Acute Myeloid Leukemia (Myeloid Neoplasms) Flashcards
Definition Pathogenesis Classification Morphology Clinical features Prognosis Treatment
AML occurs when mutations occur that impedes ______ (maturation/differentiation) of myeloid precursors
differentiation
immature myeloid blasts accumulate in the bone marrow that causes ________ in the blood
cytopenia
What is the median age for AML to occur?
60 years
Classify AML
AML w/ genetic abberation
AML w/ MDS
AML asso. w/ therapy
AML not specific
What are the mutations occuring in AML arising de novo or in young people?
t(8;21) - RUNX1/ETO fusion gene
inv(16) - CBFB/MYH1 fusion gene
t(15;17) - PML/RARA fusion gene
What genetic changes occur in MDS related AML?
Deletions
Monosomies of 5 and 7
What mutations are related with therapy related AML?
t(11q23;v) MLL FUSION GENES
De novo cases of AML include mutation ________ {inv(16)/FLT3}
inv(16)
inv(16) makes _______ fusion gene
CBFB/MYH1
RUNX1/ETO fusion gene is made by translocation of ______
t(8;21)
t(15;17) is responsible for ________ {MLL fusion genes/PML-RARA fusion gene}
PML-RARA fusion gene
________ is responsible for MLL fusion genes
t(11q23;v)
MLL fusion genes made by t(11q23;v) are _________ (MDS/therapy) related
therapy
___________ {t(8;21)/t(9;22)} is associated with de novo AML that makes RUNX1-ETO fusion gene
t(8;21)
CBFB/MYH1 is made by _______ {epigenetic changes/t(11q23;v)/inv(16)}
inv(16)
Name the eight mutations that are associated w/ AML.
t(8;21) inv(16) t(15;17) FLT3 t(11q23;v) epigenetic changes Cohesion complex NPM mutation
What do we find in the bone marrow of AML patients? (4M)
Myeloblasts Monoblasts Megakaryocytic differentiation Marrow fibrosis Rarely erythroid differentiation is seen
What are the characteristics of myeloblasts?
Cytoplasm more than lymphoblasts
Auer rods
Azurophilic granules
Peroxidase positive
What are the characteristics of monoblasts?
No auer rods
Non specific esterase positive
What are the lab findings in AML?
Blast cells may be variable they may be absent (aleukemic leukemia - do bone marrow biopsy to confirm) may be less than 10,000 may be more than 100,000 Anemia Neutropenia Thrombocytopenia
What are the clinical features of AML?
Fatigue
Recurrent infections
Mucocutaneous bleeding and petechiae
What is the feature of monocytic variant of AML?
Monoblasts invade the skin (leukemia cutis) and gingiva
Why does fatigue and infxn occurs in AML
Fatigue due to anemia
infxn due to neutropenia
Why is there a bleeding tendency in AML?
low platelets
Leukemic cells release procoagulants and fibrinolytic factors
