Acute Leukemias Flashcards
BM failure causes what 3 things in acute leukemia?
- Anemia
- Infection
- Hemorrhage
Acute vs. chronic
- Organomegaly
Acute: mild
Chronic: prominent
Which of the two types of APL has hypergranular promyelocytes and nuclei that are often bi-lobed or kidney shaped?
Typical
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
Targeted treatment
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?
BOTH alleles (2 hit theory by Knudson)
Acute lymphoblastic leukemia (ALL)
- Immunophenotying for B cell leukemias and T cell leukemias
B: CD10+, CD19+, CD20+/-
T: CD2+, CD3+, CD4+, CD5+, CD7+; CD8+
Acute lymphoblastic leukemia (ALL)
- what percentags fall w/in different white cell ranges?
- Normal WBC → 25%
- 5-25 x 10^9/L → 50%
- > 100 x 10^9/L → 10%
Acute vs. chronic
- Clinical onset
Acute: sudden
Chronic: slow/insidious
Acute lymphoblstic leukemia (ALL) is most common in who?
Children
FAB nomenclature for AML-NOS Acute monocytic leukemia
M5b
Acute leukemia BM production
Reduced BM production
- Erythrocytes → anemia
- Granulocytes → neutropenia
- Platelets → thrombocytopenia
Acute vs. chronic
- Anemia
Acute: mild to severe
Chronic: mild
AML w/ abnormal marrow eosinophils in the peripheral blood
- Myeloblasts (other immature myeloid cells)
- Monocytoid cells
- Thrombocytopenia
- Normal eos
AML w/ myelodysplasia-related changes
- Lab findings
Presents w/ severe pancytopenia
(M1) AML-NOS Without Maturation
- Blast percentage
- MPO/SBB stain?
- Auer rods?
- > 90% of non-erythroid cells
- MPO/SBB > 3% (positive)
- Auer rods (+/-)
Genes that cause dominant-acting cancer mutations (one copy)
Oncogene
Treatment/Therapy: Replacement of the patient’s hematopoietic stem cells
Stem cell transplant
AML w/ maturation in the bone marrow
- Dysplasia in the neutrophil line (monos, eos, and erythroids, components not affected)
Malignancies of the hematopoietic system are usually ____
Acquired
What does it mean if you have > 20% blasts in the PB or BM?
That is the WHO classification for acute leukemias
AML w/ maturation
- Cytogenetic abnormality
t(8;21)(q22;q22)
Two types of stem cell transplants
- Allogenic
- Autologous
(M5a) AML-NOS-Acute Monoblastic AND (M5b) Monocytic Leukemia
- Problems
- Bleeding problems common at presentation
- Cutaneous and gingival infiltration
- CNS involvement common
APL treatment
- Prescribe ATRA
- Manage coagulopathy
After chemotherapy patients often develop severe leukcytopenia so what do we do to concentrate the cells for a differential?
We make a buffy coat smear by adding EDTA-anticoag blood into a WINTROBE tube
Treatment/Therapy: oral or parenteral cancer treatment with compounds that posses anti tumor properties
Chemotherapy
(M7) AML-NOS- Megakaryoblastic
- BM and stains
- Usually dry tap
- MBO/SBB- negative
- Factor VIII stain-pos
When a slide from a patient with APL is stained with MPO, what will it look like?
Strongly positive
The platelet count of a patient w/ an untreated acute leukemia is characteristically ____
Decreased
AML w/ abnormal marrow eosinophils
- Age group affected
Primarily young adults
Treatment/Therapy: use of ionizing energy to kill malignant cells by damaging DNA
Radiation
AML w/ maturation
- Prognosis
- Good in adults but poor in children
- Responds well w/ chemotherapy
Acute lymphoblastic leukemia (ALL)
- Onset b/w what years of age?
1-5 years (peaks b/w 2-3 years of age)
FAB nomenclature for AML-NOS acute monoblastic leukemia
M5a
Acute lymphoblastic leukemia (ALL)
- Purpose of immunophenotyping
- Distinguish blasts as lymphocytic in origin and not myeloid
- Distinguish between B Cell or T Cell
- Determines maturity of B or T cells
AML Therapy-related myeloid neoplasms
- Why does it occur
Occurs as a result of therapy-related cytotoxic chemotherapy and/or radiation therapy
(M4) AML -NOS Myelomonocytic
- Stains
Blasts will be positive for both myeloid and monocytic markers
(MPO+)
(ANBE +)
In Acute Promyelocytic Leukemia (APL), t(15;17) creates a fusion gene. What is it?
PML-RARA
Acute Myeloid Leukemia (AML) affects elements in which cell lineages?
- Granulocytic
- Monocytic
- Erythroid
- Megakaryocytic
Will APL have Auer rods?
YES!! They’ll have multiple Auer rods (faggot cells)
FAB nomenclature for AML-NOS acute megakaryocytic leukemia
M7
Patient’s own stem cells are removed, conditioned, and transplanted back into the patient
Autologous stem cell transplant
APL lab results
- DIC/fibrinolysis coagulation
- Thrombocytopenia
- Hyper or microgranular promyelocytes