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Haematology > Acute Leukemias > Flashcards

Acute Leukemias Flashcards

1
Q

What is the primary cause of acute leukemias?

A

Accumulation of acquired genetic mutations within a cell

This mutation can be acquired in utero or after birth.

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2
Q

Name three types of chemotherapy agents related to the etiology of acute leukemia.

A
  • Alkylating agents
  • DNA topoisomerase inhibitors
  • Anthracyclins (e.g., doxorubicin)
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3
Q

What is the significance of the French-American-British (FAB) Classification?

A

It classifies acute leukemias based on morphology and cytochemical reactions

Diagnosis requires a blast count in PB or BM of >30%.

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4
Q

What are the two classes of mutations in the ‘two-hit’ model of AML development?

A
  • Class 1 mutations
  • Class 2 mutations
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5
Q

True or False: Most acute leukemias have a known and determined etiology.

A

False

Most acute leukemias are sporadic with unknown/undetermined etiology.

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6
Q

What are some environmental factors contributing to acute leukemia?

A
  • Chemical exposure (e.g., Benzene)
  • Ionizing radiation
  • Viruses (e.g., HTLV-1, EBV)
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7
Q

What are the main clinical features of acute leukemia?

A
  • Acute and aggressive presentation
  • Abnormalities of the 3 blood cell lines
  • Infiltration of organs & tissues
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8
Q

Fill in the blank: Acute lymphoblastic leukemia (ALL) is the most common form of cancer in _______.

A

[children]

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9
Q

What is the median age of presentation for acute myeloblastic leukemia (AML)?

A

65 years

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10
Q

What is the primary characteristic of acute myeloid leukemia (AML)?

A

Clonal expansion of myeloid blasts in the peripheral blood, bone marrow, and/or other tissues.

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11
Q

List the symptoms of anemia in acute leukemia.

A
  • Weakness
  • Easy fatigability
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12
Q

What type of leukemia is characterized by the presence of more than 20% blast cells in the blood or bone marrow?

A

Acute leukemia

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13
Q

What are the common clinical features of acute lymphoblastic leukemia (ALL)?

A
  • Hepatosplenomegaly
  • Fever
  • Fatigue
  • Lymphadenopathy
  • Bleeding
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14
Q

What is the role of cytogenetic analysis in the diagnosis of acute leukemias?

A

It helps identify specific genetic abnormalities associated with leukemia.

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15
Q

What is the incidence of acute lymphoblastic leukemia (ALL) in children?

A

Approximately 1-1.5/100,000 persons per year.

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16
Q

What classification system is used for acute lymphoblastic leukemia (ALL)?

A

French-American-British (FAB) Classification and immunological classification.

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17
Q

What is the common presentation of a patient with leukopenia/neutropenia?

A

Fever

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18
Q

What type of acute leukemia is characterized by a high frequency among adults?

A

Acute myeloblastic leukemia (AML)

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19
Q

What are the key features of acute megakaryocytic leukemia (AML M7)?

A
  • ≥20% blasts
  • ≥50% of blasts are megakaryoblasts
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20
Q

What is the role of flow cytometry in the diagnosis of acute leukemia?

A

It helps determine the immunophenotype of leukemic cells.

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21
Q

What is the typical male to female ratio for acute lymphoblastic leukemia (ALL)?

A

1.9:1.6

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22
Q

What is meant by ‘differentiation block’ in the context of acute leukemia pathogenesis?

A

It refers to the inability of hematopoietic cells to mature properly.

23
Q

What are the common laboratory investigations for diagnosing acute leukemia?

A
  • Morphology
  • Cytochemistry
  • Immunophenotyping
  • Cytogenetic analysis
  • Molecular studies
24
Q

What is the predominant subtype of leukemia in children?

A

Acute lymphoblastic leukemia (ALL)

25
Q

What are the signs of tissue or organ infiltration in acute leukemia?

A
  • Gingival hyperplasia
  • Lymphadenopathy
  • Hepatosplenomegaly
  • Bone pain
26
Q

What is the classification for acute lymphoblastic leukemia based on morphology?

A

FAB L1, L2, and L3

27
Q

What is the significance of the WHO Classification for acute myeloid leukemia (AML)?

A

It is based on morphology, immunophenotype, cytogenetics, and molecular studies.

28
Q

What are the common symptoms of thrombocytopenia in acute leukemia?

A
  • Gum bleeds
  • Mucocutaneous bleeds
29
Q

What are serum electrolytes?

A

Electrolytes present in the serum that are important for various bodily functions.

Common electrolytes include sodium, potassium, calcium, and magnesium.

30
Q

What does serum LDH stand for?

A

Serum Lactate Dehydrogenase

LDH is an enzyme that can indicate tissue damage.

31
Q

What is the significance of serum lysozymes?

A

Lysozymes are enzymes that break down bacterial cell walls, indicating immune response.

Elevated levels may suggest infection or inflammation.

32
Q

What are the components of a full blood count?

A
  • PCV/Hb
  • Total WBC
  • Absolute neutrophil count
  • Platelets
33
Q

What does AML stand for?

A

Acute Myeloid Leukemia

34
Q

What does ALL stand for?

A

Acute Lymphoblastic Leukemia

35
Q

Define the FAB classification of AML.

A

A classification system for acute myeloid leukemia based on morphology and immunophenotype, including types M0 to M7.

36
Q

What characterizes AML M0?

A

Undifferentiated with >30% blasts, agranular blasts, decreased platelets, and positive for MPO and SBB under electron microscope.

37
Q

What is the criteria for AML M1?

A

> 30% blasts, 90% or more myeloblasts, <10% promyelocytes or mature cells.

38
Q

What distinguishes AML M2?

A

> 30% blasts with 30-89% myeloblasts, presence of Auer rods, and differentiation into granulocytic series.

39
Q

True or False: Mixed phenotype acute leukemia is common.

40
Q

What are two markers expressed in mixed phenotype acute leukemia?

A
  • Myeloid
  • Lymphoid
41
Q

List complications associated with treatment of acute leukemias.

A
  • Cardiotoxicity
  • Osteonecrosis
  • Neurotoxicity
  • Bone marrow aplasia
42
Q

What is a key difference in Auer rods between AML and ALL?

A

Auer rods are present in AML and absent in ALL.

43
Q

Fill in the blank: High WBC >30000/µL is a _______ prognostic factor for adult ALL.

A

unfavorable

44
Q

What are adverse prognostic factors for remission duration in adult ALL?

A
  • Higher age >50 yrs
  • High WBC >30000/µL
  • Pro B Immunophenotype
  • Cytogenetic abnormalities (t(9;22), t(4;11))
45
Q

What is differentiation syndrome?

A

A condition occurring in APL patients characterized by fever, peripheral edema, and respiratory distress after treatment initiation.

46
Q

What is the treatment for differentiation syndrome?

A

Dexamethasone (10 mg IV every 12 hours for 3-5 days with taper)

Early recognition and management are crucial.

47
Q

What is the role of stem cell transplantation in ALL?

A

Reserved for relapse or refractory cases.

48
Q

What are the types of stem cell transplantation?

A
  • Allogeneic-SCT
  • Autologous-SCT
  • Syngeneic-SCT
49
Q

What is the primary chemotherapy regimen for AML induction?

A

3 days of Anthracycline and 7 days of Cytosine Arabinoside (Ara-C).

50
Q

What is the significance of leukapheresis?

A

A procedure for removing white blood cells to reduce complications from hyperleukocytosis.

51
Q

What are common differential diagnoses for acute leukemias?

A
  • Infectious mononucleosis
  • Aplastic anemia
  • Immune thrombocytopenic purpura
  • Marrow infiltrations by other malignancies
  • Myelodysplastic syndrome
52
Q

What are the immunophenotyping markers for Pro B ALL?

A
  • HLA DR
  • TdT
  • CD19
  • CD22
  • CD79a
53
Q

What does the conclusion about acute leukemias state?

A

In the absence of treatment, acute leukemias are very aggressive; appropriate therapy reduces morbidity and mortality.

Haematology (18 decks)

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