Acute Leukemia

Question 1

acute myelogeneous (non-lymphocytic) leukemia

etiology

Answer 1

Congenital
Viral
Oncogenes
Environmental Agents
Industrial Agents
Chemical Agents

radiation

therapeutic agents

Question 2

hereditary factors of AML

Answer 2

Chromosomal Breakage

• Bloom’s Syndrome
• Fanconi’s Syndrome

Immunologic Disorders

Down’s Syndrome
- Nondisjunctive Conditions

Question 3

clinical findings of AML

Answer 3

1) Symptomatology

Fatigue
Infection
Bleeding
Adenopathy
Left Upper Quadrant Discomfort
Leukostasis
Rectal Lesions

Question 4

physcial findins of AML

Answer 4

Splenomegaly
Lymphadenopathy
Gingival Hypertrophy
Ecchymoses, Fundal Hemorrhages
Neurological Abnormalities
Granulocytic Sarcoma
Neutrophilic Dermatosis
Congestive Heart Failure

Question 5

Other lab findings of AML

Answer 5

HYPERURICEMIA
RENAL INSUFFICIENCY
HYPOKALEMIA
HYPER- OR HYPOCALCEMIA
CSF PLEOCYTOSIS
COAGULOPATHY
ANERGY

Question 6

prognostic values of cytogenetics

Answer 6

favorable:

T(8;21)
INV (16)
T(15;17)

unfavorable:

5a-
7a-
T(9;22)

Question 7

Acute Promyelocytic leukemia

Answer 7

A unique leukemia subtype

Distinct clinical features
- Disseminated intravascular clotting

Distinct histological and cytogenetic features
- Azurophilic granules, Auer rods, t(15;17( or t(11;17)

Distinct molecular features
- PML-RARα

Question 8

chemotherapy

Answer 8

induction

consollidation

maintenance

Question 9

prognostic factors for remission and /or survival in APL

Answer 9

AGE
PRIOR RADIATION OR CHEMOTHERAPY
KARYOTPIC ABNORMALITIES, ESPECIALLY CHROMOSOMES 5 AND 7
HISTORY OF PRELEUKEMIA
GENDER
LEUKOCYTE COUNT AT PRESENTATION

Question 10

Acute lymphoblastic leukemia

Answer 10

B cell ontogeny

• Earliest B cell
• Translocation to the Germinal Center
• Antigen presentation and B-cell activation
• Plasma Cell
• Memory B cell

Malignant transformation of a committed pre-B cell
- Characteristic pre-B cell markers
CD10
Terminal deoxynucleotidyl transferase
Other B-cell, T-cell, or NK-cell markers

Question 11

Subtypes of ALL

Answer 11

Childhood A.L.L. (L1 phenotype)
- CD10-positive, hyperdiploid

Adult A.L.L. (L2 phenotype)
- 30% are Philadelphia-chromosome positive

Burkitt’s lymphoma/leukemia (L3 phenotype)
c-myc juxtaposed to Ig H, κ or λ
t(8;14) OR t(2;8), t(8;22)

Question 12

Distint clinical concerns in ALL

Answer 12

Sanctuary disease sites

• Central nervous system
• testis

The role of maintenance therapy

• Prolonged antimetabolite therapy

Question 13

Treatment of ALL

Answer 13

Corticosteroids and Vinca alkaloids
Anthracycline antibiotics
L- Asparaginase
CNS prophylaxis
Cyclophosphamide