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Liz's Hematology Module 2 > Acute Leukemias > Flashcards

Acute Leukemias Flashcards

1
Q

BM failure causes what 3 things in acute leukemia?

A
  • Anemia
  • Infection
  • Hemorrhage
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2
Q

Acute vs. chronic

- Organomegaly

A

Acute: mild
Chronic: prominent

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3
Q

Which of the two types of APL has hypergranular promyelocytes and nuclei that are often bi-lobed or kidney shaped?

A

Typical

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4
Q

Treatment/Therapy: type of medication that blocks growth of cancer cells by interfering with specific target molecules. More effective and less harmful than traditional methods

A

Targeted treatment

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5
Q

While oncogenes act in a dominant fashion, tumor suppressor genes transform cells into a malignant phenotype only after _______ _______ have been lost or inactivated. WHAT theory is this?

A

BOTH alleles (2 hit theory by Knudson)

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6
Q

Acute lymphoblastic leukemia (ALL)

- Immunophenotying for B cell leukemias and T cell leukemias

A

B: CD10+, CD19+, CD20+/-
T: CD2+, CD3+, CD4+, CD5+, CD7+; CD8+

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7
Q

Acute lymphoblastic leukemia (ALL)

- what percentags fall w/in different white cell ranges?

A
  • Normal WBC → 25%
  • 5-25 x 10^9/L → 50%
  • > 100 x 10^9/L → 10%
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8
Q

Acute vs. chronic

- Clinical onset

A

Acute: sudden
Chronic: slow/insidious

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9
Q

Acute lymphoblstic leukemia (ALL) is most common in who?

A

Children

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10
Q

FAB nomenclature for AML-NOS Acute monocytic leukemia

A

M5b

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11
Q

Acute leukemia BM production

A

Reduced BM production

  • Erythrocytes → anemia
  • Granulocytes → neutropenia
  • Platelets → thrombocytopenia
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12
Q

Acute vs. chronic

- Anemia

A

Acute: mild to severe
Chronic: mild

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13
Q

AML w/ abnormal marrow eosinophils in the peripheral blood

A
  • Myeloblasts (other immature myeloid cells)
  • Monocytoid cells
  • Thrombocytopenia
  • Normal eos
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14
Q

AML w/ myelodysplasia-related changes

- Lab findings

A

Presents w/ severe pancytopenia

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15
Q

(M1) AML-NOS Without Maturation

  • Blast percentage
  • MPO/SBB stain?
  • Auer rods?
A
  • > 90% of non-erythroid cells
  • MPO/SBB > 3% (positive)
  • Auer rods (+/-)
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16
Q

Genes that cause dominant-acting cancer mutations (one copy)

A

Oncogene

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17
Q

Treatment/Therapy: Replacement of the patient’s hematopoietic stem cells

A

Stem cell transplant

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18
Q

AML w/ maturation in the bone marrow

A
  • Dysplasia in the neutrophil line (monos, eos, and erythroids, components not affected)
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19
Q

Malignancies of the hematopoietic system are usually ____

A

Acquired

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20
Q

What does it mean if you have > 20% blasts in the PB or BM?

A

That is the WHO classification for acute leukemias

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21
Q

AML w/ maturation

- Cytogenetic abnormality

A

t(8;21)(q22;q22)

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22
Q

Two types of stem cell transplants

A
  • Allogenic

- Autologous

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23
Q

(M5a) AML-NOS-Acute Monoblastic AND (M5b) Monocytic Leukemia
- Problems

A
  • Bleeding problems common at presentation
  • Cutaneous and gingival infiltration
  • CNS involvement common
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24
Q

APL treatment

A
  • Prescribe ATRA

- Manage coagulopathy

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25
Q

After chemotherapy patients often develop severe leukcytopenia so what do we do to concentrate the cells for a differential?

A

We make a buffy coat smear by adding EDTA-anticoag blood into a WINTROBE tube

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26
Q

Treatment/Therapy: oral or parenteral cancer treatment with compounds that posses anti tumor properties

A

Chemotherapy

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27
Q

(M7) AML-NOS- Megakaryoblastic

- BM and stains

A
  • Usually dry tap
  • MBO/SBB- negative
  • Factor VIII stain-pos
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28
Q

When a slide from a patient with APL is stained with MPO, what will it look like?

A

Strongly positive

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29
Q

The platelet count of a patient w/ an untreated acute leukemia is characteristically ____

A

Decreased

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30
Q

AML w/ abnormal marrow eosinophils

- Age group affected

A

Primarily young adults

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31
Q

Treatment/Therapy: use of ionizing energy to kill malignant cells by damaging DNA

A

Radiation

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32
Q

AML w/ maturation

- Prognosis

A
  • Good in adults but poor in children

- Responds well w/ chemotherapy

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33
Q

Acute lymphoblastic leukemia (ALL)

- Onset b/w what years of age?

A

1-5 years (peaks b/w 2-3 years of age)

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34
Q

FAB nomenclature for AML-NOS acute monoblastic leukemia

A

M5a

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35
Q

Acute lymphoblastic leukemia (ALL)

- Purpose of immunophenotyping

A
  • Distinguish blasts as lymphocytic in origin and not myeloid
  • Distinguish between B Cell or T Cell
  • Determines maturity of B or T cells
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36
Q

AML Therapy-related myeloid neoplasms

- Why does it occur

A

Occurs as a result of therapy-related cytotoxic chemotherapy and/or radiation therapy

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37
Q

(M4) AML -NOS Myelomonocytic

- Stains

A

Blasts will be positive for both myeloid and monocytic markers
(MPO+)
(ANBE +)

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38
Q

In Acute Promyelocytic Leukemia (APL), t(15;17) creates a fusion gene. What is it?

A

PML-RARA

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39
Q

Acute Myeloid Leukemia (AML) affects elements in which cell lineages?

A
  • Granulocytic
  • Monocytic
  • Erythroid
  • Megakaryocytic
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40
Q

Will APL have Auer rods?

A

YES!! They’ll have multiple Auer rods (faggot cells)

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41
Q

FAB nomenclature for AML-NOS acute megakaryocytic leukemia

A

M7

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42
Q

Patient’s own stem cells are removed, conditioned, and transplanted back into the patient

A

Autologous stem cell transplant

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43
Q

APL lab results

A
  • DIC/fibrinolysis coagulation
  • Thrombocytopenia
  • Hyper or microgranular promyelocytes
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44
Q

AML-NOS Erythroleukemia (erythroid/myeloid)

- PAS stain

A

PAS- positive in RBC precursors, chunky

45
Q

AML w/ Myelodysplasia-Related Changes

- AMLs are in this category

A
  • AML evolving from previous myelodysplastic syndrome

- AML with cytogenetic abnormalites that marrow those of MDS syndromes

46
Q

FAB nomenclature for AML-NOS acute erythroleukemia

47
Q

What six immature cells will you find in AML?

A
  • Myeloblasts
  • Promyelocytes
  • Monoblasts
  • Promonocytes
  • Erythroblasts
  • Megakaryoblasts
48
Q

AML affects what age group?

A

All ages, predominated in adults around 65 years of age

49
Q

Acute vs. chronic

- Course if treated

A

Acute: < 6 month survival
Chronic: 2-6 years

50
Q

Two different types of APL

A
  • Typical (60-70%)

- Atypical (30-40%)

51
Q

T cell leukemias always involve the _____ ______ and frequently develop lesions in _____ _____or other organs

A

Bone marrow

Lymph nodes

52
Q

(M2) AML-NOS With Maturation

  • MPO
  • Auer Rods?
  • age affected
A
  • MPO positive
  • Frequent Auer rods
  • All age groups
53
Q

(M4) AML -NOS Myelomonocytic

- Bone marrow

A
  • Myeloblasts > 20%

- Monocyte components

54
Q

AML-NOS Acute Panmyelosis with Myelobibrosis (APMF)

  • clinical
  • increase in what?
A
  • Bone pain and extensive myelofibrosis

- INcreased blasts of all myeloid lines

55
Q

T-ALL patients have increased risk for what?

A
  • Risk for induction failure
  • Early relapse
  • Isolated CNS relapse
56
Q

(M4) AML -NOS Myelomonocytic

  • Peripheral blood
  • Auer rods?
A
  • Myeloblasts
  • Monocytoid cells
  • thromobcytopenia
  • Auer rods +/-
57
Q

AML w/ maturation

- Age affected

A
  • 25-30 years old

- Predominant in children and young adults

58
Q

What type of cancer is the most common cancer of childhood?

A

B-cell ALL

59
Q

Acute Myeloid Leukemia (AML) will have recurrent cytogenic abnormalities:
_______ - addition or deletion of part of - or entire- chromosome
_______ primarily translocations and inversions

A

Numerical; structural

60
Q

FAB nomenclature for AML-NOS Acute myelomonocytic leukemia (AMML)

61
Q

Acute lymphoblastic leukemia (ALL)

- Terminology used in B cell leukemia list in order

A
  • Pro B-Cell
  • Pre-Pre B-Cell
  • Pre B-Cell
62
Q

Acute lymphoblastic leukemia (ALL)

- Prognosis

A
  • Depends upon lineage, cytogenetics, cell burden, and organomegaly
  • survival is >85%
  • poor prognosis if <1 year of age
63
Q

AML w/ abnormal eosinophils

- Cytogenetic abnormality

A

inv(16)(p13.1;q22)

t(16;16) (p13.1;q22)

64
Q

If a patient has an untreated leukemia, his/her BM is most likely ____

A

Hypercellular

65
Q

AML not otherwise specified (NOS)

- Divisions within this category are based primarily off of what?

A

Morphological and cytochemical/immunophenotypic features

66
Q

(M7) AML-NOS- Megakaryoblastic

- PB

A
  • Micromegakaryocytes

- Pleomorphic blasts, blasts with agranular cytoplasm

67
Q

AML w/ abnormal marrow eosinophils in the bone marrow

A
  • Myeloblasts and promyelocytes (30-80%)
  • Monocytic component (>20%)
  • > 5% eosinophils (all stages of maturation)
68
Q

Acute vs. chronic

- Maturity of cells

A

Acute: immature
Chronic: mature

69
Q

Donor is genetically different than the patient

A

Allogenic stem cell transplant

70
Q

(M0) AML-NOS Minimal Differentiation

- What stains are negative?

A

MPO and most other stains are negative

71
Q

Acute vs. chronic

- Thrombocytopenia

A

Acute: mild to severe
Chronic: mild

72
Q

AML- Therapy-Related Myeloid Neoplasms

  • Age affected
  • Prognosis
A
  • Age affected: median age 61

- Poor prognosis (< 10% 5 year survival rate)

73
Q

Genes that code for proteins that help cells resist malignant transformation

A

Tumor suppressor gene

74
Q

AML w/ maturation in the peripheral blood

A
  • Blasts with numerous azurophilic granules
  • Some may have very large granules (Pseudo-Chediak-Higashi)
  • Auer Rods likely
75
Q

(M0) AML-NOS Minimal Differentiation

  • MPX/SBB stains
  • Auer rods?
A

Negative/no Auer rods

76
Q

Acute vs. chronic

- WBC count

A

Acute: variable
Chronic: increased

77
Q

Two types of chemotherapy

A
  • Phase specific

- Phase nonspecific

78
Q

Codes for a protein found in normal cell cycle regulation. Mutation my form an oncogene and result in disruption of normal cell cycle

A

Proto-oncogene

79
Q

Acute leukemia etiology

A
  • Oncogenic viruses
  • Genetic and congenital factors
  • Ionizing radiation
  • Chemical agents
  • Unknown
80
Q

Which of the two types of APL has microgranular promyelocytes and nuclei that are predominantly deeply notched/bilobed (butterfly)?

81
Q

The PML-RARA fusion gene leads to what?

A

Uncontrolled proliferation and inhibition of cellular differentiation

82
Q

(M0) AML-NOS Minimal Differentiation in the peripheral blood

A

Blasts: medium, round (1-2 nucleoli), fine chromatin, cytoplasm is AGRANULAR and BASOPHILIC

83
Q

AML-NOS-Basopilic Leukemia

- increased what?

A

Blasts and immature basos

84
Q

Morphology of acute leukemias

A
  • Decreased platelets, anemia (due to BM failure)
  • Blast Cells
  • Auer Rods (in some MYELOID never LYMPHOID)
85
Q

Acute promyelocytic leukemia (APL)

- Cytogenetic abnormality

A

t(15;17)(q24;q21)

86
Q

FAB nomenclature for AML w/ reuccrent cytogenetic abnormalities–AML w/ abnormal marrow eosinophils

87
Q

AML immunophenotyping

A

CD34+, HLA-DR+, CD117+, CD13+, CD33+

the last two are very specific to AML

88
Q

FAB nomenclature for AML-NOS w/ maturation

89
Q

Acute lymphoblastic leukemia (ALL)

- Cytochemistry

A
  • Myeloperoxidase: Negative
  • Sudan Black B: Negative
  • ANBe: Positive/Negative focal
  • Periodic Acid Schiff: may be positive with BLOCK positivity
90
Q

AML w/ myelodysplasia-related changes

- Prognosis

91
Q

AML in the peripheral blood

A
  • Variable leukocytosis
  • variable displasia
  • myeloblasts present in 95% of patients
  • Leukemic hiatus
92
Q

(M0) AML-NOS Minimal Differentiation

- Age affected

A

Infants and older adults

93
Q

AML w/ abnormal marrow eosinophils

- Prognosis

A

Favorable to average risk

94
Q

Tumor suppressor genes cause cancers such as acute leukemias when mutations result in what?

A

Failure to prevent malignant processes

95
Q

Having too many myeloblasts and some segs w/ no intemediate stages is known as what?

A

Leukemic hiatus

96
Q

How will someone present clinically w/ AML?

A
  • Pallor, fatigue
  • Fever/infection
  • Bruising/bleeding
  • Malignant cell infiltration into other tissues
97
Q

FAB nomenclature for AML w/ recurrent cytogenetic abnormalities–Acute Promyelocytic Leukemia t(15;17) (APL)

98
Q

Cell growth occurs in what 4 tissues in acute leukemias?

A
  • Parenchymal organs/skin
  • Thymus
  • Cerebral meninges
  • Testes
99
Q

FAB nomenclature for AML-NOS w/ minimal differentiation

100
Q

AML w/ maturation

- Fusion gene

A

RUNX1-RUNX1T1

101
Q

Acute vs. chronic

- Age of onset

A

Acute: all ages
Chronic: adult

102
Q

AML-NOS Acute Erythroid Leukemia

- Two subclasses

A
  • Erythroleukemia (erythroid and myeloblasts in BM)

- Pure Erythroid leukemia (only erythroid precursors in BM)

103
Q

Acute lymphoblastic leukemia (ALL)

- Morphology

A
  • Anemia
  • Thombocytopenia
  • Blasts +/-
  • small blasts, more common usually pre B-Cell
  • large blasts, usually pre T-Cell
104
Q

(M5a) AML-NOS-Acute Monoblastic AND (M5b) Monocytic Leukemia
- ANBE stain

A

ANBE: positive

105
Q

FAB nomenclature for AML-NOS w/o differentiation

106
Q

AML in the BM

A
  • Hypercellular increased blasts
  • > 20% blasts with limited maturation
  • variable dysplasia
107
Q

AML w/ myelodysplasia-related changes

- Age range affected

A

Elderly population

108
Q

Treatment/Therapy: Involves the use of pharmaceuticals to manage symptoms of malignancies and malignancy treatments including colony stimulating factors and erythropietin

A

Supportive therapy

Liz's Hematology Module 2 (13 decks)

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