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PATH310 > AL 2 > Flashcards

AL 2 Flashcards

1
Q

fatigue & short breath

A

low amt Hb, not enough O2

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2
Q

arm bruising, purple spots on legs

A

low platelet count

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3
Q

AL & wbc

A

low neutrophils, lymphocytes, >20% blasts

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4
Q

what are blasts?

A

immature wbc

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5
Q

AL diagnosis!

A

clin presentation, morphology, immunophenotype, cytogenetics, molecular studies

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6
Q

clin info in AL

A

~lacking but critical. history of prior BM disorder (MDS). prior cytotoxic therapy. down syndrome

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7
Q

MDS

A

myelodysplastic syndrom

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8
Q

1st indication of AL

A

morphology, guides approp ancillary tests & indicates

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9
Q

blast count for morphology

A

> 20% blasts in PB or BM

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10
Q

morphology can indicate subtype, genetic changes. example?

A

auer rods only in ML

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11
Q

needles

A

illinois BM aspirate needle & jamshidi BM biopsy needle

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12
Q

BM biopsy MI

A

morphology, immunohistochem

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13
Q

BM aspirate MFCCFM

A

morph features, flow cytometric, cytgenetic FISH, molecular analysis

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14
Q

what is performed in all suspected AL cases

A

flow cytometry

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15
Q

immunophenotype is needed for

A

diagnosis, classification.

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16
Q

phenotypes can be

A

AML, ALL, or mixed

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17
Q

immunophenotyping may ID aberrant antigen exp corresponding to what

A

specific genetic changes

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18
Q

hard to morphologically tell AML from ALL using what?

A

morphology (rely on immunophenotype)

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19
Q

flow cytometry involves

A

laser, electronics, fluidic & optic system… flor labelled cell parts, light scattered when hit cell

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20
Q

CD45 is example of

A

leukocyte antigen. expressed on all hematopoietic cells

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21
Q

cells express myeloperoxidase MPO only in

A

ML. see brown stain (instead of blue)

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22
Q

all new cases should include

A

karyotyping (key for classification)

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23
Q

molecular methods may be better than cytogenetics for some

A

abnormalities (translocations, duplication, deletion)

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24
Q

FISH

A

fluorescent in situ hybridization.

25
Q

confirm translocation w FISH

A

add probes, red binds gene on xsome 17, green for 15. in normal cell, 2R & 2G. in leukemia, see yellow (fusion signal)

26
Q

molecular studies in AL

A

PCR based assays & NGS

27
Q

PCR

A

detect new fusion proteins in AML w recurrent translocations

28
Q

what mutations are tested w PCR in all new AML cases

A

FLT3 & NPM1

29
Q

NGS

A

perform routinely in clinic for all new AL cases

30
Q

acute promyelocytic leukemia

A

w PML-RARA

31
Q

mutation w too many b-lymphocytes

A

CLL chronic lymphocytic leukemia

32
Q

myeloproliferative neoplasms w too many

A

neutrophils - CML myelogenous
platelets - ET essential thrombocythemia
rbc - polycythemia vera

33
Q

too many blasts

A

ALL or AML

34
Q

AML, ALL common in what age

A

AML - elderly

ALL - kids

35
Q

underlying disorder

A

marrow infiltration w blasts

36
Q

BM fail

A

neutropenia, anemia, thrombocytopenia

37
Q

lab features

A

BM fail, circulating blasts, intravascular coagulation

38
Q

circulating blasts

A

wbc ~ incr but not always

39
Q

intravasc coag

A

coagulopathy, hemolysis w rbc frags, thrombocytopenia (low platelet)

40
Q

BM fail leads to

A

infection, fatigue, bleeding

41
Q

circulating blasts leads to

A

leukostasis (pulm, CNS) & tissue infiltration (lymphadenopathy, splenomegaly, CNS, skin)

42
Q

intravasc coag leads to

A

bleeding

43
Q

lab & clin presentations ~acute/subacute

A

days to wks

44
Q

AL classification

A

FAB - morphology, cytochem only, limited immunophenotyping

2017 WHO - morph, immunophenotype, cytogenetics, molecular, prior disease & therapy history

45
Q

AL treatment depends on

A

type (ALL/AML), age of patient (ped vs adult vs old), curative vs palliative intent

46
Q

combination chemotherapy (2)

A

induction - for full remission. consolidation - prevent relapse

47
Q

supportive care TANPS

A

transfusions, antibiotics, nutrition, psychosocial support

48
Q

standard 3 + 7 AML treatment (chemo)

A

daunorubicin + cytarabine. no particular targets, just kill dividing cells

49
Q

daunorubicin interact w dna how

A

intercalation, inhibition of macromolecular biosynth. also inhib topoisomerase 2 (relax dna supercoils for transcrip)

50
Q

admin daunorubicin & cytarabine. how?

A

both IV. daunorubicin - 3 days, cytarabine 7 days

51
Q

cytrarabine similar to what human compound (but still diff enough to kill)

A

cytosine deoxyribose (deoxycytidine) which is incorporated into dna

52
Q

new targeted therapies for APL

A

retinoic acid, arsenic trioxide

53
Q

BM transplant for who

A

younger patients (relapsed/high risk AL)

54
Q

BM transplant HSC from who

A

matched: sibling or unrelated donor

55
Q

BM transplant is toxic therapy

A

yes, many side effects as new immune system attacks own organs (take immunosuppresants) but potential for cure

56
Q

graft vs leukemia effect

A

transplant new cells, kill out residual leukemia :) thx to immune response to tumor

57
Q

prognosis wrt age

A

survival % higher in young ppl (ALL better than AML), ~none for 75+

58
Q

treatment is long

A

at least 1 month, but some improvement in outcomes (targeted approaches)

PATH310 (8 decks)

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