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Blood and Lymph Unit 2 > Acute Leukemia > Flashcards

Acute Leukemia Flashcards

1
Q

What is acute leukemia?

A

Clonal, neoplastic proliferation of immature myeloid or lymphoid cells.

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2
Q

What are the two major categories of acute leukemia?

A
  1. Acute myeloid leukemia (AML)

2. Acute lymphoblastic leukemia (ALL)

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3
Q

What is the cause for the signs and symptoms of acute leukemia?

A

The loss of normal hematopoietic elements, and subsequently a loss of normal peripheral blood cells

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4
Q

True or False:

Acute leukemia is rapidly fatal without treatment

A

True

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5
Q

What is the most common etiology of acute leukemia?

A

Chromosomal abnormalities

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6
Q

What are two consequences of chromosomal abnormalities in acute leukemias?

A
  1. Maturation/ differentiation is blocked

2. Cells are not dependent on external factors for growth stimulation

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7
Q

Acute myeloid leukemia includes which types of cells?

A

Granulocytic
Monocytic
Erythroid
Megakaryocytic

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8
Q

Acute lymphoid leukemia includes which types of cells?

A

B or T-cell lineages

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9
Q

Name some risk factors for acute leukemia.

A 
Previous chemotherapy 
Tobacco smoke
Ionizing radiation
Benzene exposure
Genetic syndromes
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10
Q

Can acute lymphoblastic leukemia present as a solid mass?

A

Yes. It is called lymphoblastic lymphoma or LBL

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11
Q

What are the two main types of ALL?

A
  1. B-lymphoblastic ALL (B-ALL)

2. T-lymphoblastic ALL (T-ALL)

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12
Q

What patient population does ALL most commonly present in?

A

Children under 6

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13
Q

What would you expect the peripheral white blood cell count to be in a patient with ALL?

A

It could be increased, normal, decreased

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14
Q

What cell surface marker can be found on the surface of lymphoblasts?

A

CD34

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15
Q

What enzymes do lymphoblasts express that can be used to identify them?
Hint: It is not expressed in mature lymphocytes & it adds nucleotides to V(D)J exons during antibody recombination

A

Terminal deoxynucleotidyl transferase (TdT)

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16
Q

Are the majority of ALL cases B-ALL or T-ALL?

A

B-ALL

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17
Q

What three B-lineage antigens are found on B-lymmphoblasts?

A

CD19
CD22
and/or
CD79a

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18
Q

Do B-lymphoblasts express CD20?

A

No

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19
Q

What are three cytogenetic changes seen in B-ALL?

A
  1. B-ALL with t(9;22)(q34;q11.2); BCR-ABL1
  2. B-ALL with translocations of 11q23; MLL
  3. B-ALL with t(12;21)(p13;q23); ETV6-RUNX1
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20
Q

What protein product is produced by t(9;22)?

A

This is called the Philadelphia Chromosome

BCR-ABL fusion protein 190kd

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21
Q

Only 25% of cases of adult B-ALL involve the Philadelphia chromosome. How does the presence of this protein effect the prognosis?

A

B-ALL with Philadelphia chromosome has the worst prognosis of all subtypes of ALL.

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22
Q

B-ALL with abnormalities of MLL is frequently seen in what patient population?

What is the prognosis?

A

Neonates and young infants

poor prognosis

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23
Q

B-ALL with ETV6-RUNX1 is seen in what patient population?

Prognosis?

A

25% cases of childhood B-ALL

Very favorable prognosis

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24
Q

What type of leukemia is more often seen in adolescents and young adults?

A

T-lymphoblastic ALL

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25
T-ALL more frequently presents with a component of lymphoblastic lymphoma (T-LBL). Where does this mass most often present?
It presents as a large mediastinal mass.
26
How does T-ALL present?
High white blood count
27
Does T-ALL/ T-LBL favor males or females?
Males
28
What T-lineage antigens are expressed on T-lymphoblasts?
CD2, CD3, &/ or CD7 CD4 and CD8 CONCURRENTLY CD99 and CD1a
29
What factors influence the prognosis of ALL?
AGE: worse in infants (10, and adults WHITE BLOOD CELL COUNT: worse for markedly elevated WBC count SLOW RESPONSE TO THERAPY/ SMALL AMOUNTS OF RESIDUAL DISEASE AFTER THERAPY NUMBER OF CHROMOSOMES: very favorable prognosis for hyperdiploidy; poor prognosis for hypodiploidy B VS. T LINEAGE: T-ALL seems to have a worse prognosis than B-ALL
30
What is the average age of diagnosis of AML?
65 years of age
31
How is AML diagnosed?
Increased myeloblasts accounting for 20% or more of nucleated cells in the marrow or peripheral blood
32
What are Auer rods?
Fused azurophilic granules forming small stick-like structures in the cytoplasm.
33
What cells do Auer rods differentiate.
Myeloblasts are generic looking. Aeur rods differentiate myeloblasts from lymphoblasts
34
What cells are Auer rods found?
Only abnormal myeloblasts
35
Myeloblasts often express what cellular markers?
``` CD34-A generic marker of immaturity CD117 (C-Kit) Myeloperoxidase CD33 CD13 ```
36
If monocytic differentiation occurs in AML what cellular markers can be seen?
CD64 | CD14
37
If megakaryoblastic defferentiation occurs in AML what cellular markers can be seen?
CD41 | CD61
38
What type of genetic abnormality is characteristic for AML?
Balanced translocations
39
How are balanced translocations detected?
``` Cytogenetic analysis (karyotyping or FISH) Molecular analysis (RT-PCT) ```
40
What protein is produced in AML with t(8;21)(q22;q22); RUNX1-RUNX1T1?
RUNX1 encodes alpha unit of core binding factor (CBF), a transcription factor needed for hematopoiesis. The fusion protein blocks transcription of CBF-dependent genes, thus blocking differentiation.
41
What is the general prognosis of AML with t(8;21)(q22;q22); RUNX1-RUNX1T1?
Relatively good prognosis
42
What subtype of AML is characteristic of baso eos in the bone marrow?
AML with inv(16)(p13.1;q22) or t(16;16)(p13.1;q22); CBFB-MYH11
43
What are "baso eos"?
Immature eosinophils with abnormal baasophilic granules in addition to their eosinophilic granules
44
What cells are often seen in AML with inv(16)(p13.1;q22) or t(16;16)(p13.1;q22); CBFB-MYH11?
Increased myeloblasts and increasedmonocytes thus a "myelomonocytic leukemia"
45
Describe the protein produced in AML with inv(16)(p13.1;q22) or t(16;16)(p13.1;q22); CBFB-MYH11?
CBFB encodes the beta subunit of core binding factor (CBF), a transcription factor needed for hematopoiesis. The fusion protein blocks transcription of CBF-dependent genes, thus blocking differentiation.
46
What is the general prognosis for AML with inv(16)(p13.1;q22) or t(16;16)(p13.1;q22); CBFB-MYH11?
Relatively good prognosis
47
Describe the cells in acute promyelocytic leukemia with t(15;17)(q22;q12); PML-RARA.
Abnormal promyelocytes predominate instead of blasts. Hypergranular promyelocytes with many Auer rods (faggot cells)
48
How can acute promyelocytic leukemia be treated?
Supra-physiologic doses of all-transretinoic acid (ATRA) in combinatoinn with arsenic salts
49
APL can give rise to what life-threatening event?
Disseminated intravascular coagulation (DIC)
50
Describe the cells in AML with t(1/22)(p13;q13); RBM 15-MKL1.
Usually shows megakaryoblastic differentiation
51
What specific patient population is at risk of developing AML with t(1/22)(p13;q13); RBM 15-MKL1.?
Infants with Down syndrome
52
What is the general prognosis of an individual with AML with t(1/22)(p13;q13); RBM 15-MKL1.?
Relatively good prognosis with intensive chemotherapy
53
Describe the cells of AML with abnormalities of 11q23; MLL.
Frequently shows some degreee of monocytic differentiation
54
What is the general prognosis of AML with abnormalities of 11q23; MLL?
Poor prognosis
55
AML (t-AML) can be caused by what therapies?
Alkylating agents Topoisomerase-II inhibitors Ionizing radiation
56
t-AML secondary to alkylating agents or radiations occurs due to what cytological abnormality? What is the latency period?
Whole or partial loss of chromosomes 5 and/or 7 2-8 years
57
t-AML secondary to topoisomerase-II inhibitors occurs due to what cytological abnormality?
Rearrangement of the MLL gene (11q23)
58
Generally all types of t-AML have what prognosis?
Very poor
59
Monocytic differentiation is important to note as leukemic monocytes because...
They often infiltrate the skin and gums, resulting in many small lesions
60
Megakaryoblasts in AML, NOS (not otherwise specified) usually are accompanied by what life threatening disorder?
Marrow fibrosis
61
What is the most important prognostic finding for AML, NOS?
The presence of certain molecular findings 1. FLT3 ITD- NEGATIVE prognostic factor 2. NPM1- POSITIVE prognostic factor 3. CEBPA- POSITIVE prognostic factor
62
What is the general prognosis for AML?
variable. 60% of AML cases will reach complete remission after chemotherapy

Blood and Lymph Unit 2 (9 decks)

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