AML Handout & Flow Cytometry - Harrington Flashcards

1
Q

How should a cell sample be prepared for flow cytometry?

A

The sample must be diluted to a level that will not clog the cytometer, and it should be incubated with fluorescent antibodies.

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2
Q

What information is obtained from flow cytometry?

A

Forward scatter (size)

Side scatter (cytoplasmic complexity)

Fluorescence (immunophenotype)

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3
Q

Recall the cell lineages associated with the following CDs:

CD3

CD14

CD34

CD45

A

CD3 - T Lymphocytes

CD14 - Monocytes

CD34 - Blasts

CD45 - Leukocytes in general

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4
Q

Name 4 chromosomal aberrations associated with AML.

Which has the worst prognosis?

A

t(8;21), inv(16), t(15;17)

Bad: 11q23

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5
Q

Which mutations are associated with Auer rods?

Which is associated iwth dysplastic eosinophils?

A

t(8;21) and t(15;17)

Inv(16)

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6
Q

What is a t(15;17)-associated AML also called?

How is it treated, and why?

A

Acute Promyelocytic Leukemia (APL).

Treat with ATRA to rescue the cells from arrest of maturation.

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7
Q

What mutations are associated with myelodysplastic syndromes?

A

Monosomy 7 (7q), Monosomy 5 (5q)

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8
Q

Some chemotherapeutics can cause AML later in life. Name two such classes, and distinguish them.

A

Alkylating agents can cause AML ~5yrs later, with very poor prognosis. (5q/7q)

Topoisomerase II inhibitors can cause AML ~2.5yrs later, with poor prognosis. (11q23)

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9
Q

What is a myeloid sarcoma?

A

A solid, extramedullary solid tumor of white blood cells. It can be treated using the same means as equivalent AMLs.

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10
Q

What are the significance of markers FTL3 and NPM1?

A

These are new prognostic markers for AML. FTL3 is a receptor tyrosine kinase, whose gof mutation predicts poor prognosis. NPM1 mutation predicts a favorable prognosis (trumped by FTL3 though)

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11
Q

What is a langerhans cell histocytosis?

What factors is it associated with?

A

A solid tumor consisting of immature dendritic cells.

MHC-II, CD1a, Langerin (in Birbeck granules), BRAF.

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12
Q

Distinguish between multisystem and unisystem Langerhans cell histiocytoses.

What is the Hand-Schuller-Christian triad?

A

Multisystem is bad news. Unisystem is isolated, but both can affect any system.

Unisystem LCH of the head, resulting in Diabetes Insipidus, Exophthalmos, and Calvarial bone defect.

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13
Q

What are the primary and secondary causes of hemophagocytic lymphohistiocytosis?

A

Primary: Perforin/Granzyme mutations

Secondary: Infection, cancer, anything that can result in extreme inflammation.

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14
Q

Name some of the diagnostic criteria of HLH.

What is the most “classic” (secondary) cause?

A

Feer, cytopenias, splenomegaly, soluble CD25, hemophagocytosis, reduced NK cell activity, increased ferritin…

Lymphoma.

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15
Q

In a flow cytometry scatter plot:

Which cells are located in the bottom left?

The top left?

The bottom right?

A

Bottom left: RBCs (smallest, least complex)

Top left: Granulocytes (small but highly granular)

Bottom right: Blasts (large, variable cytoplasmic complexity)

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