Acute Leukemias Flashcards
how does one develop AML?
acute myeloid leukemia
can have tranformation from myelodysplastic syndrome, myeloproliferative (PV or CML or primary myelofibrosis).
AML can also develop after benzene exposure
Acute Myeloid Leukemia or AML has this on peripheral smear:
and other facts
See Auer rods with APL subtype.
>20% of myeloblasts on peripheral smear or bone marrow
see easy bruising, fatigue, infectious with pancytopenia on labs
poor prognosis in older ppl >60 yrs and younger pts can be treated with chemo and then stem cell transplant
treatment of AML subtype M3
If auer rod seen in APL subtype with M3, give all trans-retinoic acid even before t(15.17) testing is completed.
induction chemo to restore normal bone marrow function.
chemotherapy for AML (acute myeloid leukemia)
7+3
7 day continuous IV infusion of cytarabine + short infusion of anthracycline or doxorubicin on days 1-3
need to get an TTE prior to treatment
side effect of anthracyclines?
cardiotoxicity and so needs baseline TTE prior to treatment.
what is seen on acute myeloid leukemia bone marrow biopsies?
AML is a umbrella term and encompasses both APL and Acute promyelocytic leukemia with subtype M3 Diagnosis is >20% blasts.
what is seen in acute promyelocytic leukemia (APML) on bone marrow biopsy
see low blast cell count but would see hypergranular promyelocytes
when do we use all trans retinoic acid + anthracycline based chemotherapy?
for acute promyelocytic leukemia (APML)
sub type
has chromosomal translocation of t(15,17)
AML presentation
fatigue, fever, loss of appetite and weight and night sweats.
leukemia cells divide at a faster rate than normal cells
anemia - causes a lot of the symptoms
loss of normal WBC - results in recurring infections and fevers.
what is acute leukemia?
hematological malignancy characterized by infiltration of the tissues- bone marrow, blood, and other tissues- by uncontrolled proliferation and abnormal delayed differentiation of clonal myeloid or lymphoid precursor cells
this makes up >20% of bone marrow
includes AML and ALL in adults.
presentation of AML (acute myeloid leukemia)?
petechiae, epistaxis and mucosal hemorrhages when plts<20K
anemia, thrombocytopenia and functional neutropenia despite having elevated WBC
cure rates in AML <60 yrs is
60-85%
APL subtype with M3 treatment is with
all trans-retinoic acid
AML treatment is with
induction therapy with anthracycline like daunorubicin and infusional cytarabine.
goal: ablate the bone marrow and eliminate the blasts - destroys normal hematopoietic cells as well.
cells are expected to recover after a period of aplasia (3-4 weeks) and supported with transfusions or abx if fevers
consolidation therapy for responders consists of additional cycles of chemotherapy in low risk and allogenic hematopoeitic stem cell transplant in high risk pts.
AML tx for older frail pts is with:
symptomatic management - blood and platelet tranfusions
single agent chemotherapy - hydroxyurea, and low dose cytarabine and hypomethylating agents- decitabine and azacitidine.
only expect to survive months; needs hospice care.
ALL (acute lymphoblastic leukemia) is seen in what demographics?
more in children; pediatric ALL is more likely cured
adult (>19 years) ALL is worse.
acute lymphoblastic leukemia presentation:
malaise
bleeding
infections
bone pain
rarely CNS changes
ALL (acute lymphoblastic leukemia) is
75% B cell lineage - extramedullary, GI, and testicular involvement.
25% T cell lineage- mediastinal mass and SOB, stridor or wheezing. See skin involvement
diagnosis is with immunophenotype, cytogenetics and molecular abnormalities.
Philiadelphia chromosome - use imatinib or dasatinib for treatment
Treatment of ALL (acute lymphoblastic leukemia) is with:
Philiadelphia chromosome POSITIVE ALL - imatinib and dasatinib followed by traditional chemotherapy for superior remission
remission induction they should get autologous or allogenic hematopoeitic stem cell transplant
Treatment regimens are:
induction therapy: vincristine, anthracycline, corticosteroids, and L asparginase. some have allergic reactions, hypofibrinogenemia, hypertriglyceridemia .
CNS prophylaxis is needed in ALL
maintenance therapy/phase: oral mercaptopurine daily and methotrexate weekly for 2 years.
Survivors of childhood leukemia are at risk for:
what to screen for?
secondary cancer
CAD
metabolic syndrome - high BMI, truncal obesity, dyslipidemia, insulin resistance, HTN
Need to get screening lipid profile, DM2 and HTN
TTE surveillance for LV dysfunction at 3-5 years if anthrocycline exposure was high (>300 of doxorubicin) or if chest radiation was used
female survivors are high risk for myocardial dysfunction in pregnancy
osteopenia - b/c of high dose steroids
cranial radiation increases risk for:
stroke and neurocognitive deficits
screen patients with childhood leukemia (ALL) for:
Need to get screening lipid profile, DM2 and HTN
TTE surveillance for LV dysfunction at 3-5 years if anthrocycline exposure was high (>300 of doxorubicin) or if chest radiation was used
female survivors are high risk for myocardial dysfunction in pregnancy
DEXA - for osteopenia
what other tumors are ALL pts more likely to develop as adults?
skin cancer,
thyroid and parotid cancer
sarcomas
brain tumors.
secondary cancer risk is highest at 30 years (11%)
APML t (15,17) treatment with auer rods
good prognosis.
APML t(9,22) prognosis
bad prognosis
treatment <50 yrs: ara-C (cytarabine) and daunorubicin -> then to allogenic bone marrow transplant
>50 yrs: ara-C (cytarabine) and daunorubicin
M3 is treated with all trans-retinoic acid
what skin condition is associated with AML?
sweet’s syndrome
see tender erythematous plaques and nodules on face and extremities. if biopsied shows dense neutrophilic infiltrates.
If seen, get a bone marrow biopsy to look for AML.
what is this rash seen with AML?
Sweet’s syndrome.
