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IHO Week 3 > AML and MDS - Krafts > Flashcards

AML and MDS - Krafts Flashcards

1
Q

What is AML?

A

Acute Myeloid Leukemia

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2
Q

What is MDS?

A

Myelodysplastic Syndrome

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3
Q

Acute Leukemia characteristics

A

Sudden onset
Adults or Children
Rapidly fatal without treatment
Immature cells (blasts)

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4
Q

Chronic Leukemia characteristics

A

Slow onset
ONLY in adults (>40)
Longer course
Mature cells

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5
Q

What is ALL?

A

Acute Lymphoblastic Leukemia

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6
Q

What is CLL?

A

Chronic Lymphocytic Leukemia

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7
Q

What is CML?

A

Chronic Myeloid Leukemia

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8
Q

What is the definition of Acute Leukemia?

A

Malignant proliferation of immature myeloid or lymphoid cells in the blood or bone marrow

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9
Q

What causes Acute Leukemia?

A 
Clonal Expansion
Maturation Failure (Arrest)
Usually idiopathic
Genetic disorders can predispose patients (Down's Syndrome)
Sometimes caused by toxins (Benzenes)
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10
Q

What is so bad about Acute Leukemia?

A

Crowds out normal cells
Inhibits normal cell function (making immunoglobulins)
Fill up marrow space
Infiltrate other organs

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11
Q

Describe Acute Leukemia bone marrow

A

Normal Marrow space filled with many malignant cells

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12
Q

Bone Marrow Failure in Acute Leukemia symptoms

A

Fatigue
Infections
Bleeding

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13
Q

What symptoms are associated with Acute Leukemia?

A

Sudden onset
Bone Marrow Failure
Bone Pain (expanding marrow of long bones)
Organ Infiltration (liver, spleen, brain)

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14
Q

What are the laboratory findings for Acute Leukemia?

A

Leukocytosis
Anemia
Thrombocytopenia
Blasts/immature cells in blood

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15
Q

Acute Myeloid Leukemia Characteristics

A

Malignant proliferation of myeloid blasts in blood and bone marrow
20% blast cutoff for diagnosis
Poor prognosis

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16
Q

How do you know when a leukemia is myeloid?

A 
Dysgranulopoiesis
Auer Rods
Cytochemistry
Immunophenotyping
Cytogenetics
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17
Q

What is dysgranulopoiesis?

A

Nucleus is not segmented and cytoplasm is devoid of granulation

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18
Q

What are Auer rods?

A

Thin, purple rods composed of primary granules

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19
Q

Where would you find Auer rods?

A

Malignant, Myeloid Blast cells

20
Q

How would you determine myeloid leukemia using cytochemistry?

A

Stain with non-specific esterase (turns orange)

21
Q

AML-M0

A

Acute Myeloblastic Leukemia, Minimally Differentiated

HIGH number of myeloblasts
Bland blasts = no Auer rods, no granulation
Myeloperoxidase negative
Need markers on cell surface for diagnosis = via FLOW cytometry

22
Q

AML-M1

A

Acute Myeloblastic Leukemia without Maturation

HIGH number of myeloblasts
No maturation (ALL Blasts)
Auer Rods
Myeloperoxidase positive

23
Q

AML-M2

A

Acute Myeloblastic Leukemia with Maturation

Increased number of myeloblasts
Some maturing neutrophils
Some cases have special translocation t(8;21) = better outcome

24
Q

AML-M3

A

Acute Promyelocytic Leukemia

HIGH number of promyelocytes
Faggot cells with a TON of Auer rods
DIC (Disseminated Intervascular Coagulation)
ALL cases have translocation t(15;17) = good prognosis

25
Q

What is the t(15;17) translocation involved in?

A

Retinoic Acid Receptor

Treat with All-Trans Retinoic Acid

26
Q

M0, M1, M2, M3 Acute Myeloid Leukemias

A

Involve Neutrophilic Series

Myeloblasts, Promyelocytes

27
Q

AML-M4

A

Acute Myelomonocytic Leukemia

Increased myeloblasts (20%) and monocytic cells
Extramedullary Tumor Masses
Some cases have translocation inv(16) = better prognosis
28
Q

AML-M5

A

Acute Monocytic Leukemia

Increased monocytic cells
Non-Specific Esterase Positive
Two Types: M5A and M5B
Extramedullary Tumor Masses

29
Q

M4 and M5 Acute Myeloid Leukemias

A

Involve Monocytic Series

Monoblasts

30
Q

AML-M6

A

Acute Erythroblastic Leukemia

Increased Erythroblasts and Myeloblasts
Dyserythropoiesis

31
Q

M6 Acute Myeloid Leukemia

A

Involves Erythroid Series

Erythroblasts

32
Q

AML-M7

A

Acute Megakaryoblastic Leukemia

Increased Megakaryoblasts
Bland blasts
Myeloperoxidase Negative
Need cell surface markers for diagnosis via FLOW cytometry

33
Q

M7 Acute Myeloid Leukemia

A

Involves Megakaryocytic Series

Megakaryoblasts

34
Q

AML, not otherwise classified

A

AML - M0 through M7

35
Q

AML with Genetic Abnormalities

A

Good Prognosis:
AML-M2 with t(8;21)
AML-M4 with inv(16)
AML-M3 with t(15;17)

Poor Prognosis:
AML-Monocytosis with 11q23

36
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

37
Q

AML with Multi-Lineage Dysplasia

A 
≥ 20% blasts + dysplasia in ≥ 2 cell lines
Elderly
Severe pancytopenia
Chromosome abnormalities
Poor prognosis
38
Q

AML Therapy-Related

A

Previous chemotherapy from Alkylating Agents (Busulfan) or TOPO II inhibitors (Etoposide
Onset is 2-5 years after chemo
EXTREMELY HARD TO TREAT!

39
Q

Treatment for AML

A

Chemotherapy and Bone Marrow Transplant (Curative)

40
Q

Prognosis for AML

A

Not good
Better in children than adults

Better:
t(8;21)
t(15;17)
inv(16)

Worse:
FLT-3
Therapy-Related

41
Q

Myelodysplastic Syndrome

A

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

42
Q

What does dysplasia of Red Cells look like?

A

Megaloblastic nuclei with fragmentation

43
Q

What does dysplasia of Neutrophils look like?

A

Hypogranulation and Hyposegmentation

44
Q

What does dysplasia of Megakaryocytes look like?

A

Small, non-lobulated cells

45
Q

Clinical Findings in MDS

A

Older patients
Asymptomatic or Bone Marrow Failure
Macrocytic Anemia

IHO Week 3 (14 decks)

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