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Acute Lukemias Flashcards

1
Q

What is a Leukemia?

A

Group of heterogenous disorders characterized by the accumulation of malignant white cells in bone marrow and blood.

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2
Q

How do these cells cause morbidity and mortality?

A
  1. Bone Marrow failure leads to:
    - Anemia
    - Neutropenia
    - Thrombocytopenia
  2. Infiltration of organs
    - Liver
    - Spleen
    - Lymph Nodes
    - Meninges
    - Brain
    - Skin
    - testes
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3
Q

What are the classification levels for AML?

A

FAB M0-M7

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4
Q

What are the classification levels for ALL?

A

FAB: L1-L3

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5
Q

In what population is ALL most common?

A

Most common in children 3-7 falling off by 10 years and then secondary rise in risk by age 40.

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6
Q

In what age group is AML most common?

A

AML occurs is all age groups.

  • Is the most common form of acute Leukemia in adults.
  • Increasingly common with age
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7
Q

What are the 2 types of AML?

A

Primary and Secondary.

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8
Q

Which is more difficult to treat?

A

Secondary, which usually arises from MDS etc

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9
Q

Etiology of Acute Leukemias

A
  1. Idiopathic (Largest cause)
  2. Prior Chemotherapy
  3. Prior Radiotherapy
  4. Chemical exposure especially Benzene
  5. Myelodysplastic syndromes
  6. Myeloproliferative diseases
  7. Down’s syndrome
  8. Fragile chromosome syndromes (Fanconi’s anemia)
  9. Aplastic anemia and PNH
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10
Q

What is the pathogenesis of acute leukemia?

A
  1. Aggressive diseases (will rapidly cause death if not treated)
  2. Malignant transformation occurs in hematopoetic stem cells or early progenitors
  3. Genetic damage that causes increased rate of proliferation, reduced apoptosis, block in cellular differentiation

These events result in accumulation of blasts.

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11
Q

What is the definition of Acute Leukemia?

A

WHO defines Acute Leukemia as having over 20% blasts cells in the blood or BM.

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12
Q

What is a secondary defiition of Acute Leukemia?

A

Diagnosis of specific leukemia associated cytogenetic or molecular genetic abnormalities even if blast count is <20%

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13
Q

What is the difference between ALL and AML?

A

AML refers to blasts from the myeloid line and ALL refers to blasts from the Lymphoid line.

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14
Q

How is the lineage of these “BLASTS” determined?

A

Immunophenotyping to determine pattern of antigen expression on BLASTS surface.

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15
Q

What is the current method for Leukemia diagnosis?

A

Molecular Genetics.

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16
Q

What is the FAB classification of AML?

A 
M0-Undifferentiated 
M1-Without Maturation
M2-With granulocytic maturation 
M3-Acute promyelocytic 
M4-Granulocytic and Monocytic maturation
M5-Monoblastic (M5a) or monocytic (M5b)
M6-erythroleukemia
M7-megakaryocytic
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17
Q

What is the key morphologic difference between ALL and AML?

A

Presence of Auer rods with AML.

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18
Q

What are other methods of differential diagnosis?

A

Genetic analysis

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19
Q

What are the most useful immunological markers in AML?

A

MPO, CD33, CD13, HLA-DR

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20
Q

What are the most useful immunological markers in ALL?

A

TdT, CD10, CD19, CD20

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21
Q

What is the translocation responsible for APML (M3)?

A

t(15;17)

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22
Q

What is the translocation responsible for AML M2?

23
Q

Which of the AML translocations are associated with “good risk”?

A
  1. Inv 16 or t(16;16)
  2. t(8;21)
  3. t(15;17)
24
Q

Which of the AML translocations are associated with intermediate risk?

A
  1. Normal Cytogenetics
  2. 8+ alone
  3. t(9;11)
25
Q

Which of the AML translocations are associated with “poor risk”?

A
  1. Complex (>3 clonal chromosomal abnormalities)
  2. Monosomal Karyotype
  3. -5, 5q-, -7, 7q-
  4. 11q23 - non t(9;11)
  5. Inv(3), t(3;3)
  6. t(6;9)
  7. t(9:22)
26
Q

What is the treatment course for AML?

A
  1. Remission induction therapy
  2. Post-remission therapy
  3. Maintenance therapy and or Allogenic Bone marrow transplant
27
Q

What constitutes “Remission?”

A

Absence of detectable leukemia cells

28
Q

What are the strategies for Older Adults?

A
  1. Supportive care
  2. Standard intensive chemotherapy
  3. New noncytotoxic agents
  4. Reduced-intensity conditioning HSCT
29
Q

In both adult and childhood ALL what genetic abnormalities are associated with a poor outcome?

A

Genetic abnormalities MLL-AF4 and BCR-ABL

30
Q

What gene is thought to be involved in most ALL

31
Q

What genetic abnormalities of hyperploidy are associated with a good outcome in childhood ALL?

A

E2A-PBX and TEL-AML

32
Q

What are the three treatment phases in All treatment?

A
  1. Remission induction
  2. Consolidation (intensification)
  3. Maintenance
33
Q

What drug can be used to alleviate the dangers of tumor lysis syndrome?

A

Allopurinol

34
Q

What is also done during treatment?

A

CNS prophylaxis with Intrathecal MTX

35
Q

What is the current cure rate in children?

36
Q

What is the most common specific abnormality in childhood B-ALL?

A

t(12;21) TEL-AML

37
Q

Classification of ALL?

A
  1. L1-small blast cells, uniform high nuclear cytoplasmic ratio
  2. L2-Larger blast cells, heterogenous, lower nuclear to cytoplasmic ratio
  3. L3-vaculoated blasts, basophilic cytoplasm
38
Q

What two proteins are fused together in the APML t(15;17)?

39
Q

What does the aberrant PML-RARα do in APML?

A

Homodimerizes and activates a self-renewal program by binding to DNA

40
Q

What are cells called when bundles of Auer Rods are found?

A

Faggot cell.

41
Q

What are possible complications of APML?

A
  1. DIC from degranulation of cells
  2. Thrombocytopenia
  3. Leukocytosis
42
Q

What are the immunophenotypes of APML?

A
  1. CD34-
  2. HLA-DR
  3. CD13
  4. CD33
43
Q

What is the nuclear Morphology generally found in APML?

A
  1. Auer rod stacks
  2. Heart-shaped/bat-wing nuclei
  3. Butterfly nuclei
44
Q

Treatment for APML

A
  1. Induction-ATRA
  2. Consolidation-ATRA + Anthracyline
  3. Maintenance-ATRA + 6MP + Methotrexate
  4. Arsenic (Black Box warning Cardiovascular issues)
45
Q

In a patient with Acute Promyelocytic Leukemia coagulation tests would be normal?

46
Q

What are the markers present in AML with minimal differentiation?

A
  1. CD13
  2. CD33
  3. CD34
  4. CD117
47
Q

The translocation in M2 AML t(8;21) results in the fusion of which 2 proteins?

A

[ETO-AML]/[RUNX1-RUNX1T1]

48
Q

Ways in which the translocation ETO-AML1 causes malignancy? Core Binding leukemia (also t(16;16)

A
  1. Bind to DNA as co-repressor (blocking differentiation)

2. Form constitutively active pro-proliferation system

49
Q

What mutation is associated with the highest risk in AML?

A

Flt3-ITD, 5-, 7-

50
Q

What two biochemical test can provide helpful information on the presence of Leukemia?

A
  1. Raised Uric Acid

2. Raised Lactate Dehydrogenase

51
Q

What proteins are fused in the Inv(16;16)?

A

CBFB-MYH11 (inhibits myeloid maturation)

52
Q

What is the morphology associated with Inv (16;16)?

A
  1. Mixed Granulocyte-monocyte (myelomonocytic)

2. Eosinophilia

53
Q

What are the immunophenotypes present in Inv(16;16)

A

CD14+, CD11b+ (monocyte)
CD13=, CD33+
CD34+, CD117+

Haematology (16 decks)

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