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Block 7 Week 1 > Acute and Chronic Leukemias-Usera > Flashcards

Acute and Chronic Leukemias-Usera Flashcards

1
Q

What are the 2 types of myelogenous leukemias?

A

Acute myelogenous leukemia (AML)

Chronic myelogenous leukemia (CML)

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2
Q

What are the four types of Lymphocytic/lymphoblastic leukemias?

A

Acute Lymphoblastic Leukemia (ALL)
Chronic Lymphocytic Leukemia (CLL)
Hairy Cell Leukemia
Adult T cell Leukemia

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3
Q

What are the 2 types of acute lymphoblastic leukemia (ALL)?

A

B cell and T cell

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4
Q

What is HTLV-1?

A

a type of adult T cell Leukemia

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5
Q

What kind of leukemia is prevalent in 0-14 year olds?

A

ALL

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6
Q

What kind of leukemia is prevalent in 15-59 year olds?

A

AML

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7
Q

What kind of leukemia is prevalent in 40-60 year olds?

A

AML/CML

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8
Q

What kind of leukemia is prevalent in elderly adults (greater than 60)?

A

CLL

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9
Q

What is this:

maturational arrest in granulocyte development, leading to proliferation of malignant precursor cells

A

Acute myelogenous leukemia

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10
Q

What age groups get acute myelogenous leukemia?

A

young to middle aged adults

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11
Q

APL acute myeloid leukemia has a recurrent genetic abnormality, what is it?

A

t(15;17)(q22;q12); PML-RARA

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12
Q

What AML are not otherwise specified?

A

AML with maturation

Acute monoblastic/monocytic leukaemia

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13
Q

What are the clinical features of AML?

A 
anemia
thrombocytopenia
neutropenia
leukocytosis with increased blasts
Evidence of marrow failure
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14
Q

What are the signs/symptoms of AML?

A

fatigue
bleeding/ecchymoses
DIC (APL)
gum infiltration (monocytic)

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15
Q

If you have a marrow failures, what will you see?

A

marrow packed with blasts

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16
Q

What do you do with an aspirate?

A 
flow cytometry
smear
cytogenetics (FISH, Karyotype)
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17
Q

In AML you are going to see (blank), the features of these are fine powdery chromatin, they are immature cells with widely dispersed chromatin with high nuclear cytoplasmic ratio.

A

blasts

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18
Q

The only morphologic key when dealing with blasts is (blank). They tell you if they are myeloid cells. (cuz they are fused primary granules)

A

auer rods

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19
Q

Acute promyelocytic leukemia corresponds to (blank).

A

FAB M3

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20
Q

APML with t(blank), q(blank)

A

15;17

22;12

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21
Q

Acute promyelocytic leukemia is found in (blank) percent of AML

A

5-8

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22
Q

What age group gets promyelocytic leukemia?

A

any age, but usually 3-5 decades of life

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23
Q

What does APML typically present with?

A

DIC

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24
Q

APML often has large numbers of (blank)

A

auer rods

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25
Q

IF you see tons and tons of auer rods what should you be thinking of?

A

promyelocytic leukemia

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26
Q

What is the pathogenesis behind the APL translocation?

A

balanced translocation b/w RARA and PML that results in a fusion product that arrests the cell at the maturational stage so it cant progress from promyelocyte to myelocyte.

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27
Q

What is RARA and what does this mean for APL?

A

it is a retinoid acid receptor alpha (receptor for vit A) so this means if you get APL you can cure it by taking vit A and an alkylating agent

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28
Q

APL has a translocation between chromosome (blank) and (Blank)

A

15 and 17

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29
Q

How do you treat acute promyelocytic leukemia?

A

ATRA and alkylating agent

80-90% remission

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30
Q

What is this:
auer rods are rare
gum infiltration is frequently the presenting sign

A

Acute monocytic leukemia

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31
Q

What is this:
15% of adult leukemias
may be related to radiation or benzene
pluripotent
t (9,22) BCR-ABL fusion gene AKA philadelphia chromosome
Protracted chronic phsae, sometimes many years, followed by blast crisis

A

Chronic myelogenous leukemia

32
Q

What are the chromosomes involved in chronic myelogenous leukemia?

A

9 and 22

33
Q

What is the are the fusion genes associated with CML?

A

BCR-ABL fusion gene AKA phildelphia chromosome

34
Q

Chronic myelogenous leukemia has a (blank) chronic phase, sometimes many years, followed by blast crisis

A

protracted

35
Q

Philadelphia chromosome is caused by a (blank) mutation

A

de novo

36
Q

Is the philadelphia chromosome specific for CML?

A

no

37
Q

(blank) fusion gene produces a constitutively active tyrosine kinase, leading to dysregulation of proliferation and normal apoptosis.

A

BCR-ABL1

38
Q

The BCR-ABL1 fusion product primarily deals with the (blank) pathway

A

STAT5 pathway

39
Q

In chronic myelogenous leukemia, the WBC count is greater than (blank)

A

5X10^9

40
Q 
What is this:
splenomegaly
bleeding/ecchymoses
fever, night sweats, weight loss
less than 10% blasts
Characteristic diffusion, with full spectrum of granulocytes represented
A

Chronic Myelogenous Leukemia

41
Q

Why do you get splenomegaly in CML?

A

deposition of messed up neutrophils

42
Q

(blank) is the terminal stage of chronic myelogenous leukemia that is characterized by a marked increase in the proportion of blast cells, by fever and pain in the bones, and by increased severity of anemia, thrombocytopenia, and splenomegaly—called also blastic crisis

A

Blast phase (crisis)

43
Q 
What is this:
progression to acute leukemia
greater than 20% blasts
large aggregates in BM and extramedullary tissue
Usually fatal
A

Blast phase (crisis)

44
Q

CML-> deposition of malignant cells in his tissues. (blank) is when CML has reached blast breaking point and then wil go into acute ML. Rapidly fatal. (blast count above 20% makes chronic turn to acute)

A

Blast crisis

45
Q

How do you treat CML?

A

with tyrosine kinase inhibitors (imatinib, gleevec)

and allogenic stem cell transplant

46
Q

In CML, allogenic stem cell transplants, give you a 5 year progression free survival in (blank) percent of patients

A

80-95%

47
Q

What is the most common leukemia in children?

A

B cell acute lymphoblastic leukemia

48
Q

Which is more prevalent B cell acute lymphoblastic leukemia or T cell acute lymphoblastic leukemia?

A

B cell (80-85%)

49
Q

(blank) percent of B cell acute lymphoblastic leukemia involve children under 6 years of age.

A

75%

50
Q

What will you see in acute lymphoblastic leukemia?

A

Primitive, undifferentiated lymphoblasts, express CD10 and tdt!!!

51
Q

What are the clinical features of acute lymphoblastic leukemia?

A

marrow failure: anemia, thrombocytopenia, neutropenia. WBC count can be variable.
EXTRAMEDULLARY involvement common in CNS, LN, Spleen, liver, testis

52
Q

What is the prognosis of acute lymphoblastic leukemia?

A

90-95% complete remission

53
Q

What are favorable factors associated with acute lymphoblastic leukemia?

A

age 1-10
t (12,22) ETV-RUN X1
hyperdiploidy (greater than 52 chromosomes)

54
Q

What are the chromosomes involved with acute lymphoblastic leukemia?

A

t(12;22)/ETV-RUNX1

55
Q

Once you realize someone has acute lymphoblastic leukemia, what should you immediately look at?

A

CNS

56
Q

What does T cell acute lymphoblastic leukemia typically present with?

A

mediastinal mass or acute leukemia

57
Q

What percent of childhood leukemias are T-cell ALL?

A

15-20%

58
Q

What are the T cell markers for acute lymphoblastic leukemia?

A

CD10-, tdt+

might see CD3,CD4, and CD8 on one cell

59
Q

(blank) is a pan T cell marker.

A

CD3

60
Q

Chronic lymphocytic leukemia is a clonal (blank) cell neoplasm

A

B

61
Q

Chronic lymphocytic leukemia is a clonal B cell neoplasm that is (blank) chain restricted.

A

light

kappa vs lambda

62
Q

What is the most common human leukemia?

A

chronic lymphocytic leukemia

63
Q

What is the most common leukemia in ederly?

A

Chronic lymphocytic leukemia

64
Q

Which cells does chronic lymphocytic leukemia effect?

A

mature, virgin B-cells (CD19+,CD20+) blasts less than 10%

65
Q

Where do you see aberrant co-expression of CD5 and CD23?

A

chronic lymphocytic leukemia

66
Q 
What is this:
WBC 10-100 x 109/L
Small mature lymphs
Clumped chromatin
Smudge cells
A

chronic lymphocytic leukemia (CLL)

67
Q

Chronic lymphocytic leukemia is a (blank) disease so treatment is usually withhheld, however if you need treament then use (blank)

A

Indolent disease

chlorambucil

68
Q

What is the prognosis of chronic lymphocytic leukemia?

A

variable

69
Q

What makes you have a favorable prognosis (median survival 293 months) with CLL?

A

mutated IGVH

70
Q

What makes you have an unfavorable prognosis with CLL?

A

ZAP-70 and CD38 expression

71
Q

2-8% percent of CLL patients develop (blank) with a median survival of less than 1 year

A

DLBCL (richtor transformation)

72
Q 
What is this:
Neoplasm of memory B cells
Older Caucasian males
Indolent disease
Pancytopenia, monocytopenia*
Splenomegaly
CD11c, CD25, CD103
A

hairy cell leukemia

73
Q

What are the markers associated with hairy cell leukemia?

A

CD11c, CD25, CD103

(only time you will ever see a three digit marker)!!!

74
Q

What is this:
Frequent splenic red pulp sequestration – splenomegaly
Diffuse bone marrow involvement – fried egg appearance
Dense reticulin network – “dry tap”

A

Hairy cell leukemia

75
Q

What is this:
CD4+ T cell neoplasm caused by HTLV-1
LA, hepatosplenomegaly, lymphocytosis
Rapidly progressive and fatal within 1 yr

A

Adult T cell leukemia

76
Q

Where is adult T cell leukemia endemic?

A

Japan
West Africa
Caribbean

Block 7 Week 1 (10 decks)

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