Acute Myeloid Leukemia

Question 1

Two big difference in acute vs chronic myeloid leukemia?

Answer 1

actue

• Rapidly fatal
• IMMATURE cells (BLASTS)

chronic

• ONLY in adults
• MATURE cells

Question 2

Two causes of acute leukemia:

Answer 2

• clonal expansion

- maturation failure (hence the immature cells)

Question 3

Worst problem caused by acute leukemia?

Answer 3

-crowding out of normal cells

also:
inhibit normal cell function
infiltrate other organs

Question 4

Clinical findings in acute leukemia:

Answer 4

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)

Question 5

What criteria must be met for AML dx?

Answer 5

at least 20% Blasts present among all nucleated cells

Question 6

Subclasses of AML involving the neutrophilic series:

Answer 6

M0
M1
M2
M3

Question 7

Subclasses of AML involving monocytic series:

Answer 7

M4

M5

Question 8

Subclasses of AML involving erythroid series:

Answer 8

M6

Question 9

Subclasses of AML involving megakaryocytic series:

Answer 9

M7

Question 10

• lots of myeloblasts
• “bland” looking cells
• MPO negative
• need markers for dx

What is it?

Answer 10

AML-M0

Question 11

• lots of myeloblasts
• no maturation
• AUER rods
• MPO positive

What is it?

Answer 11

AML-M1

Question 12

• fewer myeloblasts but still at least 20%
• maturing neutrophils
• t(8;21) in some cases = better prognosis

What is it?

Answer 12

AML-M2

Question 13

• 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?

Answer 13

AML-M3

Question 14

• lots of myeloblasts
• lots of monocytic cells
• extramedullary tumor masses (gums common)
• inv(16) in some cases = better prognosis

Answer 14

AML-M4

Question 15

• lots of monocytic cells (any stage)
• NSE positive (non-speceific esterase stain)
• M?A and M?B
• extramedullary tumor masses

**tissue paper looking nuclei

Answer 15

AML-M5

Question 16

• lots of erythroblasts
• lots of myeloblasts
• dyserythropoesis

Answer 16

AML-M6

Question 17

• lots of megakaryoblasts
• “bland” looking blasts
• MPO negative
• need cell markers for dx

Answer 17

AML-M7

Question 18

Three genetic abnormalities associated with relatively better AML prognosis:

Answer 18

t(8;21)

inv(16)

t(15;17)

Question 19

Genetic abnormality associated with poor AML prognosis:

Answer 19

11q23

Question 20

• mutation associated with tyrosine kinase
• present in 1/3 of AML
• monocytic cells
• POOR prognosis

Answer 20

FLT-3 mutation

Question 21

• at least 20% blasts + dysplasia in at least 2 cell lines
• severe PANcytopenia
• elderly pts
• chromosome abnormalities (5, 7)
• POOR prognosis

Answer 21

AML with multilineage dysplasia

Question 22

• previous chemo
• 2-5 years to onset
• very hard to treat

Answer 22

AML, Therapy Related

Question 23

Tx for AML:

Answer 23

Chemo

BM transplant

Question 24

What must be given before cytotoxins in AML with t(15;17)?

Answer 24

ATRA

**prevents DIC from lysis and systemic distribution of Auer rods

Question 25

• abnormal stem cells
• dysmyelopoesis
• maybe incr blasts (less than 20%)
• may evolve into AML

Answer 25

Myelodysplastic syndrome (MDS)

Question 26

3 clinical/lab findings in MDS:

Answer 26

older patients

asymptomatic or BM failure

MACROcytic anemia