Acute Leukemias Flashcards
Fever, Fatigue, Shortness of Breath, and Nosebleed are common symptoms of ACUTE leukemias. What is the root cause of each of these symptoms?
Fever:
• Neutropenia
Nose Bleed:
• Low Platelets
Fatigue, Shortness of Breath:
• Low RBCs
T or F: acute myeloid leukemias and acute lymphoid leukemias can easily be differentiated by review of the peripheral smear.
False, while there are some fairly obvious cases (Auer bodies) rarely you can be definitive by looking alone
What age are you statistically least likely to get an acute lymphocytic leukemia?
• What about an acute myelocytic leukemia?
ALL:
11-39 years old
Incidence is highest:
3-7 and dropping off by age 10
Second rise is seen at age 40
AML:
Seen in all age groups and becomes increasingly common with age
What is the defining difference between Primary AML and secondary AML?
• Which is more difficult to treat?
• Why?
Secondary AML developes from Myelodysplastic Syndromes or other Hematologic Malignancies meaning there are more mutations present and its an OLDER INDIVIDUAL
Primary AML arrises de novo and is usually in younger people who are more resilient to the treatments
T or F: smoking is a major cause of Acute Myeloid Leukemia.
False, smoking is not a cause of AML but does cause some types of CML.
T or F: the vast majority of AMLs are idiopathic.
True, other common causes include:
- Chemo/Radiotherapy
- PNH/Aplastic Anemias
- Myelodysplastic/Myeloproliferative Syndromes
- Down’s Syndroms
- Chemical Exposure
For AML and ALLs where do we see the mutations that cause malignancy arising?
Mutations Typically occur in Hematopoetic Stem Cells or in early progenitors
How is acute leukemia defined?
The Presence of Over 20% blast cells in the blood or bone marrow
***Specific CYTOGENETIC or MOLECULAR genetic abnormalities may allow it to be Dx. at a lower threshold.
HOW DO HEMOTOLOGISTS KNOW WHETHER A CANCER IS AN AML OR ALL?
IMMUNOPHENOTYPING can be used to tell us which we are dealing with.
T or F: the presence of Auer rods is DIAGNOSTIC of AML.
TRUE
What are 4 myeloid antigens?
- MPO
- CD33
- CD13
- HLA-DR
What are 4 lymphoid antigens?
- TdT
- CD10
- CD19
- CD20
When reading a CBC think about whether you’re dealing with a pancytopenia.
When reading a CBC think about whether you’re dealing with a pancytopenia.
What is the point of giving of giving a patient with t(15,17) ATRA and Arsenic?
ALLOWS FOR CELL DIFFERENTIATION
ATRA - binds to the PML-RARA protein and helps unbind it from DNA
Arsenic - does the same but acts on K160 of PML
What are the 3 stages of therapy in AML?
Remission Induction Therapy:
• 1 to 2 courses of intensive therapy to achieve a complete response (NO leukemia cells detectable)
Post-remission therapy:
• 3 to 4 courses of intensive short-courses to get what we can’t see
SOME PTS:
- maintenance therapy lasting Months or Years (less intense) OR
- Allogeneic Bone Marrow Transplant
What treatment strategies might you consider for older adults with AML?
- Supportive Care
- New noncytoxic agents with less side effects
- Reduced intensity (HSCT) - bone marrow transplant
Probably would avoid standard intensive chemotherapy because it can be toxic and the response usually isn’t great
T or F: in both adult and childhood ALL, the MLL-AF4 and BCR-ABL are associated with poor outcome
True
What are some things that we must do differently in the stages of therapy for ALL vs. AML?
ALL:
- Remission Induction
- Consolidation
- Maintenance
Differences:
- *Maintenance is more commonly needed in ALL
- *Allopurinol needed to prevent Tumor Lysis Syndrome
- *CNS PROPHYLAXIS NEEDED
Between AML and ALL, which requires CNS prophylaxis?
• Why?
ALL - need CNS prophylaxis via intrathecal injection because cancer more commonly spreads here in ALL than AML
What is the cure rate in children and in adults with ALL?
• how do we account for this difference?
Children: 75-80% cure rate
Adults: 40%
Difference may be attributed to worse genetic features present in genome when adult acquire it
What type of testing is the best prognostic indicator?
Genetic Testing
Which would you tailor therapy bases on a FLT3 mutation AML or ALL?
AML
