Acute Leukemia Flashcards
What illnesses go on to develop Acute Leukemia?
Genetic abnormalities: Trisomy 21, Fanconi’s Anemia, Klinefelters, Turners
Benign conditions: Paroxysmal Nocturnal Hemoglobinuria, Aplastic anemia
Malignant conditions: Myelodysplastic syndrome, Myeloproliferative syndrome
What exposures lead to acute leukemia?
Chemicals: benzene
Radiation therapy, radiation
Tobacco
Chemotherapy: alkylating agents
What is the presentation of Leukemia?
Fatigue, pallor, weakness, bone pain, fever/infection, Petechiae, ecchymoses, infiltration of skin, Sweet’s syndrome
Retinal hemorrhage, CNS symptoms, Wet purpura, gum infiltration, Joint issues, NO ORGANOMEGALY in AML
which of the acute leukemias do you treat differently?
Acute Progranulocytic Leukemia
M3
Where do you see Auer Rods?
AML, Myeloperoxidase inclusions
aka leukemia cutis - sores on the skin
Gingival infiltration -
What is unique about APL?
result of translocation t15:17
Tx: All trans Retinoic acid (ATRA) - it is a maturation agent
all get 7+3 induction also
Arsenic trioxide
APL differention syndrome: edema, Pleural effusion, lung probs
DIC
what are complications of bone marrow exam?
bleeding - controlled by pressure,
Infection
sternal aspiration - bad
What is the tx for AML?
need to anialate the marrow
Cytarabine for 7 days, then 3 days of anthracyclines
follow with consolidation chemo
allogenic stem cell transplant for high risk
add imatinib if tyrosine kinase +
IF not able to do the 7 + 3 (age >60 yrs)
supprortive,
high dose cytarabine
FLAG
Gentuzumab/azacitadine
make sure EF is >40% b4 adding drugs
AML Induction support
Irradiate all blood products
platelet infusion
abx prophylactic, anti emetics
What is the tx for AML?
need to anialate the marrow
Cytarabine for 7 days, then 3 days of anthracyclines
follow with consolidation chemo
allogenic stem cell transplant for high risk
add imatinib if tyrosine kinase +
IF not able to do the 7 + 3 (age >60 yrs) supprortive, high dose cytarabine FLAG Gentuzumab/azacitadine make sure EF is >40% b4 adding drugs
AML Induction support Irradiate all blood products platelet infusion abx prophylactic, anti emetics, PICC line, WBC growth factors (G-CSF), HEPA rooms (pressure higher in room - flow out), no raw fruits and veggies, no sick visitors allopurinol, alkalinize, menorhaggia: progesterone
What is the prognosis for acute leukemia?
w/ tx 50% cured
>5% die in 50 days under 50 as complication of tx
What is ALL?
Median age 14
Lymphoid
Chromosome structual abnormalities in kids more than adults
Molecular markers: MDR gene, Notch-1 mut, Glutathione s transferase, thymidylate synthase genotype
B or T?
If over 35 not good. B cell >30K not good, T cell >100k not good, time to remission >4 wks not good, drug resistance not good
Tx;
induction: CHemo adults
allogenic peripheral blood stem cell tranx for adults
Maintenance: forever
POMP
CML
Presentation: easy bleed, fatigue, fever, infections
Lot of mature WBC in marrow,
Philadelphia chromosome 9:22, BCR-ABL
Tx: Imatinib
