B-ALL Flashcards

1
Q

B-ALL Morphologically and IMPT defined

A

>20% Blasts

Pro-B: CD19, CD22, CD79a and TdT
Common-B: CD10
Pre-B: cIgM
Transitional-B: HC but not LC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Features of B-ALL with high hyperdiploidy

A
  • 51-56 chromosomes
  • Kids
  • Mutation in RTK-Ras pathway
  • Good Prognosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Features of B-ALL with hypodiploidy

A
  • < 43 chromosomes
  • Teens and adults
  • TP53 mutations
  • Poor Prognosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Modalities for detection of aneuploidy

A

I. Karyotype
* Metaphase
* 20 cells cultured
* 2 cells for abN and 3 cells for loss of chromosome

II. FISH
* Interphase

III. Flow
* DNA Index (DI)
* Ratio of MFI Blasts : Normal cells
* < 0.9 Hypodiploidy and > 1.16 Hyperdipoidy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q
A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Features of B-ALL with BCR::ABL1

A
  • t(9;22) p190
  • Increases with age
  • Myeloid Markers CD13, CD33 (and CD25)
  • Poor prognosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Features of B-ALL with KMT2A

A
  • 11q23 (+++ fusion partners)
  • Infants
  • > WCC and CNS involvement
  • Positive for CD19, Negative for CD10, TdT and CD24
  • Myeloid markers CD15 and CD65
  • Poor prognosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Features of B-ALL with TCF::PBX1

A
  • t(1;19)
  • Kids
  • Pre-B: CD19, CD10 and cIgM
  • Bright CD9 and Dim to negative CD34
  • Intermediate risk
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Features of B-ALL with TCF3::HLF

A
  • t(19;17)
  • Rare
  • Kids
  • Poor prognosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Features of B-ALL with IgH::IL3

A
  • t(5;14)
  • Kids and teens
  • Eosinophils with low/no PB blasts
  • Common-B: CD19 and CD10
  • Myeloid markers CD13, CD33 and CD123
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Features of B-ALL with ETV6::RUNX1

A
  • t(12;21)
  • kids
  • Positive CD9, CD20, CD66c and CD17
  • Myeloid Markers CD13 and CD33
  • Good prognosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Features of B-ALL with iAMP21

A
  • Kids
  • Low WCC
  • Poor prognosis (High relapse rate)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Features of B-ALL with BCR::ABL1-like

A
  • Mutations consituitively activate JAK/STAT
  • > with age and DS
  • High WCC
  • Poor prognosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Features of B-ALL with ETV6::RUNX1-like

A
  • Kids
  • CD27 Positivity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

DDx for B-ALL with Myeloid Markers

A
  1. BCR::ABL1 (CD13,CD33 and CD25)
  2. KMT2A (CD15 and CD65)
  3. IgH::IL3/t(5;14) (CD13, CD33 and CD123)
  4. ETV6::RUNX1/t(12;21) (CD13, CD33)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Predictors of adverse prognosis in B-ALL (6)

A
  1. Age < 1 & > 10 (Africans and Boys)
  2. WCC > 50
  3. Slow blast clearence
  4. Genomic entities (Hypodiploidy)
  5. MRD post-induction and consolidation (Nr 1 predictivie factor - MRD Neg = < 0.01%)
  6. CNS involvement
17
Q

Treatment options for B-ALL

A

Chemo±Immunotherapy:
I. Chemo:
* BFM (Berlin, Frankfurt and Munster) protocol
* HyperCVAD (Cyclophos, Vincristine, Doxorubicin, Dexa

II. Immuno:
* Mabs (Ritux)
* TKI (for BCR::ABL1)
* ADCs (Inotuzumab)
* T-cell engagers (Blinatumumab)
* CART (CD19 and CD22)

18
Q
A