AML & ALL Flashcards
AML- epidemiology
- 3.6 per 100,000 people
- 5 males to 3 females
- median age is 66yrs
- 5 yr survival is 23.8yrs
ALL - epidemiology
- 1.6 per 100,000
- median age is 14 yrs
- 5 year survival is 65% and even higher fo r children
which is more common -AML or ALL?
AML
Which age group is more affected by AML? ALL?
- AML is adults
- ALL is mostly children but there are children
Most common genetic abnormality increase risk for acute leukemia?
Other common condition that increases risk?
- Down syndrome
- Kleinfelters
Which benign conditions inc risk for acute leukemia?
- paroxysmal nocturnal hemoglobinuria (PNH)
- aplastic anemia
Which malignant conditions inc risk for acute leukemia?
- myelodysplastic syndrome (MSD)
- myeloproliferative syndrome (P. vera)
- marrow failure syndromes: fanconi, schwachman-diamond…etc
CML - epidemiology:
- 4 per 100,000
- 2males to 1 female
- median age of 65yrs
- 5 year survival is 60%
CLL - epidemiology:
- 4.2 per 100,000
- most common leukemia in adults
- 5 year survival is 78.8%
Acute leukemia - patient presentation/symptoms
- general fatigue
- pallor
- weakness
- -bone pain that is infrequent - sternal or long bones
- -fever/infection - neutropenia
- -skin: pallor, petechiae, GUMS enlarged, ecchymoses, infiltration of the skin (AMML)
- Sweet’s syndrome: red/violaceous tender nodules & plaques: acute febrile, neutrophilic dermatosis
- -Eye: retinal hemorrhage or white plaques
- -CNS: headache, cranial nerve palsy, visual changes, more common with monocytic component
- -oropharynx: wet purpura, gum infiltration
- -organomegaly: not too common
- -joints: symmetrical or migratory polyarthritis or arthralgia
- -myeloid sarcoma: AML with extra medullary disease
Which FAB classification is treated very differently from the others? How is it different?
- M3 - APL or acute progranulocytic (APL)
- ATRA (maturation agent) and 7+3 induction
FAB classification system of AML
-M0-M7… DONT WORRY ABOUT THIS.
- M0- minimally differentiated
- M1- AML without maturation
- M2- AML with granulocyte maturation
- M3- APL or acute progranulocytic
- M4- Acute myelomonocytic
- M5- acute myelomonocytic with eosinophils
- M6- acute erythroleukemia (a &b)
- M7- acute megakaryoblastic leukemia
Auer rods… which disease? what are they?
- AML!
- Fused lysosomes and neutrophilic granules with enzymes and crystalline inclusions
- Sternal bone marrow sample info:
- normal spot for BM biopsy:
- contraindicated: that bone is only 1cm thick and 16 gauge needle into heart not a good idea
- PSIS
AML treatment idea:
- need to wipe the BM out except with APL
- give anthrcycline and cytarabine (c-ara)
AML induction support - important item:
- antibiotics!
- no sick visitors
- wash hands
tumor lysis syndrome:
definition:
what happens as a result:
treatment?
kill so many cancer cells results in so many metabolites being released into blood
- alakaline urine trashes the kidneys = dialysis
- rasburicase - for uric acid control
APL common translocation?
fusion of what genes?
15,17 - PML/RARalpha = inhibition of genes involved in promyelocytic differentation
vitamin therapy for which cancer?
APL - use all trans-retinoid acid (ATRA) - maturation agent - induces remision of disease then give 7+3
what does ATRA do for APL?
induces maturation
What do APL patients usually present with?
DIC
Retinoic acid syndrome/APL differentiation syndrome.
- due to?
- what happens?
- fix with what treatment?
- due to ATRA treatment
- leaky capillaries = edema, pleural effusion, lung infiltrates
- steroids help fix!
Molecular markers for ALL:
- MDR gene
- DNA microarray-base gene expression patterns
- NOTCH-1 mutations (50% t-cell ALL)
- glutathione S-trasferase
- thymidylate synthase
worse prognosis for ALL when…
- older than 35 yrs
- b cells>30k
- t cells>100k
- karyotype 9,22
- persistent minimal residual disease
ALL treatment: ideal tx?
-hyper-CVAD but if can get good BM transplant do it
CML presentation:
- easy bleeding
- fatigue
- fever
- frequent infections
- WL without effort
- anorexia
- LUQ pain - spleen infarct -refers to L shoulder
- night sweats
left shoulder pain.. what happened??
ruptured spleen
CML epidemiology
- male dominant
- 4 per 100,000
- 5 year survival 60%
CLL epidemiology:
- most common leukemia in adults
- 5 year survival is 79%
Most common leukemia in adults?
CLL
smudge cells is which disease?
CLL
CML chromosome translocation:
9,22 translocation BCR/ABL1
CML risk factors:
- increase in age
- increased radiation exposure
3 phases of CML
- chronic
- accelerated
- blastic (pretty much AML)
drug tx for CML?
- tyrosine kinase inh:
1) imatinib
2) dasatinib
3) nilotinib - biological:
1) interferon alpha - chemo:
1) hydroxyurea
