Acute Leukemia Flashcards
2 types of acute leukemia?
Acute Myeloid Leukemias (AML)
Acute Lymphoid Leukemias (ALL)
Incidence for AML
- 7/ 105 individuals < 65 y.o.
15. 9/ 105 individuals > 65 y.o.
Acute Myeloid Leukemias Etiology (5)
Antecedent MDS or Rarely MPS
Inherited Predispositions (Down Syndrome)
Chemotherapies: Alkylating Agents, Topoisomerase II Inhibitors, Chloramphenicol, Phenylbutazone
Chemicals & Radiation (Benzene, Pesticides)
What is one important characteristic of cancers?
that the Cells of the Cancer Seem to Have Stopped Differentiating at Some Point in their Maturation
Classification of AML (FAB)A Morphologic and Histochemical Classification Based on Stage of Maturation Arrest
M0: Minimally Differentiated AML M1: Myeloblastic Without Differentiation M2: Myeloblastic With Differentiation M3: Promyelocytic Acute Leukemia M4: Myelomonocytic Acute Leukemia M5: Monocytic Acute Leukemia M6 Erythroleukemia M7: Megakaryocytic Acute Leukemia
How does WHO classify AML?
More Complicated and More Comprehensive Classification System This System Incorporates Patient History Cellular Morphology Histochemistry Flow Cytometry Chromosomal Analysis and Molecular Evaluation
Presenting Symptoms and Signs for AML?
The most common Sxs are Fever, Bleeding, Fatigue and SOB
Stroke-like symptoms or other Thrombotic Complications
Retinal Hemorrhages
Gingival Hyperplasia (Monocytic Leukemias)
Solid Tumors
What should immediately raise the possibility of Acute Promyelocytic Leukemia (APL).
stroke like symptoms or other thrombotic complications
Lab Findings in AML?
Anemia: Macrocytic in MDS related cases WBC: ~35% < 5 x 103 WBC/mm3 ~ 45% 5 x 103 – 99 x 103 WBC/ mm3 ~ 20% > 100 x 103 / mm3 The Characteristic Peripheral Smear: Blast with a “Leukemic Hiatus” (Poly and Blasts, but no intermediate forms) Most Patients will be Thrombocytopenic
What do you do If the Patient has Not Entered a Complete Remission (CR)?
Re-treat
Switch to Salvage Regimen such as High Dose Cytarabine
If this Fails Consider Allogeneic HSCT
How are new patients treated with AML?
Induction Therapy Consisting of
7 days of Cytarabine given by Continuous IV Infusion
3 Days of an Anthracycline, Usually Daunorubicin.
Patient > 70 y.o. Usually Cannot Tolerate Standard Therapy so how do you treat them?
Treatment Usually Consists of Low Dose Decitabine, a DNA Methyltransferase Inhibitor.
Reduced Intensity Conditioning Regimens with Allo-HSCT have also been successful
Intensive Supportive Therapy with Antibiotics, Blood Products, Care of Mucous Membranes
Signs and Symptoms of APL
Like Other Patients with Acute Leukemia EXCEPT Bleeding and Thrombosis are Common.
This is Due to Disseminated Intra-Vascular Coagulation (DIC)
DIC is a Syndrome Characterized by Widespread Small Vessel Thrombosis, End Organ Ischemia & Depletion of Clotting Factors
What does ATRA do?
ATRA will induce APL Promyelocytes to Differentiate into Mature Myeloid Cells, like Polys etc..
ATRA induces a Complete Remission (CR) is > 90% of Patients
What is ATRA used to treat?
APL
What is the prognosis of AML?
Prognosis is Better in Young People.
Prognosis Depends on Achieving a CR.
What is complete remisson defined as? (3)
< 5% Blasts in the Bone Marrow after Rx
Resolution of Cytogenetic and Molecular Abnormalities in the Bone Marrow
CBC with ANC (Absolute Neutrophil Count) > 103 & Platelets > 105
What are 2 general classes of ALL
B Cell & T Cell
disease of children and young adults
Etiology and epidemiology of ALL
Trisomy 21, Down Syndrome Associated with Incidence of ALL
Radiation Exposure Associated with Increased Incidence of T Cell ALL
Many Cases of Unknown Etiology
What will the physical exam of someone with ALL reveal?
Commonly Reveal Lymphadenopathy &
Hepato-Splenomegaly
ALL’s first peak is in pts less than 20. When is the second peak?
second Peak Incidence of ALL in Individuals > 70 y.o. These Individuals have a Poor Prognosis.
What is considered standarded care for patients with ALL?
lumbar puncture is considered Standard in ALL as CNS Involvement is Common and Requires Special RX
What is the prognosis of ALL
Long Term Survival in Pediatric ALL > 90%
Long Term Survival in Adult ALL ~ 35%
how do you treat ALL?
Vincristine & Prednisone causes Rapid Reduction in ALL Blasts
The Addition of an Anthracycline increases CR to ~ 80%.
