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Heme Exam 3 > AML & ALL > Flashcards

AML & ALL Flashcards

1
Q

AML- epidemiology

A
  • 3.6 per 100,000 people
  • 5 males to 3 females
  • median age is 66yrs
  • 5 yr survival is 23.8yrs
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2
Q

ALL - epidemiology

A
  • 1.6 per 100,000
  • median age is 14 yrs
  • 5 year survival is 65% and even higher fo r children
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3
Q

which is more common -AML or ALL?

A

AML

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4
Q

Which age group is more affected by AML? ALL?

A
  • AML is adults

- ALL is mostly children but there are children

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5
Q

Most common genetic abnormality increase risk for acute leukemia?

Other common condition that increases risk?

A
  • Down syndrome

- Kleinfelters

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6
Q

Which benign conditions inc risk for acute leukemia?

A
  • paroxysmal nocturnal hemoglobinuria (PNH)

- aplastic anemia

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7
Q

Which malignant conditions inc risk for acute leukemia?

A
  • myelodysplastic syndrome (MSD)
  • myeloproliferative syndrome (P. vera)
  • marrow failure syndromes: fanconi, schwachman-diamond…etc
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8
Q

CML - epidemiology:

A
  • 4 per 100,000
  • 2males to 1 female
  • median age of 65yrs
  • 5 year survival is 60%
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9
Q

CLL - epidemiology:

A
  • 4.2 per 100,000
  • most common leukemia in adults
  • 5 year survival is 78.8%
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10
Q

Acute leukemia - patient presentation/symptoms

A
  • 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
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11
Q

Which FAB classification is treated very differently from the others? How is it different?

A
  • M3 - APL or acute progranulocytic (APL)

- ATRA (maturation agent) and 7+3 induction

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12
Q

FAB classification system of AML

-M0-M7… DONT WORRY ABOUT THIS.

A
  • 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
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13
Q

Auer rods… which disease? what are they?

A
  • AML!

- Fused lysosomes and neutrophilic granules with enzymes and crystalline inclusions

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14
Q
  • Sternal bone marrow sample info:

- normal spot for BM biopsy:

A
  • contraindicated: that bone is only 1cm thick and 16 gauge needle into heart not a good idea
  • PSIS
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15
Q

AML treatment idea:

A
  • need to wipe the BM out except with APL

- give anthrcycline and cytarabine (c-ara)

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16
Q

AML induction support - important item:

A
  • antibiotics!
  • no sick visitors
  • wash hands
17
Q

tumor lysis syndrome:
definition:
what happens as a result:
treatment?

A

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
18
Q

APL common translocation?

fusion of what genes?

A

15,17 - PML/RARalpha = inhibition of genes involved in promyelocytic differentation

19
Q

vitamin therapy for which cancer?

A

APL - use all trans-retinoid acid (ATRA) - maturation agent - induces remision of disease then give 7+3

20
Q

what does ATRA do for APL?

A

induces maturation

21
Q

What do APL patients usually present with?

A

DIC

22
Q

Retinoic acid syndrome/APL differentiation syndrome.

  • due to?
  • what happens?
  • fix with what treatment?
A
  • due to ATRA treatment
  • leaky capillaries = edema, pleural effusion, lung infiltrates
  • steroids help fix!
23
Q

Molecular markers for ALL:

A
  • MDR gene
  • DNA microarray-base gene expression patterns
  • NOTCH-1 mutations (50% t-cell ALL)
  • glutathione S-trasferase
  • thymidylate synthase
24
Q

worse prognosis for ALL when…

A
  • older than 35 yrs
  • b cells>30k
  • t cells>100k
  • karyotype 9,22
  • persistent minimal residual disease
25
Q

ALL treatment: ideal tx?

A

-hyper-CVAD but if can get good BM transplant do it

26
Q

CML presentation:

A
  • easy bleeding
  • fatigue
  • fever
  • frequent infections
  • WL without effort
  • anorexia
  • LUQ pain - spleen infarct -refers to L shoulder
  • night sweats
27
Q

left shoulder pain.. what happened??

A

ruptured spleen

28
Q

CML epidemiology

A
  • male dominant
  • 4 per 100,000
  • 5 year survival 60%
29
Q

CLL epidemiology:

A
  • most common leukemia in adults

- 5 year survival is 79%

30
Q

Most common leukemia in adults?

A

CLL

31
Q

smudge cells is which disease?

A

CLL

32
Q

CML chromosome translocation:

A

9,22 translocation BCR/ABL1

33
Q

CML risk factors:

A
  • increase in age

- increased radiation exposure

34
Q

3 phases of CML

A
  • chronic
  • accelerated
  • blastic (pretty much AML)
35
Q

drug tx for CML?

A
  • tyrosine kinase inh:
    1) imatinib
    2) dasatinib
    3) nilotinib
  • biological:
    1) interferon alpha
  • chemo:
    1) hydroxyurea

Heme Exam 3 (8 decks)

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