AML and MDS

Question 1

Who has chronic leukemia?

Answer 1

adults

Question 2

Acute leukemia vs. chronic leukemia cells

Answer 2

acute: blasts chronic: fewer immature cells, mostly differentiated cells

Question 3

AML vs. ALL names

Answer 3

acute myeloid leukemia acute lymphoblastic leukemia

Question 4

This general term encompasses the general symptoms of acute leukemias

Answer 4

bone marrow failure (fatigue, infections, bleeding due to lack of cell types)

Question 5

AML cutoff for Dx

Answer 5

20% blasts (myeloblasts) or equivalents

Question 6

Prognosis for AML

Answer 6

bad

Question 7

Answer 7

Auer rods

malignant blasts-myeloid

Question 8

AML-M0

Minimally Differentiated

Answer 8

• very high myeloblasts (barely differentiated)
• bland
• MPO negative (myeloperoxidase)
• Need markers

Question 9

These tests differentiate AML-M0 and AML-M1

Answer 9

M1 has + MPO (myeloperoxidase stain)

Auer rods

Question 10

AML-M1

AML: w/o Maturation

Answer 10

• high myeloblasts (look like myeloblasts)
• no further maturation
• Auer rods
• MPO positive

Question 11

AML-M2

AML: w/ Differentiation

Answer 11

• high myeloblasts
• maturing neutrophils
• t(8;21) in some cases

Question 12

AML-M3

Acute Promyelocytic Leukemia

Answer 12

• very high promyelocytes
• Faggot cells (many Auer rods)
• DIC (from Faggot cells busting open)
• t(15;17) in all cases

Question 13

Genetic translocation in AML-M3

Acute Promyelocytic Leukemia

Answer 13

t(15;17)

Question 14

What happens if you give someone with AML-M3 normal chemo?

Acute Promyelocytic Leukemia

Answer 14

Faggot cells lyse and release coagulation factors

–> DIC

Question 15

AML-M3 t(15:17) translocation treatment

Acute Promyelocytic Leukemia

Answer 15

all-trans-retinoic acid

promotes differentiation

prevents lysis

Question 16

What kind of cell are most prominent in AML-M3

Acute Promyelocytic Leukemia

Answer 16

promyelocytes

Question 17

Answer 17

Faggot cell

AML-M3: Acute Promyelocytic Leukemia

Sh*t ton of Auer rods (>42)

Question 18

AML-M4

Acute Myelomonocytic Leukemia

Answer 18

• increased myeloblasts
• increased monocytic cells
• extramedullary tumor masses
• inv(16) in some cases

Question 19

This type of AML has extramedullary tumor masses

Answer 19

monocytic leukemias

AML-4 or AML-5

acute myelomonocytic leukemia

acute monocytic leukemia

Question 20

AML-5

Acute Monocytic Leukemia

Answer 20

• increased monocytic cells
• NSE positive (nonspecific esterase)
• M5A and M5B
• extramedullary tumor masses

Question 21

NSE stain

Answer 21

non-specific esterase

finds cells of monocyte lineage

Question 22

AML-M6

acute erythroblastic leukemia

Answer 22

• increased erythroblasts
• increased myeloblasts
• dyserythropoiesis

Question 23

AML-M7

Acute megakaroblastic leukemia

Answer 23

• increased megakaryoblasts
• bland blasts
• MPO negative
• Need markers

Question 24

FLT-3 mutation

(encodes tyrosine kinase)

Answer 24

• poor prognosis
• high proliferation rate
• WBC count skyrockets

Question 25

AML with multilineage dysplasia

Answer 25

- normally in elderly - ≥ 2 cell lineages involved - severe pancytopenia

Question 26

Severe pancytopenia: which AML subtype

Answer 26

AML with multilineage dysplasia

Question 27

t(15;17) translocation

Answer 27

promyelocytic leukemia AML-M3 Need to treat first with all-trans retinoic acid before normal chemo to avoid DIC

Question 28

Myelodysplastic Syndrome (MDS) General principles

Answer 28

- dysmyelopoiesis - may evolve into acute leukemia

Question 29

2 big findings of MDS

Answer 29

- bone marrow failure - macrocytic anemia