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Internal Medicine > Acute Leukemia > Flashcards

Acute Leukemia Flashcards

1
Q

What is leukemia?

A

Clonal neoplastic disease of the hematopoietic system

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2
Q

What is acute lymphoblastic leukemia (ALL)?

A

Most common malignancy of childhood between 0-15 years old
Rapid onset,rapid progressing
Unknown etiology
Uncommon in adults

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3
Q

What are the clinical features of ALL?

A 
Fatigue/ weakness
Fever
Lymphadenopathy 
Splenomegaly 
Bone pain
Bleeding
Mediastinal mass in adolescent but more common with T-ALL
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4
Q

What are the lab features of ALL?

A

Blast forms
Bone marrow involvement
Anemia
Leukopenia

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5
Q

What are the abnormalities associated with poor outcome in ALL?

A

Translocation t(9:22)- Philadelphia chromosome ( mostly in older children)

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6
Q

What are the abnormalities associated with favorable prognosis in ALL?

A

Translocation t(12:21) ETV6/RUNX1

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7
Q

What are some adverse prognostic features at diagnosis of ALL?

A 
Age>30
WBC>30,000
T cell variant
CNS involvement 
No complete remission in 30 days
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8
Q

How is ALL treated?

A

Chemotherapy consisting of 3 phases
Induction:4-6 weeks
Consolidation/ intesification: 6-9 months
Maintenance :2-3 years
CNS therapy ( methotrexate)for all children even if there is no CNS involvement

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9
Q

What is the drugs used for induction and consolidation ?

A

Vincristine
Dexamethasone or prednisone
Imatinib(Gleevec) included for Philadelphia chromosome
Higher doses are used during consolidation and not induction to avoid tumor lysis syndrome

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10
Q

What are the drugs used for maintenance therapy?

A

Methotrexate and 6- Mercaptopurine

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11
Q

What are the characteristics of tumor lysis syndrome ?

A 
Hyperphosphatemia
Hypocalcemia
Hyperuricemia
Hyperkalemia 
Increased creatinine
Increased LDH
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12
Q

What are the adverse effects of treatment of ALL?

A

Thrombosis
Bleeding
Infection
Hypothalamic pituitary adrenal axis suppression

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13
Q

What is the difference in outcomes between childhood and adult ALL?

A

Both adults and children achieve high initial remission rates
Most children are cured while most adults relapse

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14
Q

What is acute myelogenous leukemia (AML)?

A

Illness of myeloid or monocytic derivation
Bone marrow replacement by blast cells
Most common leukemia after 15 years old
Increases with age (65 or older)
Associated with radiation exposure, chemotherapy, genetic disease (Downs, Fanconi)

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15
Q

What are the 2 types of AML?

A

De novo- newly diagnosed patient with no identified exposure to known leukemogenic agents
Secondary- prior myelodysplasia, prior radiation, chemotherapy or certain chemical exposure

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16
Q

How is AML classified?

A 
M0-undifferentiated
M1- myeloblastic without maturation
M2- myeloblastic with maturation
M3- promyelocytic t(15:17)
M4- myelomonocytic
M5- monocytic
M6-erythroid
M7-megakaryoblastic
17
Q

What are the clinical features of AML?

A 
Symptoms related to complications of pancytopenia 
Weakness and easy fatigue 
Gingival bleeding, ecchymoses, epistaxis
Lymphadenopathy 
Organomegaly(spleen, liver)
Fever
Sternal tenderness
18
Q

What are the labs features of AML?

A

Pancytopenia
Blast circulation
Coagulopathy
Tumor lysis

19
Q

How is AML diagnosed?

A

Bone marrow biopsy
Cytogenetic abnormalities
Flow cytometry for immunophneotyping

20
Q

What are some adverse prognostic features of AML?

A

Age<2 or >60

Poor performance status

21
Q

How is AML treated?

A

Chemotherapy consisting of:
Induction- cytarabine eor 7 days followed by idarubicin for 3 days
Consolidation- high dose cytarabine for 2-4 cycles
Allogenic stem cell transplant - most common but expensive

22
Q

What is acute promyelocytic leukemia?

A 
Subset of AML
Also known as progranulocytic leukemia or M3 leukemia 
Has a specific genetic marker t(15:17)
High incidence of DIC
Medical emergency
23
Q

How is M3 leukemia treated?

A

All trans retinoic acid (ATRA) and idarubicin
Can lead to Capillary leak toxicity that is treated with dexamethasone
Complete remission >80%
Cure:40-60%

Internal Medicine (20 decks)

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