acute leukemia

Question 1

clinical symptoms

Answer 1

ymptoms due to:
 bone marrow failure
 tissue infiltration
 leukostasis
 other (DIC)
usually short duration of symptoms.
Constitutional symptoms
fever and night sweats
weight loss

Question 2

labratory changes

Answer 2

Laboratory alterations
WBC usually elevated
blasts in peripheral blood
normocytic anemia
thrombocytopenia
DIC

Question 3

lab studies

Answer 3

Laboratory studies
Morphology (smear, histology)
Immunophenotyping
 Flow cytometry
Cytogenetics
 Karyotyping
 FISH (fluorescence in situ hybridisation)
Molecular genetics
 PCR, RT-PCR
 RFLP (restriction fragment length polymorphism)
 DNA microarray

Question 4

all vs aml

Answer 4

ALL (lymphoblast)
 Blast size: small
 Cytoplasm: scant
 Chromatin: dense
 Nucleoli: indistinct
 Auer-rods: never present
AML (myeloblast)
 large
 moderate
 fine, lacy
 prominent
 present in 50%
flow cytometry: CD markers
special stains (cytochemistry)

Question 5

aml, all (b cells) and t cell all markers.

Answer 5

AML : CD13, CD33
ALL B-cell : CD10, CD19, CD22
T-cell : CD3, CD7

Question 6

prog factors aml

Answer 6

 AML:
– Good prognosis: t(8;21), t(15;17), inv(16)
– Poor prognosis: del(5q), complex cytogenetic alterations,
abnormal 3q

Question 7

all prog factors

Answer 7

ALL:
– Good prognosis: hyperdiploidy, t(12;21)
– Poor prognosis: Philadelphia-chromosome, complex
karyotype, t(4;11), t(8;14

Question 8

who and fab classifications

Answer 8

Current: WHO-classification
based on morphology, immunophenotype,
cytogenetic and molecular alteration  It is
useful for planning treatment and predicting
prognosis
Previously used: FAB-classification (French
American British) – based on morphological and
cytochemical features only

Question 9

all classification

Answer 9

WHO classification
 B-lymphoblastic leukemia/lymphoma
– Recurrent genetic abnormalities
– Not otherwise specified (NOS)
 T-lymphoblastic leukemia/lymphoma

FAB classification: previous system, being phased out
 L1 – small, similar cells
 L2 – large, different cells
 L3 – large, different cells with vacuoles (not ALL, Burkitt)

Question 10

Acute Myeloid Leukemia (AML)

classification- who

Answer 10

WHO-classification
 AML with recurrent genetic abnormalities
 AML with myelodysplasia-related changes
 Therapy-related myeloid neoplasms
 AML not otherwise categorized
 Myeloid sarcoma
 Myeloid proliferations related to Down syndrome

Question 11

Acute Myeloid Leukemia (AML)

classification- fab

Answer 11

FAB-classification (of AML not otherwise categorized)
 M0: AML, minimally differentiated
 M1: AML, without maturation
 M2: AML, with granulocytic maturation
Adult cases: 30 - 40%

 M3: Acute promyelocytic leukemia (APL)
t(15:17) is diagnostic: the retinoic
acid receptor-alpha (RARA) gene is
involved
 ATRA (all-trans retinoid acid)
therapy: stimulates differentiation
 Granules contain procoagulants
(thromboplastin-like) - massive DIC

 M4: Acute myelomonocytic leukemia, M4eo: with eosinophilia
Gingival hyperplasia is frequent

 M5: Acute monoblastic (M5a) or acute monocytic (M5b) leukemia
Often infiltrates into gingiva, skin and
CNS

 M6: Acute erythroid leukemias
 M7: Acute megakaryoblastic leukemia

Question 12

treatment

Answer 12

Allogeneic Stem Cell Transplantation
Combination chemotherapy
 first goal is complete remission
 further Rx to prevent relapse
supportive medical care
 transfusions, antibiotics, proper isolation,
hygiene, nutrition, supplements
psycho-social support
 patient and family

Question 13

treatment chemo

Answer 13

Treatment of most cases of acute myeloid leukemia (AML) is usually divided into 2 chemotherapy (chemo) phases:

Remission induction (often just called induction)
Consolidation (post-remission therapy)
Treatment usually needs to start as quickly as possible after the diagnosis because AML can progress very quickly. Sometimes another type of treatment needs to be started even before the chemo has had a chance to work.