Acute Leukaemias

Question 1

Leukaemia infiltration (organs)

Answer 1

liver, spleen, lymph nodes, meninges, brain, skin or testes

Question 2

Consequences of bone marrow failure

Answer 2

anemia, neutropenia, thrombocytopenia

Question 3

Acute Lymphoblastic Leukemia (ALL)

Answer 3

most common leukemia in children; highest incidence 3-7 years; falls off by 10; secondary rise by age 40

Question 4

Acute Myeloid Leukemia (AML)

Answer 4

.

Question 5

Myelodysplastic Syndrome

Answer 5

part of a continuum of AML; leukemia not as apparent in myelodysplastic s.

Question 6

Acute Leukemia

Answer 6

over 20% blast cells in the blood or BM;

<20% blasts if specific aleukemia-associated cytogenetic or molecular genetic abnormalities are present

Question 7

M0

Answer 7

undifferentiated

Question 8

M1

Answer 8

without maturation

Question 9

M2

Answer 9

with granulocytic maturation

Question 10

M3

Answer 10

acute promyelocytic; AML with t(15;17)

Question 11

M4

Answer 11

granulocytic and monocytic maturation

Question 12

M5 (M5a, M5b)

Answer 12

monoblastic or monocytic

Question 13

M6

Answer 13

erythroleukemia

Question 14

M7

Answer 14

megakaryocytic

Question 15

L1

Answer 15

blast cells small, uniform high nuclear to cytoplasmic ratio

Question 16

L2

Answer 16

blast cells larger, heterogenous, lower nuclear to cytoplasmic ratio

Question 17

L3

Answer 17

vacuolated blasts, basophilic cytoplasm

Question 18

Auer rods

Answer 18

acute myeloid leukemia

Question 19

myeloid antigens

Answer 19

MPO (myeloperoxidase), CD33, CD13, HLA-DR

Question 20

lymphoid antigens

Answer 20

TdT, CD10, CD19, CD20

Question 21

Acute Promyelocytic Leukemia (M3)

Answer 21

t(15;17)
Auer rods
PML-RARα (protein product binds to histone methyl transferases and together they bind to DNA and reprogram the cell to become a leukemia cell)
All-trans retinoic acid (ATRA) and Arsenic disrupt this complex

Question 22

Acute Myeloid Leukemia

Answer 22

t(8;21)

ETO-AML1

Question 23

good risk AMLs

Answer 23

inv(16)
t(8;21)
t(15;17)

Question 24

complete response

Answer 24

absence of detectable leukemia cells

Question 25

Treatment of AML

Answer 25

1. Remission induction therapy
2. Post-remission therapy
3. In some patients: maintenance therapy OR allogeneic bone marrow transplantation

Question 26

Remission induction therapy

Answer 26

1 to 2 courses of intensive therapy to achieve a complete response

Question 27

Post-remission therapy

Answer 27

aka consolidation therapy;

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

Question 28

maintenance therapy

Answer 28

months to years of less intensive therapy to further prevent recurrence

Question 29

allogeneic bone marrow transplantation

Answer 29

particularly toxic treatment

Question 30

Symptoms associated with anemia

Answer 30

chest pain; shortness of breath

Question 31

Symptoms associated with neutropenia

Answer 31

infection; fever

Question 32

Symptoms associated with thrombocytopenia

Answer 32

bleeding

Question 33

primary AML

Answer 33

de novo AML

Question 34

secondary AML

Answer 34

develops from MDS or other hematological malignancies; more difficult to treat than primary AML

Question 35

Core binding factor leukemias

Answer 35

t(8;21)

inv(16)

Question 36

poor outcomes in both pediatric and adult ALL

Answer 36

MLL-AF4

BCR-ABL

Question 37

good outcomes in pediatric ALL (rarely seen in adults)

Answer 37

hyperdiploidy
E2A-PBX
TEL-AML

Question 38

leukemia with tendency to penetrate into CNS

Answer 38

ALL