Acute Leukemias

Question 1

Etiologies of AML

Answer 1

• Antecedent MDS (rarely MPS)
• Inherited syndromes (Downs)
• Drugs (chemos)
• Chemicals/Radiation

Question 2

Clinical presentation of AML

Answer 2

• Symptoms less than 3 mos

- Fever, bleeding, fatigue, SOB

Question 3

WBC counts of AML?

Answer 3

Not always elevated - about 1/3 of patients will actually have a leukopenia

Question 4

Characteristic peripheral smear of AML

Answer 4

Polys and blasts but no intermediate forms (“leukemic hiatus”)

Question 5

What is required to diagnose AML?

Answer 5

BM biopsy

Question 6

Treatment for AML (NOT including APL)

Answer 6

• Induction therapy: 7 days of Cytarabine (continuous IV) and 3 days of Daunorubicin (an anthracycline)
• Intensive supportive therapy

Question 7

How to treat AML if induction therapy has not resulted in complete remission?

Answer 7

• Treat again
• Switch to salvage regimen (e.g. high dose cytarabine)
• If this fails, consider allogeneic HSCT

Question 8

How should AML patients over 70 yo be treated?

Answer 8

Most cannot tolerate standard tx

• Low dose Decitabine
• Reduced intensity conditioning regimens w/allo-HSCT
• Intensive supportive therapy

Question 9

Clinical presentation of APL

Answer 9

Presents similar to other acute leukemia BUT bleeding and thrombosis are common

Question 10

Why do APL patients present with bleeding/thrombosis?

Answer 10

Due to disseminated intravascular coagulation (DIC)

Question 11

Prognosis of APL

Answer 11

85% of pts will be cured with modern treatment (there used to be a lot of early mortality due to ICB and DIC)

Question 12

Typical APL patients

Answer 12

Younger and RARELY preceded by MDS

Question 13

What does BM biopsy of APL look like?

Answer 13

Large and granular promyelocytes frequently with prominent Auer rods

Question 14

What is the most distinguishing feature of APL?

Answer 14

Mutation of retinoic acid receptor gene (can try to treat with high doses of Vitamin A)

Question 15

Treatment of APL

Answer 15

• All-trans Retinoic Acid (ATRA, component of Vitamin A, NOT myelosuppressive)
• Arsenic trioxide

Question 16

How does ATRA treat APL?

Answer 16

• Component of Vitamin A
• Will induce APL promyelocytes to differentiate into mature myeloid cells
• Induces CR in over 90% of pts

Question 17

CR of APL is defined as:

Answer 17

• Less than 5% blasts in BM
• Resolution of cytogenetic/molecular abnormalities in BM
• CBC with ANC over 10^3 and platelets over 10^5

Question 18

Who is MC affected by ALL?

Answer 18

Children and young adults

Question 19

General classes of ALL

Answer 19

B cell and T cell

Question 20

Etiology of ALL

Answer 20

• Trisomy 21 (Down)
• Radiation exposure (T cell type)
• Many cases UNKNOWN

Question 21

Common PE findings of ALL

Answer 21

• Lymphadenopathy

- Hepatosplenomegaly

Question 22

Treatment of ALL

Answer 22

• Vincristine (NOT myelosuppressive) and prednisone: rapidly reduces ALL blasts
• Intensification treatment (similar to induction tx of AML - 7/3 of cytarabine and anthracycline)

Question 23

Maintenance treatment of ALL

Answer 23

6-MP (oral) and weekly MTX for 2-3 years

Question 24

Prognosis of pediatric ALL

Answer 24

Over 90% survival rate

Question 25

Prognosis of adult ALL

Answer 25

Long term survival is approx 35% pts