AML/ALL Other Flashcards by Chelsea Luedtke

What is the most common cause of cancer in children?

Acute leukemia

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T/F complete remission is higher in adult patients with acute leukemias than children

False!

>85% CR in children/young adults

65-85% in adults

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Does AML or ALL have more estimated new cases?

AML

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Does AML or ALL have more estimated deaths?

AML

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T/F in acute leukemia cells continue to differentiate

False!

Do not continue to differentiate

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T/F ALL has a higher survival rate in pediatrics and adults compared to AML

TRUE!

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Etiology of acute leukemias

- most times don’t know!

Genetic conditions
Socioeconomic
Immunologic factors
Environmental exposure
Toxins (
Family history (high birth rate?)

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What is the median age of diagnosis of ALL?

10 years

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What is the median age of AML?

67 years

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T/F leukemia is more common in females

False!

Males

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T/F ALL has a higher incidence in caucasians

True

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In acute leukemia diagnosis what blast % will they have?

What is a normal blast %?

>20% - leukemia

<5% - normal

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S/S of acute leukemia

anemia
thrombocytopenia
neutorpenia
CNS (seizures, HA, visual disturbances)
gingival hyperplasia
bone pain
extra-medullary disease (leukemia cutis, chloromas)

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S/S of anemia in acute leukemia

fatigue

malaise

CNS

cardiac

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S/S of thrombocytopenia in acute leukemia

bleeding

bruising

petechiae

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S/S of neutropenia in acute leukemia

infection

fever

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What labs should you get to diagnose acute leukemia?

CBC with differential
Uric acid, K, P, SCr
Peripheral blood smear (blasts)
Coagulation studies
Bone marrow biopsy
Cytogenetic analysis

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What is the main goal of treatment in acute leukemia?

Cure!

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What are the 3 things needed to achieve complete remission in acute leukemias?

< 5% blasts in bone marrow
Recovery of platelets to > 100,000
Recovery of ANC >1500

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What are all the goals of treatment for acute leukemias

cure
rapidly achieve CR
maintain CR- prevent recurrence
minimize toxicity

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What is treatment based on in AML?

risk of relapse

T/F if you have features associated with a good response in AML you would give a more intensive chemotherapy regimen

False!

good response: less chemo

poor response: more chemo

Goal of remission induction in AML

attain complete remission

restore normal hematopoesis

How do you look for residual disease after induction in AML?

look at bone marrow

empty: no further treatment

What is pancytopenia comprised of?

1. neutropenia: ~30 days 2. anemia 3. thrombocytopenia

T/F you premedicate with gemtuzumab

True! APAP, benadryl, methylpred - risk of infusion reaction

What is Vyxeos?

liposomal cytarabine + daunorubicin

Which drug contains copper and monitor for toxicity? What is it used to treat?

Vyxeos for AML

What drug class do you use to treat \> 60 year olds with AML?

hypomethylating agents

What are the 2 hypomethylating agents used to treat AML?

Decitabine Azacitidine

What is venetoclax target?

BCL-2 protein

Goal of consolidation in AML

achieve durable remission

In AML who do you use HSCT for?

poor-risk cytogenetics if chance of cure relapse

T/F the risk of AML relapse is related to duration of 1st remission

true

T/F APL has a poor prognosis

False! Good prognosis!

What is APL characterized by?

severe coagulopathies

S/S of APL differentiation syndrome

fever respiratory distress interstitial pulm infiltrates pleural effusions weight gain DEATH

How can you prevent or treat APL differentiation syndrome?

Dexamethasone

What do you monitor when taking arsenic (ATO)?

K and Mg - risk of QT prolongation

T/F B cell ALL is less common than T cell ALL

False B cell more common

T/F CNS involvement is more common in AML than ALL

False! More common in ALL

What are the risk features associated with relapse in ALL?

- WBC \> 50,000 - chromosome abnormalities (Ph+, t(4;11) - \< 1 yo; \> 10 yo - extra-medullary involvement - no remission within 4 weeks of tx - male

Which drugs are used intrathecally for CNS issues in ALL?

MTX Cytarabine Hydrocortisone \*\*NOT vincristine\*\*

T/F you only do CNS prophylaxis in ALL treatment during induction

False Due during remission induction and consolidation/intensification

Goal of induction in ALL

reduce tumor burden

Goal of consolidation in ALL

eliminate leukemic cells remaining after induction

Goal of maintenance therapy in ALL

prevent disease relapse after post remission induction and consolidation

What are CALGB 811 and Hyper-CVAD used for?

ALL

T/F CART can be used in ALL

True

What is used in standard induction in pediatric ALL?

Vincristine Prednisone/dexameth asparginase/PEG/asp

What is added to high risk induction in pediatric ALL?

daunorubicin