AML Flashcards
Acute Monocytic Leukemia:
-Diagnostic Criteria
<80% of monocytic cells are Monoblasts
What is diGuglielmo syndrome?
Acute Erythroid Leukemia
Acute Monocytic/Monoblastic Leukemia:
-Diagnostic Criteria
Monocytic differentiation in >80% of nonerythroid cells
-Includes: monoblasts, promonocytes, and monocytes
This AML with recurrent cytogenetics is common in children and has a poor prognosis. The blasts show monoblastic differentiation and are positive for CD4, CD11b, CD14, CD64, and lysozyme (CD34 Negative!).
AML w/ t(9;11) [AML w/ MLL gene anomalies]
AML, with Maturation:
-Blasts (3)
> 10% Blasts
- Monocytic differentiation in <20% of nonerythroid cells)
- Frequent Auer Rods/Cytoplasmic Granulations
Acute Megakaryoblastic Leukemia (FAB M7):
-Diagnostic Criteria
> 50% Megakaryocytic Blasts:
-PPO Technique (EM staining for Peoxidase)
or
-CD41/CD61 Positive
AML, NOS, Minimally DIfferentiated:
-Blasts (3)
<3% Blasts stain w/ SBB, MPO, NSE
- Agranular Cytoplasm
- Myeloid differentiation only by Immunophenotyping
AML w/ t(8;21) (q22;q22):
-IHC Positive for (6)
- CD13
- CD19
- CD33
- CD34
- CD56
- HLA-DR.
Which AML subtype affects younger patients and oftern manifests as soft tissue infiltration (gingival, CNS)?
Acute Monocytic/Monoblastic Leukemia
AML with inv(16) - [t(16;16)(p13;q22)] - Morphology:
-Blasts
Mylomonocytic differentiation w/ Abnormal Eosinophils
This AML subtype is associated with mediastinal germ cell tumors and I(12p). The blasts express CD41 and CD61.
Acute Megakaryoblastic Leukemia (FAB M7)
AML with t(15;17) [APML]:
-t(15;17) results in what?
Juxtaposition of the Retinoic Acid Receptor (RARa) gene and the PML gene
Acute Erythroid Leukemia - Erythroleukemia subtype:
-Diagnostic Criteria (2)
> 50% of all nucleated cells are Erythroids
>20% of nonerythroids are Myeloblasts
Acute Erythroid Leukemia Subtypes.
- Erythroleukemia
- Pure Erythroid Leukemia
Criteria for AML with Myelodysplasia Related Changes:
- At least (1)
- And one of (3)
- And Absence of (2)
Criteria for AML with Myelodysplasia Related Changes:
- At least:
- 20% blasts - And one of:
- Hx of MDS
- MDS Related Cytogenetic Abnormality
- Multilineage Dysplasia (>50% of 2 cell lines) - And Absence of:
- Prior Cytotoxic Chemotherapy
- Any AML w/ RGAs
AML with t(15;17) [APML]:
- Variant Translocations
- Treatment
t(11;17) and t(5;17)
-Insensitive to ATRA
AML: 4 Major Categories
- Recurrent Genetic Abnormalities
- Therapy Related
- w/ Myelodysplasia related changes
- NOS
What are the subtypes of AML, NOS? (3)
- Minimally Differentiated
- Without Maturation
- with Maturation
Which AML with recurrent cytogenetics shows the following Immunophenotype:
- Positive - CD13, CD15 (dim), CD33
- Negative - CD34, HLA-DR
AML with t(15;17) [Acute Promyelocytic Leukemia (APML)]
Relapsed cases of AML w/ t(8;21) (q22;q22) have what genetic abnormality?
High rate of activating KIT mutations
AML presentation. (4)
- Leukocytosis
- Pancytopenia
- Soft tissue mass (Chloroma)
- Blasts present in PB
10% of all de novo cases of AML that typically affects young adults. Thankfully it is highly chemosensitive. The blasts have pronounced Azurophilic granularity, including occasional large (pseudo Chediak-Higashi) granules. Auer Rods are Present too. The IHC of the blasts stains positive for CD13, CD19, CD33, CD34, CD56, and HLA-DR. Whats the diagnosis?
AML w/ t(8;21) (q22;q22)
AML w/ t(8;21) (q22;q22) translocation genes. (2)
*Encodes what?
- AML1 (RUNX1)
- ETO (RUNX1T1)
*AML1 encodes the a-chain of core binding factor (CBFa)
Acute Erythroid Leukemia - Pure subtype:
-Diagnostic Criteria (2)
> 80% of all nucleated cells are erythroid precursors
NO excess Myeloblasts
Acute Erythroid Leukemia:
-P. Smear (2)
- Anemia (Not Erythrocytosis)
- Numerous circulated nucleated RBCs (nRBCs)
Therapy Related AML:
- Latency
- BM finding
- Prognosis
- 5 years latency (avg)
- Marked Erythroid Hyperplasia
- Poor
AML, NOS, WithOut Maturation:
-Blasts (2)
3-10% Blasts show maturation (stain w/ SBB, MPO, NSE)
-Rare Auer rods and/or Granulation
Acute Myeloid Leukemia (AML) is the most common type of acute leukemia in what populations? (2)
-Median Age
- Adults
- Infants (1st year of life)
*65 y/o (Median)
Acute Myelomonocytic Leukemia:
-Diagnostic Criteria
Nonerythroid Cells:
- > 20% have monocytic differentiation
- > 20% have neutrophilic differentiation
AML with inv(16) - [t(16;16)(p13;q22)]:
-Genes (2)
- MYH1 (myosin)
- CBFb
AML with t(15;17) [APML] - Immunophenotype:
-Positive for (3)
- CD13
- CD15 (dim)
- CD33
Acute Monoblastic Leukemia:
-Diagnostic Criteria
> 80% of monocytic cells are Monoblasts
AML with t(15;17) [APML] - Immunophenotype:
-Negative for (2)
- CD34
- HLA-DR
AML with inv(16) - [t(16;16)(p13;q22)] - Immunophenotype:
-Positive for (8)
- CD2
- CD11b
- CD13
- CD14
- CD33
- CD64
- HLA-DR
- lysozyme
Diagnosis of AML.
> 20% Blasts* in PB
- Blast Equivalents:
- Promyelocytes (APML)
- Promonocytes (Acute Monocytic Leukemia)
This AML with recurrent cytogenetics involves the MYH1 (myosin) and CBFb genes and typically affects younger adults (thankfully it is chemosensitive). IHC is positive for CD2, CD11b, CD13, CD14, CD33, CD64, HLA-DR, and lysozyme.
AML with inv(16) - [t(16;16)(p13;q22)]
AML w/ t(8;21) (q22;q22):
-Blast morphology (3)
- Azurophilic granularity
- Large (pseudo-Chediak-Higashi) granules (+/-)
- Auer Rods
Diagnosis of AML with <20% blasts.
- Pure Erythroleukemia
- Myeloid Sarcoma
- Recurrent Genetic Abnormalities (ie, t(8:21))
AML Immunophenotype:
-Some express (2)
- CD7
- CD19
AML with t(15;17) [APML] Presentation.
-Treatment
DIC
-ATRA (All Transretinoic Acid)
AML with t(15;17) [APML]:
-Blast Equivalent Morphology
Abnormal Promyelocytes
- Kidney-shaped or Bilobed Nuclei
- Hyper to Agranular cytoplasm
Therapy Related AML:
- Agents (3)
- Latency
- BM finding
- Prognosis
- Topoisomerase II Inhibitors
- Alkylating Agents
- Ionizing Radiation
The Microgranular variant of AML w/ t(15;17) has occasional ___ ___ and is strongly ___ positive.
The Microgranular variant of AML w/ t(15;17)
- Auer Rods
- MPO positive
AML Immunophenotype:
-Positive for (5)
*What differs in APML?
- CD13
- CD33
- CD34
- CD45 (dim)
- HLA-DR
*APML - Negative for CD34/HLA-DR
Acute Erythroid Leukemia - Immunophenotype:
-Erythroids (4)
- CD34
- CD71 (aberrantly dim)
- Glycophorin (CD235a)
- HLA-DR
Acute Erythroid Leukemia - Erythroid Morphology:
-Cytoplasmic Finding
*Also seen in?
- Vacuolated Cytoplasms
- Globular PAS Positivity
*ALL Blasts
AML with inv(16) - [t(16;16)(p13;q22)] - Morphology:
- Eosinophils
- Stain positively with what?
- Eos in PB?
- Large, often Basophilc granules
- a-Naphthyl Acetate Esterase
- NO eosinophila in PB
