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IHO Week 4 > AML and MDS > Flashcards

AML and MDS Flashcards

1
Q

acute leukemia

-onset, age, course, immature vs mature

A

Sudden onset
Can occur in either adults or children
Rapidly fatal without treatment
Composed of immature cells (blasts)

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2
Q

chronic leukemia

-onset, age, course, immature vs mature

A

Slow onset
Occurs only in adults
Longer course
Composed of mature cells

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3
Q

malignant proliferation of immature myeloid or lymphoid cells in the bone marrow

A

acute leukemia

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4
Q

acute leukemia cause

A

Clonal expansion

Maturation failure

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5
Q

acute leukemia badness

A

Crowd out normal cells
Inhibit normal cell function
Infiltrate other organs

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6
Q

Clinical findings in acute leukemia

A 
Sudden onset (days)
Symptoms of bone marrow failure
Fatigue
Infections
Bleeding
Bone pain (expanding marrow)
Organ infiltration (liver, spleen, brain)
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7
Q

Things have to know about AML

A

Malignant proliferation of myeloid blasts in blood, bone marrow
20% cutoff for diagnosis
Many subtypes
Bad prognosis

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8
Q

how many of the nucleated cells have to be malignant/blast to be diagnosed as AML

A

20%

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9
Q

old classifications of AML - big grouping

A

M0-3: involve neutrophilic series (myeloblasts, promyelocytes, etc.)
M4-5: involve monocytic series (monoblasts, etc)
M6: involve erythroid series (erythroblasts)
M7: involve megakaryocytic series (megakaryoblasts)

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10
Q

dysgranulopoiesis

A

not enough lobes or cytoplasm in neutrophils

a clue that acute leukemia is probably myeloid

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11
Q

how to tell if leukemia is myeloid vs. lymphoid

A 
dysgranulopoiesis
auer rods
cytochemistry (MPO = neutrophils)
immunophenotyping
Cytogenetics
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12
Q

Auer rods

A

azurophilic granules strung together in rods

clue that it is AML

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13
Q

Myeloperoxidase shows that cells are from what lineage

A

neutrophils

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14
Q

AML New classification

A 
AML with genetic abnormalities
AML with FLT-3 mutation
AML with multilineage dysplasia
AML, therapy-related
AML, not otherwise classified
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15
Q

AML-M0 things you must know

A

INCREASED myeloblasts
“Bland” blasts
MPO negative
Need markers

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16
Q

AML-M1 things you must know

A

INCREASED myeloblasts
No maturation
Auer rods
MPO positive

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17
Q

AML-M2 things you must know

A

Increased myeloblasts
Maturing neutrophils
t(8;21) in some cases

18
Q

AML-M3 things you must know

A

INCREASED promyelocytes (special)
Faggot cells
DIC
t(15;17) in all cases

19
Q

Faggot cells

A

tons of auer rods

M3

20
Q

why is AML-M3 so dangerous

A

granules stimulate clotting cascade –> clotting and then bleeding = DIC

21
Q

Treatment AML-M3

A

Use ATRA (retinoic acid) to overcome block in maturation

22
Q

Lab findings in acute leukemia

A

Blasts/immature cells in blood
Leukocytosis
Anemia
Thrombocytopenia

23
Q

AML-M4 things you must know

A

increased myeloblasts
increase monocytic cells
extramedullary tumor masses
inv(16) in some cases= good

24
Q

AML-M5 things you must know

A

Increased monocytic cells
NSE positive
M5A and M5B
Extramedullary tumor masses

25
Q

NSE specific for

A

monocytic cells

26
Q

AML-M6 things you must know

A

Inc erythroblasts, inc myeloblasts

dyserythropoiesis

27
Q

AML-M7 things you must know

A

Incr megakaryoblasts
“bland” blasts
MPO negative
need markers

28
Q

t(8;21)

A

good prognosis (common in M2)

29
Q

inv(16)

A

good prognosis (common in M4)

30
Q

t(15;17)

A

good prognosis (always in M3)

31
Q

11q23

A

worse prognosis

32
Q

AML with FLT-3 mutation

A

Mutation of FLT-3 (a tyrosine kinase)
Present in 1/3 of cases of AML!
Monocytic cells
Poor prognosis

33
Q

AML with multilineage dysplasia

A

Elderly
Severe pancytopenia
Chromosome abnormalities (5, 7)
Poor prognosis

34
Q

AML, therapy-related

A

Previous chemotherapy
2-5 years to onset
Very hard to treat

35
Q

tx AML

A

chemotherapy

bone marrow transplant

36
Q

prognosis AML

A

dismal
t(8;21), inv(16), t(15;17) better
FLT-3, therapy-related worse

37
Q

MDS

A

Problem: abnormal stem cells
Dysmyelopoiesis
Maybe inc blasts
May evolve into acute leukemia

38
Q

what does dysplasia look like - red cells

A

megaloblastic nuclei, fragmentation

39
Q

what does dysplasia look like - neutrophils

A

hypogranulation, hyposegmentation

40
Q

what does dysplasia look like - megakaryocytes

A

small, non-lobulated cells

41
Q

clinical and lab findings in MDS

A

older patients
asymptomatic, or BM failure
macrocytic anemia

42
Q

tx MDS

A

Low-grade: support, follow.

High-grade: be aggressive.

IHO Week 4 (15 decks)

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