6-2: Acute Leukemia

Question 1

General concept: Hallmark of acute leukemia?

Answer 1

The Myeloid and lymphoid stem cells cannot mature further into other cells and they pile up (PROLIFERATIONG OF -BLASTS!)

Question 2

How much of an increase in blasts is defined as acute leukemia?

Answer 2

> 20% –> move into blood stream and inc WBC count

Question 3

Blasts on blood smear?

Answer 3

large, immature cells with punched out nucleoli

Question 4

Accumulation of myeloid stem cell term=

*KEY MARKER?

Answer 4

Acute MYELOBLASTIC leukemia (AML)

-Myeloperoxidase (MPO) –. MPO can crystallize into AUER RODS!

Question 5

Accumulation of lymphoid stem cell term=

*KEY MARKER?

Answer 5

Acute LYMPHOBLASTIC leukemia (ALL)

Positive for “tDt”in nucleus (tDt is a DNA polymerase)

Question 6

AUER ROD THINK…

What are auer rods?

Answer 6

Acute MYELOBLASTIC LEUKEMIA

-crystallized myeloperoxidase =auer rod

Question 7

tDt positive nuclear stain think?

Answer 7

Acute LYMPHOBLASTIC LEUKEMIA (or lymphoma if T-ALL)!

Question 8

What is tDt and associated with which type of cell?

Answer 8

-tDt is a DNA polymerase only in lymphoblasts!

Question 9

After the age of 5, ALL is associated with?

Answer 9

Children with Down Syndrome

Question 10

ALL most commonly arises in what age group?

Answer 10

CHILDREN

Question 11

ALL can be subclassified into what groups?

Answer 11

B-cell ALL (B-ALL)

T-cell ALL (T-ALL)

Question 12

What are the surface markers to distinguish B-ALL and T-ALL?

Answer 12

Both will have tdt…

B will have CD10, CD19, and CD20

T will have CD2 -CD8

Question 13

B-ALL treatment prognosis?

Answer 13

Excelent response to chemotherapy but need prophylaxis to scrotum and CSF

Question 14

Chromosomal translocation relationships to B-ALL, prognosis, and affected age group?

Answer 14

• t(12, 21) - Good prognosis - common in kids

- t(9, 22) - poor prognosis - common in adults (PHILADELPHIA ALSO DEFINING FEATURE OF CML!)

Question 15

• when see T-ALL think…

- What does T-ALL stand for?

Answer 15

• “T” for THYMIC (Mediastinal mass) and “T” for TEENAGER

- SINCE ITS A THYMIC MASS (AND NOT CELLS FLOATING AROUND IN THE BLOOD) THIS IS AN ACUTE LYMPHOBLASTIC LYMPHOMA

Question 16

Punched out nucleolus think…

Answer 16

AML OR (T or B)-ALL

Question 17

AML most commonly seen in what age range?

Answer 17

50-60 years

Question 18

Subclassification of AML:

Answer 18

1) cytogenetic abnormalities - determine if there is something reoccuring such as a translocation
2) lineage of myeloblasts
3) surface markers

Question 19

*AML chromosomal translocations (or what cytogenetic abnormality)? *and what happens?

Answer 19

• -t(15;17) = CALLED ACUTE PROMYELOCYTIC LEUKEMIA
• -> causes disruption of RAR receptor = disrupted ability to mature
• these immature cells have numerous auer rods ==> increased risk for DIC

Question 20

*Tx for Acute promyelocytic leukemia?

Answer 20

*ATRA (all transretinoic acid) - causes the blasts to mature

Question 21

t(15;17) is called?

Answer 21

Acute Promyelocytic Leukemia

Question 22

Acute monocytic leukemia -

• proliferation of what cell?
• where do these cells infiltrate?

Answer 22

-monoblasts proliferate
-infiltrate the gums
LACK MPO

Question 23

Acute megakaryoblastic leukemia-

• proliferation of what cell?
• associated with what disease?

Answer 23

-proliferation of megakaryocytes
-associated with Down syndrome (before age 5)
(DONT HAVE MPO - dont need it bc they dont kill things)

Question 24

Down Syndrome associated diseases…

• before age of 5=
• after age of 5 =

Answer 24

• before = acute megakaryoblastic leukemia

- after = acute lymphocytic leukemia (ALL)

Question 25

History of exposure to alkylating agents of radiotherapy yields what disease?

Answer 25

AML (from predisposing dysplasia) –> AKA myelodysplastic syndrome

Question 26

myelodysplastic syndrome - presentation:

Answer 26

• cytopenias
• hypercellular bone marrow
• abnormal maturation of cells
• increased blasts

Question 27

outcomes for people with myelodysplastic syndrome

Answer 27

-die from infection or bleed

OR may progress to acute leukemia if the WBC > 20%