Acute Leukemia Cases - Nikcevich

Question 1

Normal values for: 
WBC diff: 
RBC: 
Hbg: male vs. female
Platelets: 
INR

Answer 1

WBC diff: 4,500 -11,000 10^9
Hbg: Male: 14-16 F: 12-14
Platelets: M: 190-290K F: 210-340K
INR: 1

Question 2

Pancytopenia

Answer 2

Bone marrow isn’t producing cells so you get:

Anemia
Neutropenia
Thrombocytopenia

Question 3

AML clinical features:

Answer 3

• Pancytopenia
• B symptoms: fever, night sweats, chills malaise, weight loss
• Extramedually disease (monocytic leuks)
• Hyperleukocytosis

Question 4

AML info

Answer 4

• uncontrolled clonal proliferation and accumulation of neoplastic hematopoietic precursor cells of myeloid lineage
• can’t make cells or defective maturation
• Need 20% myeloblasts in BM

Question 5

What drives prognosis and determines treatment?

Answer 5

CYTOGENETICS!

Question 6

Good prognosis signs in AML?
cytogenetics:
karyotype?
Auer rods?

Answer 6

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

Normal karyotype with NPM1+, FLT3–
Presence of Auer rods :)

Question 7

Unfavorable risk of AML

Answer 7

**11q23
del 5 or 7
trisomy 8

Question 8

Test question on 11q23

Answer 8

sign of unfavorable risk

*usually from prior chemo exposure!

Question 9

Treatment if less than 60 y/o

Answer 9

Induction chemo with anthracycline (rubicins) plus cytosine arabinoside in 7+3 regimen

Get remission? then do consolidation chem (cytosine arabinoside x 4 cycles) or transplant

No remission? especially poor prognostic sign

Question 10

Allogeneic stem cell transplant:

Answer 10

• stem cell transplant from donor or cord blood
• Match HLA phenotypes
• Basically give them a new immune system (blood type and bone marrow will have DNA of donor)
• Graph vs host disease is possible

Question 11

Treatment if over 60 y/o

Answer 11

Same induction chemotherapy and same if you go into remission

• probably no role for allogeneic transplant
• maybe just supportive care

Question 12

What is diffuse adenopathy a sign of?

Answer 12

Extramedullary disease

-always do LP to see if it’s in CSF

Question 13

Low fibrinogen in AML patient?

Answer 13

DIC= disseminated intravascular coagulation

Question 14

Acute Promyelocytic Leukemia (M3)

Please don’t miss this diagnosis!

Answer 14

***t(15:17) -->better prognosis 
fusion gene: PML/RAR-alpha
Poor risk disease with t(11;17)
**AUER RODS 
*watch out for DIC 
tx: ATRA

Question 15

AML-M4

Answer 15

• Hyperleukocytosis
• Hyperviscosity –>fatigue, blurred vision, headache

Monocytic

Question 16

What should you think if the automated differential reports monocytosis?

Answer 16

–Maybe it miscounted blast cells for monocystosis

Question 17

FLT-3 receptor tyrosine kinase inhibitor for AML

Answer 17

Quizartinib

Effective with 47% response rate