Acute and chronic leukemias - Usera

Question 1

Name the myelogenous leukemias.

Answer 1

1. Acute myelogenous leukemia (AML)

2. Chronic myelogenous leukemia (CML)

Question 2

Name the lymphocytic/lymphoblastic leukemias.

Answer 2

1. Acute lymphoblastic leukemia (ALL) - can be B cell or T cell
2. Chronic lymphocytic leukemia (CLL)
3. Hairy cell leukemia
4. Adult T cell leukemia

Question 3

Which leukemia is more common in the 0-14 age group?

Answer 3

Acute lymphoblastic leukemia (ALL)

Question 4

Which leukemia is more common in the 15-59 age group?

Answer 4

Acute myelogenous leukemia (AML)

Question 5

Which leukemia is more common in the 40-60+ age group?

Answer 5

1. AML

2. CML

Question 6

Which leukemia is more common in the >60 age group?

Answer 6

CLL

Question 7

What are some characteristics of Acute myelogenous leukemia?

Answer 7

1. most common in the 15-59 age group - young to middle aged adults
2. causes maturation arrest in granulocyte development (in the myeloid lineage) leading to proliferation of malignant precursor cells
3. the proliferation causes normal bone marrow structure to be obliterated - this accounts for the clinical features

Question 8

What are the clinical features of AML?

Answer 8

1. anemia -
2. thrombocytopenia
3. neutropenia
4. leukocytosis with increased blasts

Question 9

What are the signs and symptoms of AML?

Answer 9

1. fatigue - due to anemia
2. bleeding/ecchymkoses
3. DIC - diffuse intravascular coagulation
4. monocytic gum infiltration

Question 10

What will the bone marrow look like in AML?

Answer 10

Diffuse infiltration of the bone marrow with blasts.

Question 11

What is immunophenotype?

Answer 11

This term refers to which CD markers are being expressed on immune cells.

Question 12

What will a peripheral smear look like with AML?

Answer 12

You will see lots of blasts (roundish cell with large nucleus and a high n/c ratio) with and you may see Auer rods.

Question 13

What are Auer rods

Answer 13

These are fused primary granules. If you see Auer rods then this is indicative of the cell being from the myeloid lineage. This is the way you can tell if the blasts you are looking at are from the myeloid or lymphoid lineage.

Question 14

What is the n/c ratio?

Answer 14

This refers to the nucleus to cytoplasm ratio. If it is high then this means that the nucleus takes up more room in the cell than cytoplasm. The nucleus is large.

Question 15

Describe Acute promyelocytic leukemia.

Answer 15

1. a type of acute myelogenous leukemia - 5-8%
2. can occur at any age but more common in 3rd to 5th decade of life
3. frequently presents with DIC
4. exhibits rapid doubling time
5. often has large numbers of Auer rods

Question 16

What genetic abnormality is associated with acute promyelocytic leukemia?

Answer 16

A balanced translocation between parts of chromosome 15 and 17. This translocation causes maturational arrest of cells in the myeloid lineage.

Question 17

How is acute promyelocytic leukemia treated?

Answer 17

It is treated with ATRA and alkylating agent. Treatment has a 80-90% remission rate.

Question 18

Describe acute monocytic leukemia.

Answer 18

1. a type of acute myelogenous leukemia
2. Auer rods are rare in peripheral smear
3. gum infiltration is frequently the presenting sign
4. diagnosis hinges on immunophenotype or CD markers

Question 19

Describe Chronic myelogenous leukemia.

Answer 19

1. 15% of adult leukemias
2. may be related to radiation or benzene
3. pluripotent
4. caused by a de novo mutation
5. has a protracted chronic phase, possibly for many years, followed by blast crisis

Question 20

Describe the chromosomal abnormality that causes chronic myelogenous leukemia.

Answer 20

Chromosome 9 and chromosome 22 undergo a translocation that creates a BCR-ABL fusion gene called the Philadelphia chromosome. This gene produces a constitutively active tyrosine kinase that leads to the dysregulation of proliferation and normal apoptosis in the myeloid lineage. This mutation is not specific for CML only.

Question 21

What are the clinical features of CML?

Answer 21

1. WBC count > 5X10^6/L
2. characteristic differential with full spectrum of granulocytes represented
3. <10% blasts
4. splenomegaly
5. bleeding/ecchymoses
6. can proceed to blast phase or blast crisis if blasts exceed 20%, this will result in large aggregates depositing in bone marrow and extra medullary tissue and is usually fatal

Question 22

What will you see on a peripheral smear in CML?

Answer 22

You will see immature granulocytes of all of the myeloid lineage.

Question 23

What will you see in the bone marrow in CML?

Answer 23

You will see hyper proliferation of all the bone marrow lineages.

Question 24

Name a drug that is used to successfully treat CML.

Answer 24

Iminitib - ie. Gleevac. This drug binds to the BCR-ABL protein and turns it off.

Question 25

Describe acute lymphoblastic leukemia.

Answer 25

1. the cells involved could be B-cells, T-cells are both but B-cell ALL is much more common (80-85%)
2. most common leukemia in children - 75% of cases involve children under 6
3. the mutant cells are primitive, undifferentiated lymphoblasts
4. if B-cell then they will express CD10 and tdt markers

Question 26

What will you see in a peripheral smear with ALL?

Answer 26

You will see small lymphoblasts with high n/c ratio and no Auer rods.

Question 27

What are the clinical features of ALL?

Answer 27

1. marrow failure
2. anemia
3. thrombocytopenia
4. neutropenia
5. WBC can be low, normal or high