Acute Leukemias Flashcards by Kosi Amadi-Duru

What is the primary cause of acute leukemias?

Accumulation of acquired genetic mutations within a cell

This mutation can be acquired in utero or after birth.

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

Alkylating agents
DNA topoisomerase inhibitors
Anthracyclins (e.g., doxorubicin)

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

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

Class 1 mutations
Class 2 mutations

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

False

Most acute leukemias are sporadic with unknown/undetermined etiology.

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What are some environmental factors contributing to acute leukemia?

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

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What are the main clinical features of acute leukemia?

Acute and aggressive presentation
Abnormalities of the 3 blood cell lines
Infiltration of organs & tissues

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

[children]

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

65 years

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

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

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List the symptoms of anemia in acute leukemia.

Weakness
Easy fatigability

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

Acute leukemia

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

Hepatosplenomegaly
Fever
Fatigue
Lymphadenopathy
Bleeding

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

It helps identify specific genetic abnormalities associated with leukemia.

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

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

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

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

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

Fever

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

Acute myeloblastic leukemia (AML)

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

≥20% blasts
≥50% of blasts are megakaryoblasts

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

It helps determine the immunophenotype of leukemic cells.

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

1.9:1.6

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

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

What are the common laboratory investigations for diagnosing acute leukemia?

Morphology
Cytochemistry
Immunophenotyping
Cytogenetic analysis
Molecular studies

What is the predominant subtype of leukemia in children?

Acute lymphoblastic leukemia (ALL)

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

* Gingival hyperplasia * Lymphadenopathy * Hepatosplenomegaly * Bone pain

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

FAB L1, L2, and L3

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

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

What are the common symptoms of thrombocytopenia in acute leukemia?

* Gum bleeds * Mucocutaneous bleeds

What are serum electrolytes?

Electrolytes present in the serum that are important for various bodily functions. ## Footnote Common electrolytes include sodium, potassium, calcium, and magnesium.

What does serum LDH stand for?

Serum Lactate Dehydrogenase ## Footnote LDH is an enzyme that can indicate tissue damage.

What is the significance of serum lysozymes?

Lysozymes are enzymes that break down bacterial cell walls, indicating immune response. ## Footnote Elevated levels may suggest infection or inflammation.

What are the components of a full blood count?

* PCV/Hb * Total WBC * Absolute neutrophil count * Platelets

What does AML stand for?

Acute Myeloid Leukemia

What does ALL stand for?

Acute Lymphoblastic Leukemia

Define the FAB classification of AML.

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

What characterizes AML M0?

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

What is the criteria for AML M1?

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

What distinguishes AML M2?

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

True or False: Mixed phenotype acute leukemia is common.

False

What are two markers expressed in mixed phenotype acute leukemia?

* Myeloid * Lymphoid

List complications associated with treatment of acute leukemias.

* Cardiotoxicity * Osteonecrosis * Neurotoxicity * Bone marrow aplasia

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

Auer rods are present in AML and absent in ALL.

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

unfavorable

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

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

What is differentiation syndrome?

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

What is the treatment for differentiation syndrome?

Dexamethasone (10 mg IV every 12 hours for 3-5 days with taper) ## Footnote Early recognition and management are crucial.

What is the role of stem cell transplantation in ALL?

Reserved for relapse or refractory cases.

What are the types of stem cell transplantation?

* Allogeneic-SCT * Autologous-SCT * Syngeneic-SCT

What is the primary chemotherapy regimen for AML induction?

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

What is the significance of leukapheresis?

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

What are common differential diagnoses for acute leukemias?

* Infectious mononucleosis * Aplastic anemia * Immune thrombocytopenic purpura * Marrow infiltrations by other malignancies * Myelodysplastic syndrome

What are the immunophenotyping markers for Pro B ALL?

* HLA DR * TdT * CD19 * CD22 * CD79a

What does the conclusion about acute leukemias state?

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