B-ALL

Question 2

aplastic anemia clinical features

Answer 2

a. blood cell -penia
b. common infections of mouth/throat
c. bruising, excessive bleeding
d. no enlarged lymph nodes, liver, spleen

Question 3

aplastic anemia lab findings

Answer 3

a. normochromic, macrocytic
b. very low reticulocyte count
c. thrombocytopenia
d. low granulocytes, normal looking neutrophils, maybe low lymphocytes
e. no abnormal cells in PBS
f. bone marrow hypoplasia with 75% fat

Question 4

Major leading causes of AML?

Answer 4

chemotherapy

pre-existing hematological disorder such as myelodysplastic syndrome

Question 5

leukemia in children

Answer 5

ALL (kids 3-7 and then in people over 40)

Question 6

malignant transformation of what cell type results in acute leukemia?

Answer 6

stem cells or early progenitors which causes accumlation of blast cells (early BM hematopoietic cells)

Question 7

Difference between AML and ALL

Answer 7

based on whether blasts are myeloblasts or lymphoblasts (determined by immunophenotyping)

Question 8

Differentiating PBS of AML from ALL

Answer 8

AML- auer rods, MPO, CD33, CD13, HLA-DR

ALL- TdT, CD10, CD19, CD20

Question 9

nose bleeding
coagulopathy with elevated INR and decreased fibrinogen,
white blood count of 2.0, haemoglobin of 8.1 and platelet count of 43, with blasts present on peripheral smear.

Answer 9

Acute promyelocytic leukemia (M3 AML)

Question 10

Acute promyelocytic leukemia (M3 AML) cytogenetics

Answer 10

Chromosome 15,17 translocation

Question 11

t(5,17)

Answer 11

Acute promyelocytic leukemia

Question 12

40 year old Hispanic male presented with easy bruising, tiredness and sore throat. On examination he had bleeding gums and pallor. Spleen tip was palpable.
His CBC came back with Hb 7gm/dl, WBC 50 x103/dl, platelet 75 x 103/dl. Peripheral smear showed numerous blasts cells with a single Auer rods in some of them.

Answer 12

AML

Question 13

Immunophenotyping is positive for CD13, CD33, CD34, CD7, CD 117 and Myeloperoxidase and is negative for CD2, CD3, CD19, CD10, TdT.
Differential from bone marrow showed 60% blasts, nuetrophils 30%, promyelocytes 2%, monocytes 4%, myelocytes 3%, eosinphils 1%

Answer 13

AML

Question 14

Cytogenetics showed t(8;21) and –Y.

Answer 14

AML

Question 15

He has acute myeloid leukemia FAB M2 on morphology with t(8;21) and –Y. Molecular analysis showed no evidence of c. kit mutation.

What risk group is this patient’s AML?
Better risk
Standard or intermediate risk
Poor risk group

Answer 15

Better

Question 16

Treatment for AML

Answer 16

Remission induction therapy: 1 to 2 courses of intensive therapy to achieve a complete response (absence of detectable leukemia cells)

Post-remission therapy:
consolidation therapy: 3 to 4 courses of intensive short- course therapy to further reduce the subclinical body burden of tumor

Followed by (in some patients): 
maintenance therapy: months to years of less intensive therapy to further prevent recurrenceor 
allogeneic bone marrow transplantation

Question 17

Which ALL patient has the worst prognosis?

a. An 8 year old with ALL with E2a-PBX (chr 1,19) translocation on cytogenetics
b. A 21 year with T-ALL and normal cytogenetics
c. A 16 year old with TEL-AML1 (chr 12,21) translocation on cytogenetics
d. A 51 year old with BCR-ABL1 (chr 9,22) translocation on cytogenetics

Answer 17

D

Question 18

good outcome genetics of childhood ALL

Answer 18

E2A-PBX and TEL-AML

Question 19

poor outcome genetics of adult and child ALL

Answer 19

MLL-AF4 and BCR-ABL

Question 20

What is needed to counter hyperuricemia from tumor cell breakdown

Answer 20

allopurinol