Acute Leukemia

Question 1

What is leukemia, what are the two cancer types of leukemia

Answer 1

Cancer of the blood cell lines/ myeloid and lymphoid

Question 2

T/F: Chronic leukemia need prompt treatment

Answer 2

False: Chronic is more indolent and sometimes doesn’t require treatment while acute needs prompt treatment

Question 3

What are the risk factors for leukemia

Answer 3

genetic predisposition, acquired disease (MPD, aplastic anemia), occupational and enviornmental exposure, certain drugs

Question 4

What therapies are associated with getting Acute myeloid leukemia (AML)

Answer 4

Alkylating agent (cyclophophamide, melaphalan, nitrogen mustard) causing abnormalities on chromosome 5 or 7/ Topoisomerase inhibitors (etoposide) causing abnormalities on 11q23 along with M4 and M5 morphologic features

Question 5

How is acute leukemia differentiated from chronic leukemia

Answer 5

If a patient has blast percentage more than 20% it is acute leukemia, if a patient has a blast percentage less than 20% it is chronic leukemia

Question 6

What are poor prognostic factors for leukemia

Answer 6

Advanced age (greater than 60), MDS or chemotherapy, cytogenetics and mutations, patients who do not have complete remission or remission less than 6 months, FAB subtype M6 and M7, elevated LDH

Question 7

T/F: AML is easire to cure than ALL

Answer 7

True

Question 8

What are the favorable cytogeneics for AML

Answer 8

t(15;17), inv(16), t(8;21)

Question 9

How is AML diagnosed

Answer 9

Bone marrow biopsy

Question 10

What are the two treatment stages for AML

Answer 10

Induction therapy (induce complete remission) and Post-remission therapy (eliminate undectable leukemia)

Question 11

What is the Induction therapy for AML

Answer 11

Cytarabine 100-200 mg/m2 IVPB continous infusion over 24 hours for 7 days PLUS Daunorubicin 45-90 mg/m2 IV for 3 days (7 + 3)

Question 12

T/F: Giving higher doses of Daunorubicin leads to higher outcomes of complete remission

Answer 12

True

Question 13

What are the complications of Inductiion therapy for AML

Answer 13

Tumor lysis syndrome (prevent with hydration allopurinol and rasburicase), myelosupression

Question 14

What is the post-remission therapy for AML with good to intermediate risk, low risk

Answer 14

High dose cytarabine 3g/m2 every 12 hours Day 1,3 and 5 for 3 to 4 cycles/ stem cell transplant

Question 15

What are the two main complications of cytarabine

Answer 15

Neurotoxicity and Ocular toxicity (dexamethasone eye drops)

Question 16

What is AML subtype with best prognosis and why

Answer 16

Acute promylegenous leukemia, has a clear mutation that defines it: t(15;17)

Question 17

What makes APL deadly if not treated

Answer 17

DIC due to promyelocytes packed with granules release tissue factors and acitivate the coagulation cascade

Question 18

What is the main medication that is given for APL, what is given if the patient has low to intermediate risk, high risk

Answer 18

All Trans Retinoic Acid (ATRA) 45mg/m2/day every 12 hours, arsenic trioxide, idarubicin

Question 19

What is given post remission for APL

Answer 19

ATRA PLUS Arsenic trioxide

Question 20

What is the MOA of ATRA

Answer 20

Induces proliferation of the abnormal clone of the maturation, differentiation and prognosis

Question 21

What patients should not get ATRA, other side effect

Answer 21

Not recommended to start in patients with WBC greater than 10,000 since retinoic acid syndrome is more likely/ QT prolongation

Question 22

What presentation of symptoms helps to differentiate between AML and ALL

Answer 22

CNS involvement (mental status changes, headaches)

Question 23

What are cytogenetics for ALL indicate a good prognosis, poor prognosis

Answer 23

Hyperploidy or del(9p)/ t(9;22), complex karyotype, t(8;14)

Question 24

What are the 4 stages for treating ALL

Answer 24

Induction, consolidation, delayed intensification, maintenance

Question 25

Why is CNS prophylaxis given to treat ALL, how is the CNS drugs given

Answer 25

Relapse in seen in Greater than 50% of patients surviving more than 2 years/ Intrathecal administration (methotrexate, cytarabine, hydrocortisone)

Question 26

What drugs are given for ALL induction

Answer 26

Anthracycline, vinicristine, corticosteroids, high dose cytarabine, methotrexate

Question 27

What is given for maintenance of ALL

Answer 27

6-MP, oral methotrexate, vinicristine, prednisone