Acute Myeloid Leukemia Flashcards
Two big difference in acute vs chronic myeloid leukemia?
actue
- Rapidly fatal
- IMMATURE cells (BLASTS)
chronic
- ONLY in adults
- MATURE cells
Two causes of acute leukemia:
- clonal expansion
- maturation failure (hence the immature cells)
Worst problem caused by acute leukemia?
-crowding out of normal cells
also:
inhibit normal cell function
infiltrate other organs
Clinical findings in acute leukemia:
Sudden onset (days)
Symptoms of bone marrow failure
- fatigue (decreased RBCs)
- Recurrent infx (leukocytopenia)
- bleeding (thrombocytopenia)
Bone pain (expanding marrow)
Organ infiltration (liver, spleen, brain)
What criteria must be met for AML dx?
at least 20% Blasts present among all nucleated cells
Subclasses of AML involving the neutrophilic series:
M0
M1
M2
M3
Subclasses of AML involving monocytic series:
M4
M5
Subclasses of AML involving erythroid series:
M6
Subclasses of AML involving megakaryocytic series:
M7
- lots of myeloblasts
- “bland” looking cells
- MPO negative
- need markers for dx
What is it?
AML-M0
- lots of myeloblasts
- no maturation
- AUER rods
- MPO positive
What is it?
AML-M1
- fewer myeloblasts but still at least 20%
- maturing neutrophils
- t(8;21) in some cases = better prognosis
What is it?
AML-M2
- lots of promyelocytes (at least 20%)
- Faggot cells (a ton of AUER rods) **diagnostic!
- DIC (disseminated intravascular coagulation) potential–>fatal
- t(15;17) in ALL cases = best prognosis
What is it?
AML-M3
- lots of myeloblasts
- lots of monocytic cells
- extramedullary tumor masses (gums common)
- inv(16) in some cases = better prognosis
AML-M4
- lots of monocytic cells (any stage)
- NSE positive (non-speceific esterase stain)
- M?A and M?B
- extramedullary tumor masses
**tissue paper looking nuclei
AML-M5
- lots of erythroblasts
- lots of myeloblasts
- dyserythropoesis
AML-M6
- lots of megakaryoblasts
- “bland” looking blasts
- MPO negative
- need cell markers for dx
AML-M7
Three genetic abnormalities associated with relatively better AML prognosis:
t(8;21)
inv(16)
t(15;17)
Genetic abnormality associated with poor AML prognosis:
11q23
- mutation associated with tyrosine kinase
- present in 1/3 of AML
- monocytic cells
- POOR prognosis
FLT-3 mutation
- at least 20% blasts + dysplasia in at least 2 cell lines
- severe PANcytopenia
- elderly pts
- chromosome abnormalities (5, 7)
- POOR prognosis
AML with multilineage dysplasia
- previous chemo
- 2-5 years to onset
- very hard to treat
AML, Therapy Related
Tx for AML:
Chemo
BM transplant
What must be given before cytotoxins in AML with t(15;17)?
ATRA
**prevents DIC from lysis and systemic distribution of Auer rods
