Acute Leukemia Flashcards
What is leukemia, what are the two cancer types of leukemia
Cancer of the blood cell lines/ myeloid and lymphoid
T/F: Chronic leukemia need prompt treatment
False: Chronic is more indolent and sometimes doesn’t require treatment while acute needs prompt treatment
What are the risk factors for leukemia
genetic predisposition, acquired disease (MPD, aplastic anemia), occupational and enviornmental exposure, certain drugs
What therapies are associated with getting Acute myeloid leukemia (AML)
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
How is acute leukemia differentiated from chronic leukemia
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
What are poor prognostic factors for leukemia
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
T/F: AML is easire to cure than ALL
True
What are the favorable cytogeneics for AML
t(15;17), inv(16), t(8;21)
How is AML diagnosed
Bone marrow biopsy
What are the two treatment stages for AML
Induction therapy (induce complete remission) and Post-remission therapy (eliminate undectable leukemia)
What is the Induction therapy for AML
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)
T/F: Giving higher doses of Daunorubicin leads to higher outcomes of complete remission
True
What are the complications of Inductiion therapy for AML
Tumor lysis syndrome (prevent with hydration allopurinol and rasburicase), myelosupression
What is the post-remission therapy for AML with good to intermediate risk, low risk
High dose cytarabine 3g/m2 every 12 hours Day 1,3 and 5 for 3 to 4 cycles/ stem cell transplant
What are the two main complications of cytarabine
Neurotoxicity and Ocular toxicity (dexamethasone eye drops)
What is AML subtype with best prognosis and why
Acute promylegenous leukemia, has a clear mutation that defines it: t(15;17)
What makes APL deadly if not treated
DIC due to promyelocytes packed with granules release tissue factors and acitivate the coagulation cascade
What is the main medication that is given for APL, what is given if the patient has low to intermediate risk, high risk
All Trans Retinoic Acid (ATRA) 45mg/m2/day every 12 hours, arsenic trioxide, idarubicin
What is given post remission for APL
ATRA PLUS Arsenic trioxide
What is the MOA of ATRA
Induces proliferation of the abnormal clone of the maturation, differentiation and prognosis
What patients should not get ATRA, other side effect
Not recommended to start in patients with WBC greater than 10,000 since retinoic acid syndrome is more likely/ QT prolongation
What presentation of symptoms helps to differentiate between AML and ALL
CNS involvement (mental status changes, headaches)
What are cytogenetics for ALL indicate a good prognosis, poor prognosis
Hyperploidy or del(9p)/ t(9;22), complex karyotype, t(8;14)
What are the 4 stages for treating ALL
Induction, consolidation, delayed intensification, maintenance
Why is CNS prophylaxis given to treat ALL, how is the CNS drugs given
Relapse in seen in Greater than 50% of patients surviving more than 2 years/ Intrathecal administration (methotrexate, cytarabine, hydrocortisone)
What drugs are given for ALL induction
Anthracycline, vinicristine, corticosteroids, high dose cytarabine, methotrexate
What is given for maintenance of ALL
6-MP, oral methotrexate, vinicristine, prednisone
