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Hematology 2 Lec > AML > Flashcards

AML Flashcards

1
Q

▪ otherwise known as Acute Non-Lymphocytic Leukemia (ANLL)

A

ACUTE MYELOCYTIC LEUKEMIA (AML)

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2
Q

▪ progressive, malignant disease affecting stem (precursor) cells

A

ACUTE MYELOCYTIC LEUKEMIA (AML)

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3
Q

▪ a stem cell disorder with predominance of blast cells (> 20%) in the blood or marrow

A

ACUTE MYELOCYTIC LEUKEMIA (AML)

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4
Q

• blast cells: immature due to

A

1) genetic mutation or 2) induced by radiation, virus, chemical exposure

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5
Q

partially differentiated or undifferentiated cells

A

• blast cells

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6
Q

▪ may resemble [?] at presentation due to ↑WBC counts (w/ fever and weakness) → [?] → [?]

A

acute infection

pancytopenia

death

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7
Q

(leads to abnormal bleeding; lack of resistance to infection; abnormal proliferates = normal decreases)

A

pancytopenia

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8
Q

▪ affects all ages, but increases with older age (> 60 years = disease of adulthood); newborns (pre-mature leukemic development)

A

ACUTE MYELOCYTIC LEUKEMIA (AML)

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9
Q

▪ also the most common form of acute leukemia during the first few months of life

A

ACUTE MYELOCYTIC LEUKEMIA (AML)

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10
Q

tested for the identification of AML stage or classification using stains and CD markers

A

• Myeloperoxidase (MPO)
• CD13
• CD33
• CD117
• CD14
• CD64

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11
Q

• first stage; large

A

primitive myeloblasts

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12
Q

• usually stained with MPO

A

primitive myeloblasts

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13
Q

• detected with CD13, CD33, and CD117 (more specific than staining/no staining capability; identification via CD markers/immunology)

A

primitive myeloblasts

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14
Q

• usually stained with MPO, Sudan Black B (SBB), Chloroacetate Esterase (CAE)

A

more mature blasts (2-3 stages)

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15
Q

AML ETIOLOGY

A
  1. RADIATION
  2. GENETICS
  3. CHEMICALS
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16
Q

▪ linked to an increase incidence of leukemia (aggravates leukemic conditions)

A
  1. RADIATION
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17
Q

Chromosomal defects

A

• aneuploidy

• breakage and rearrangement

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18
Q
  • unstable chromosomes bound to be modified or rearranged
A

• breakage and rearrangement

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19
Q
  • (e.g., Fanconi Syndrome, Bloom Syndrome, Ph1 chromosome)
A

• breakage and rearrangement

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20
Q
  • extra or missing chromosome
A

• aneuploidy

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21
Q
  • (e.g., Trisomy 21 or Down Syndrome)
A

• aneuploidy

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22
Q
  1. CHEMICALS
A

a. Leukomogen

b. Benzene

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23
Q

suppress the bone marrow and eventually causes aplasia

A

Leukomogen

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24
Q

(inhibition of production of blood cells in the bm = [?]; disease in which the red bone marrow disappears and consequently ceases to produce red blood cells, white blood cells and platelets)

A

balstic aplasia

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25
Q

Leukomogen proposed (still controversial; not evidential but linked to leukemia):

A
  • chloramphenicol
  • phenylbutazone
  • arsenic-containing compounds
  • sulfonamides
  • insecticides
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26
Q

: only proven chemical known to cause cancer

A

Benzene

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27
Q

▪ not conclusive/proven to humans but linked like the chemical etiology

A
  1. VIRUSES
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28
Q

: • most common class of tumor associated with animal leukemia and lymphoma

A

▪ Type C RNA viruses

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29
Q

: • carry genes responsible for the induction of cancer

A

▪ Retroviruses (e.g., HIV)

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30
Q

• activates our proto-oncogene to oncogene which causes or induces cancer cells

A

▪ Retroviruses (e.g., HIV)

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31
Q

AML with minimal differentiation/ Undifferentiated leukemia

A

M0

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32
Q

(similar to Undifferentiated MDS; general features: myelocytic and monocytic origin)

A

M0

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33
Q

AML without maturation

A

M1

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34
Q

▪ myelocytic origin

A

M1
M2
M3

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35
Q

▪ > 30% myeloblast in BM

A

M1

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36
Q

▪ + Auer rods (fused primary granules; spindle-shaped, redpurple)

A

M1
M2

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37
Q

AML with maturation

A

M2

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38
Q

Myeloblast + Mature cells

A

M2

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39
Q

▪ myelocytic origin

A

M2

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40
Q

▪ > 30% myeloblast with > 10% granulocytic component

A

M2

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41
Q

▪ + Auer rods

A

M1
M2

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42
Q

→ t(8q;21)

A

M2

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43
Q

Acute Promyelocytic Leukemia /Hypergranular Promyelocytic Leukemia

A

M3

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44
Q

→ t(15;17)

A

M3

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45
Q

Lesser blast (2nd stage)

A

M3

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46
Q

▪ myelocytic origin

A

M3

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47
Q

▪ with heavy granulation

A

M3

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48
Q

▪ many Auer rods in bundles called “faggot cells”

A

M3

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49
Q

▪ nuclear shape: bilobed or reniform (kidney-shaped)

A

M3

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50
Q

▪ associated with DIC

A

M3

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51
Q

M3 Coagulation tests/blood findings:

A

• prolonged PT, APTT, TCT
• ↓fibrinogen, platelet, AT-III
• ↑FSP, fibrin monomers
• (+) D-dimer

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52
Q

Acute Myelomonocytic Leukemia

A

M4

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53
Q

→ inv(16) subclass M4e

A

M4

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54
Q

▪ > 20% of PB WBCs are monocytes or monocytic precursors (promonocytes)

A

M4

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55
Q

▪ > 30% blasts

A

M4

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56
Q

▪ > 20% granulocytes

A

M4

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57
Q

▪ associated with CNS involvement or tissue infiltration (capable of infiltrating tissue barriers on the brain)

A

M4

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58
Q

▪ increased lysozyme

A

M4

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59
Q

Acute Monocytic Leukemia

A

M5

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60
Q

Schilling’s Leukemia

A

M5

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61
Q

→ t(9;11)

A

M5

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62
Q

▪ > 80% of BM elements are of monocytic series

A

M5

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63
Q

▪ increased lysozyme

A

M5

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64
Q

▪ associated with CNS involvement

A

M5

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65
Q

• poorly differentiated monocytic leukemia (nonspecific cell location; due to the presence of promonocyte and mature monocyte in both PB and BM)

A

M5a

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66
Q

• predominant cell: promonocyte (immature) in BM and PB

A

M5a

67
Q

• M5a distinguishing morphologic features:

A
  • lacy chromatin in the nucleus (normal)
  • cerebriform shape nucleus (brain-like structure)
68
Q

well differentiated (more mature seen in PB)

A

M5b

69
Q

• more of promonocytes (BM) and monocytes (PB)

A

M5b

70
Q

Naegeli monocytic Leukemia

A

M4

71
Q

Erythroleukemia

A

M6

72
Q

Erythremic Myelosis

A

M6

73
Q

DiGuglielmo Disease (common name)

A

M6

74
Q

Pure Erythroid Leukemia

A

M6

75
Q

▪ with neoplastic myeloblasts and erythroblasts

A

M6

76
Q

▪ > 50% are erythroid cells in all stages of maturation in PB

A

M6

77
Q

▪ > 30% blasts in PB (acute)

A

M6

78
Q

▪ dyserythropoiesis (presence of erythroblasts, nuclear fragments, N:C asynchrony or megaloblastic changes, and normoblastosis)

A

M6

79
Q

• normoblastosis: increased nucleated RBCs in peripheral blood (erythroblast)

A

M6

80
Q

▪ Stains (+): Periodic Acid Schiff (PAS)

A

M6

81
Q

Acute Megakaryocytic Leukemia

A

M7

82
Q

→ ch21 abnormality

A

M7

83
Q

▪ predominantly megakaryoblasts (≥30%)

A

M7

84
Q

▪ > 30% myeloblasts

A

M1
M2
M7

85
Q

▪ myelosclerosis

A

M7

86
Q

• sclerosis of the bone marrow

A

M7

87
Q

• obliteration of the marrow cavity by small spicules of bone

A

M7

88
Q

• irregularly thickened bony trabeculae

A

M7

89
Q

• proliferation of fibroblastic cells (build-up of fibrous CT) in the bone marrow (affecting blood production) associated with splenomegaly and enlargement of liver

A

M7

90
Q

▪ Stains (-): SBB and Peroxidase

A

M7

91
Q

M1, M2, M3 STAINS

A

▪ SBB
▪ Peroxidase (MPO)
▪ a-Naphthol chloroacetate esterase (ANCAE)

92
Q

M4 STAINS

A

▪ SBB*
▪ PAS
▪ Peroxidase
▪ a-Naphthol chloroacetate esterase (ANCAE)
▪ a-Naphthyl butyrate (ANB) and acetate esterase

93
Q

M5 STAINS

A

▪ PAS
▪ a-Naphthyl acetate esterase
▪ a-Naphthyl butyrate esterase (ANB)
▪ ANCAE

94
Q

M6 STAINS

A

▪ PAS
▪ a-Naphthyl acetate esterase
▪ a-Naphthyl butyrate esterase
▪ a-Naphthol chloroacetate esterase (ANCAE)

95
Q

M7 STAINS

A

▪ Acid phosphatase
▪ PAS
▪ a-Naphthol chloroacetate esterase (ANCAE)

96
Q

WHO Classification - Main Categories of AML

A
  1. AML with recurrent cytogenetic abnormalities
  2. AML with multilineage dysplasia
  3. AML, Therapy related
  4. AML, Not otherwise specified (subclassified by morphology and immunophenotype).
97
Q

AML with t(8;21) FAB:

A

M2

98
Q

AML with inv(16) FAB:

A

M4e

99
Q

APL with t(15;17) FAB:

A

M3

100
Q

AML with t(9;11) FAB:

A

M5a

101
Q

AML with t(1;22;21) FAB:

A

M7

102
Q

▪ ≥20% blasts

A

AML with t(8;21)

103
Q

▪ ≥10% maturing granulocytes

A

AML with t(8;21)

104
Q

▪ Auer rods

A

AML with t(8;21)

APL with t(15;17)

105
Q

▪ dysplasia

A

AML with t(8;21)

106
Q

▪ abnormal granules

A

AML with t(8;21)

107
Q

▪ Blasts with both monocytic and neutrophilic differentiation

A

AML with inv(16)

108
Q

▪ increased eosinophils/immature eosinophils

A

AML with inv(16)

109
Q

▪ Promyelocytes with azurophilic granules

A

APL with t(15;17)

110
Q

▪ Monoblasts and promonocytes predominate

A

AML with t(9;11)

111
Q

▪ Multilineage dysplasia

A

AML, therapy related

112
Q

▪ RS

A

AML, therapy related

113
Q

▪ increased basophils

A

AML, therapy related

114
Q

▪ Any morphology may be seen but myelomonocytic is most common

A

AML with t(6;9)

115
Q

▪ Any morphology may be seen except APL

A

AML with inv(3) or t(3;3)

116
Q

▪ Megakaryoblastic morphology with small and large megakaryocytes

A

AML with t(1;22;21) FAB: M7

117
Q

▪ Any

A

AML with FLT3 mutation/duplication

118
Q

▪ Myelomonocytic and monocytic features

A

AML with NPM1 mutation

119
Q

▪ Variable, generally similar to less differentiated AMLs in FAB scheme (M1, 2)

A

AML with CEBPA mutation

120
Q

AML

A

Acute myeloid leukemia

121
Q

APL

A

acute promyelocytic leukemia

122
Q

ATRA

A

all-trans retinoic acid

123
Q

PML

A

promyelocytic leukemia

124
Q

RARα

A

retinoid acid receptor gene-α

125
Q

CD13, CD33, CD117, CD19, CD34

A

AML with t(8;21)

126
Q

CD13, CD33, CD14, CD4, CD64

A

AML with inv(16)

127
Q

CD13, CD33, CD2, ± CD117

A

APL with t(15;17)

128
Q

CD33, CD65, CD4, HLADR

A

AML with t(9;11)

129
Q

CD13, CD33, CD34, ± CD56, CD57

A

AML, therapy related

130
Q

CD13, CD33, CD38, HLADR, CD117

A

AML with t(6;9)

131
Q

CD13, CD33, HLADR, CD34, CD38

A

AML with inv(3) or t(3;3)

132
Q

CD41, CD61, ± CD13, CD33

A

AML with t(1;22;21)

133
Q

CD13, CD33, CD34 is negative

A

AML with NPM1 mutation

134
Q

CD13, CD33, CD65, CD11b, CD15

A

AML with CEBPA mutation

135
Q

t(8;21)(q22;q22)

A

AML with t(8;21)

136
Q

AML1/ETO

A

AML with t(8;21)

137
Q

More favorable

A

AML with t(8;21)

AML with inv(16)

AML with CEBPA mutation

138
Q

inv(16)(p13;q22)

A

AML with inv(16)

139
Q

t(16;16)(p13;q22)

A

AML with inv(16)

140
Q

More favorable if responsive to ATRA

A

APL with t(15;17)

141
Q

 Inc px survival upon treatment

A

ATRA

142
Q

t(15;17)(q22;q12)

A

APL with t(15;17)

143
Q

PML/RARα

A

APL with t(15;17)

144
Q

Variants all involve 17q12

A

APL with t(15;17)

145
Q

t(9;11)(p22;q23)

A

AML with t(9;11)

146
Q

MLLT3-MLL

A

AML with t(9;11)

147
Q

Intermediate

A

AML with t(9;11)

148
Q

11q23 abnormality seen with topoisomerase II inhibitor–associated AML

A

AML, therapy related

149
Q

Less favorable

A

AML, therapy related

AML with t(6;9)

AML with inv(3) or t(3;3)

AML with t(1;22;21)

AML with FLT3 mutation/duplication

150
Q

Median survival: < 3 years

A

AML, therapy related

151
Q

More favorable in absence of FLT3

A

AML with NPM1 mutation

152
Q

NPM1 mutation

A

AML with NPM1 mutation

153
Q

cytoplasmic expression

A

AML with NPM1 mutation

154
Q

DEK-NUP214

A

AML with t(6;9)

155
Q

t(6;9) (p23;q35)

A

AML with t(6;9)

156
Q

Inv(3)(q21;q26.2)

A

AML with inv(3) or t(3;3)

157
Q

t(3;3)(q21;q26.2)

A

AML with inv(3) or t(3;3)

158
Q

RPN1- EV11

A

AML with inv(3) or t(3;3)

159
Q

t(1;22)(p13;q13)

A

AML with t(1;22;21)

160
Q

RBM15-MKL1

A

AML with t(1;22;21)

161
Q

t(6;9)(p23;q34)

A

AML with FLT3 mutation/duplication

162
Q

t(15;17)(q22;q12) or normal

A

AML with FLT3 mutation/duplication

163
Q

CEBPA mutation

A

AML with CEBPA mutation

Hematology 2 Lec (29 decks)

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