AML and CLL cases

Question 1

Pre-existing diseases associated with greater risk of AML?

Answer 1

Down Syndrome

Ataxia telangiectasia

Fanconia anemia

Li Fraumeni syndrome

Wiskott-Aldrich

familial leukemia

myelodysplasia

PNH

Question 2

Secondary AML risk from:

Answer 2

prior chemo

radiation exposure

BENZENE exposure

Question 3

Extramedullary disease most common with which lineage of AML?

Answer 3

Monocytic

Question 4

Biggest prognostic factor in AML?

Answer 4

CYTOGENETICS

Question 5

“Good” risk cytogenetics of AML:

Answer 5

t(8;21)

t(16;16)

t(15;17)

Question 6

Finding on blood smear associated with “good” prognosis of AML (M3)?

Answer 6

Lots of Auer rods

Question 7

Intermediate prognostic factor of AML:

Answer 7

Normal karyotype with NPM1+, Flt3-

Question 8

Unfavorable prognostic cytogenetics in AML:

Answer 8

del 5
del 7

trisomy 8

11q23

other complex karyotypes

Question 9

Unfavorable prognostic factor in AML associated with prior chemo?

**on the test

Answer 9

11q23

Question 10

Defining criteria of remission in AML?

Question 11

Treatment given to “mop up” after remission achieved in AML:

Answer 11

Consolidation chemo

Question 12

Contraindication for allogenic transplant?

Answer 12

age > 60

Question 13

What is DIC? What are it’s characteristics?

Answer 13

Disseminated Intravascular Coagulation

• coagulopathy
• depressed fibrinogen
• thrombocytopenia
• FATAL hemmorrhage

Question 14

Why is dx of acute promyelocytic leukemia (M3) time sensitive?

Answer 14

DIC is rapidly fatal

**ATRA should be given in under 6 hours

“Don’t let the sun set on M3”

Question 15

Danger of hyperleukocytosis seen in M4?

Answer 15

Hyperviscosity –> sludging in vasculature –> ischemia and/or infarction

Question 16

Tx for hyperleukoocytosis:

Answer 16

Leukophoresis to reduce WBC to

Question 17

What the problem with automated differentials?

Answer 17

Can mistake blast cells for monocytosis.

Question 18

Most common leukemia in adults?

Answer 18

CLL

Question 19

“Better” prognostic indicator for CLL?

Answer 19

Mutated Ig Vh genes

Question 20

Cell markers seen on flow cytometry for CLL:

**on test!!

Answer 20

CD5+

CD19+

CD20+

CD23+

Question 21

Physical exam finding for CLL:

Answer 21

Diffuse adenopathy

Question 22

Rai classification of CLL

lymphocytosis

Answer 22

Rai 0

Question 23

Rai classification of CLL

lymphocytosis
+
lymphadenopathy

Answer 23

Rai 1

Question 24

Rai classification of CLL

lymphocytosis
\+
lymphadenopathy
\+
splenomegally

Answer 24

Rai 2

Question 25

Rai classification of CLL ``` lymphocytosis + lymphadenopathy + splenomegally + Hgb ```

Answer 25

Rai 3

Question 26

Rai classification of CLL ``` lymphocytosis + lymphadenopathy + splenomegally + Hgb ```

Answer 26

Rai 4

Question 27

Binet classification system for CLL: lymphocytosis +/- 1-3 sites of lymphadenopathy

Answer 27

A

Question 28

Binet classification of CLL: lymphocytosis + > 3 sites of lymphadenopathy

Answer 28

B

Question 29

Binet classification of CLL: lymphocytosis + anemia and/or thrombocytopenia

Answer 29

C

Question 30

CLL cytogenetic abnormalities:

Answer 30

13q (-) Best prog I Normal Karyotype I I Trisomy 12 I I 11q (-) I V 17q (-) Worst prog **ALWAY get FISH, 17q(-) behaves like Mantle cell

Question 31

Flow cytometry marker for poorer prognosis of CLL:

Answer 31

CD38+ = unmutated Ig genes (9 yrs median survival)

Question 32

Flow cytometry marker for better prognosis of CLL:

Answer 32

CD38(-) = mutated Ig genes (>20 yrs median survival)

Question 33

ZAP-70+ = ________ prognosis for CLL.

Answer 33

Poorer

Question 34

ZAP-70 expression correlates with:

Answer 34

Ig Vh gene mutations CD38+ expression

Question 35

Smudge cells are associated with what cytogenic abnormality in CLL and indicate _________ prognosis.

Answer 35

13q(-) good

Question 36

Something that should be on your DDX with pure red cell aplasia?

Answer 36

parvovirus infx

Question 37

Really good tx for CLL but big financial toxicity?

Answer 37

Ibrutinib