394 - 395 - Leukemias Flashcards
What populations are most often affected by ALL?
Age < 15 years, Down syndrome patients
How does T-cell ALL present?
mediastinal mass (leukemic infiltration of the thymus)
What are the blood smear and bone marrow findings in ALL?
↑ lymphoblasts
What serum markers are present in ALL?
- TdT+ (marker of pre-T and pre-B cells)
2. CD10+ (pre-B cells only)
How responsive is ALL to therapy?
It is the most responsive leukemia to therapy
What are some places especially at risk for ALL spread?
CNS and testes
What translocation in ALL is associated with a better prognosis?
t(12, 21)
What lymphoma is considered the counterpart to CLL?
small lymphocytic lymphoma (SLL)
What is the difference b/w SLL and CLL?
CLL has ↑ peripheral blood lymphocytosis or bone marrow involvement
What is the normal age range for CLL patients?
> 60 years
What markers indicate CLL?
CD20+, CD5+
IS CLL of T or B cell origin?
B cell
What is the presentation and course of CLL?
Often asymptomatic, progresses slowly
What is found in the peripheral blood smear in CLL?
smudge cells
What condition involving RBCs is associated with CLL?
autoimmune hemolytic anemia
Who is affected by hairy cell leukemia?
Adults/elderly
What type of cells make up hairy cell leukemia?
Mature B-cells with filamentous, hair-like projections
How would you diagnose hairy cell leukemia?
stain for TRAP (becoming outdated) or do flow cytometry
What would you find on bone marrow aspiration in hairy cell leukemia?
It would be a dry tap because of marrow fibrosis
How do you treat Hairy cell leukemia?
Cladribine (2-CDA) - an adenosine analog (inhibits adenosine deaminase)
Who gets AML?
older people (median onset 65 years)
What is seen on blood smear in AML?
- auer rods
- peroxidase+ cytoplasmic inclusions (mostly in M3 subtype)
- ↑↑↑ circulating myeloblasts
What are the risk factors for AML?
- alkylating chemotherapy
- radiation
- myeloproliferative disorders
- Down syndrome
What is another name for the M3 subtype of AML?
Acute Promyelocytic Leukemia (APL)
What translocation leads to the M3 subtype of AML (APL)?
t(15;17)
How do you treat APL?
all-trans retinoic acid (vitamin A) → induces differentiation of myeloblasts
What is a hematologic complication of M3 AML and its treatment?
DIC is a common presentation and can be induced by chemotherapy due to release of Auer rods
Who gets CML?
peak incidence 45-85 years – median age at diagnosis 64 years
What is the translocation in CML?
t(9;22) - Philadelphia chromosome
What is on the Philadelphia chromosome?
bcr-abl
What cells make up CML?
myeloid stem cells: ↑ neutrophils, metamyelocytes, basophils
What might you find on physical exam of the abdomen in CML?
splenomegaly
What is the prognosis of CML?
It responds to imatinib; can accelerate and transform to AML or ALL (blast crisis)
What is imatinib?
a small-molecule inhibitor of bcr-abl tyrosine kinase
What is the trade name of imatinib?
Gleevec
