AML and MDS Flashcards
Characteristics of Acute Leukemia
Sudden onset
Adults or children
Rapidly fatal without treatment
Composed of immature cells (Blasts)
Characteristics of Chronic Leukemia
Slow onset
Only adults
Longer course
Composed of mature cells
Definition of leukemia?
malignant proliferation of immature myeloid or lymphoid cells in the bone marrow
Causes of leukemia
Clonal expansion
Maturation failure
Why is leukemia so bad?
It crowds out normal cells
Inhibits normal cell functions
Infiltrates other organs
Clinical findings in acute leukemia?
Sudden onset
Symptoms of bone marrow failure
Bone pain (expanding marrow)
Organ infiltration (liver, spleen, brain)
Signs of bone marrow failure
fatigue
infections
bleeding
lab findings in acute leukemia
blasts/immature cells in blood
Leukocytosis
Anemia
Thrombocytopenia
Acute Myeloid Leukemia
Malignant proliferation of myeloid blasts in blood, bone marrow
20% cutoff for diagnosis
subtypes
bad prognosis
What percentage of blood cells (off of total count) need to be blasts to diagnose AML?
20%
M0, M1, M2, M3
Involve neutrophilic series (myeloblasts, promyelocytes, etc.)
M4 and M5
involve monocytic series (monoblasts etc.)
M6
involves erythroid series (erythroblasts)
M7
involves megakaryocytic series (megakaryocytes)
What do you count as a blast in your 20% count?
anything with nucleus
immunophenotyping
flow cytometry for CD markers
Dysgranulopoiesis
Neutrophils don’t have enough lobes
Neutrophils don’t have granules in cytoplasm (instead of pink - clear or grey)
Auer rods
ONLY IN MALIGNANT MYELOBLASTS
Myeloperoxidase (MPO)
stains neutrophils
Chloraceteate esterase
Neutrophil stain (blue)
Non-specific esterase
Monocytes (red)
AML-M0
Increased myeloblasts
“bland” blasts
MPO negative
Needs markers to diagnose
AML-M1
Increased myeloblasts
No maturation
Auer rods
MPO positive
AML-M2
Increased myeloblasts
Maturing neutrophils
t(8;21) in some cases
AML-M3
Increased PROMYELOCYTES (not blasts) Faggot cells (many auer rods) DIC t(15;17) in all cases
What is diagnostic for AML-M3
Faggot cells
AML-M2 translocation
t(8;21)
AML-M3 translocation
t(15;17)
AML-M4 mutation?
inv(16)
AML-M5
MONOCYTES
NSE positive
extramedullary tumor masses
AML-M7
Megakaryoblasts
AML with genetic abnormalities
t(8;21) better
t(15;17) better
inv(16) better
11q23 worse prognosis
Which genetic abnormality has a worse prognosis?
11q23
AML with FLT-3 mutation
FLT-3 is a tyrosine kinase
1/3 cases of AML
Monocytic cells
Poor prognosis
AML with Multilineage Dysplasia
Elderly
Severe pancytopenia
Chromosome abnormalities (5 and 7)
Poor prognosis
AML therapy related
from previous chemotherapy
2-5 years onset
VERY hard to treat
Treatment of AML
Chemo
Bone marrow transplant
Prognosis of AML
not great
t(8;21), inv(16)and t(15;17) are better
FLT-3, therapy worse
Myelodysplastic Syndrome (MDS)
Problem: abnormal stem cells
dysmyelopoiesis
Maybe increased blasts
May evolve into acute leukemia
Dysplasia looks like…
Red cells - megaloblastic nuclei, fragmentation
Neutrophils - hypogranulation, hyposegmentation
Megakaryocytes - small, non=lobulated cells
Clinical and lab findings MDS
older patients
asymptomatic
BM failure
macrocytic anemia
Treatment and prognosis of MDS
Low grade: support and follow
High grade: be more aggressive
