Chapter 132 Acute Myeloid Leukemia

Question 1

What hereditary syndrome is associated with AML?

Answer 1

Trisomy 21

Down syndrome

Question 2

What inherited diseases with defective DNA repair are associated with AML?

Answer 2

Fanconi anemia
Bloom syndrome
Ataxia telangiectasia

Question 3

Survivors of the atomic bombs in Japan were exposed to ___ that can increase risk of myeloid leukemia (peak 5-7 years after exposure)

Answer 3

High dose radiation

Question 4

Solvent in chemical, plastic, rubber, pharmaceutical industries associated with increased incidence of AML?

Answer 4

Benzene

Question 5

What type of leukemia has t(15;17)?

Answer 5

Acute promyelocytic leukemia (APL)

Very good prognosis compared to other translocations

Question 6

Complete blood count picture of AML?

Answer 6

Anemia
Leukocytosis / Leukopenia / Leukocyte dysfunction
Thrombocytopenia

Question 7

Half of patients have this as the first symptom of AML?

Answer 7

Fatigue

Other symptoms: Weight loss, anorexia, weakness

Question 8

Common PE findings in AML

Answer 8

Hepatomegaly
Splenomegaly
Fever
Lymphadenopathy
Sternal tenderness

Retinal hemorrhages

Question 9

Type of anemia in AML?

Answer 9

Normocytic normochromic

Accompanied by decreased reticulocyte count

Question 10

Immediate use of platelet transfusion even if platelet count is moderately decreased in the presence of:

Answer 10

Bleeding

Question 11

Common complication in AML expected after chemotherapy that need allopurinol or hydration at diagnosis

Answer 11

Hyperuricemia

Uric acid nephropathy

Question 12

Recombinant uric oxidase useful for treating uric acid nephropathy, can normalize serum uric acid within hours with a single dose of treatment

Answer 12

Rasburicase

Question 13

Initial primary goal of treatment in AML

Answer 13

Induce complete remission (CR)

Question 14

Two phases of treatment in AML is (1) induction and (2) postremission management. What is the most commonly used CR induction regimen?

Answer 14

Cytarabine + an Anthracycline

Question 15

Toxicity in high dose cytarabine manifests as:

Answer 15

Cerebellar toxicity (irreversible)
Pulmonary toxicity

More common in elderly greater than 60 years and those with renal impairment

Question 16

Treatment of APL with this drug drastically improved outcomes, making prognosis favorable

Answer 16

Tretinoin

Question 17

Complication of tretinoin in APL

Answer 17

APL Differentiation Syndrome

• fever fluid retention dyspnea chest pain hypoxemia pleural and pericardial effusions
• due to adhesion of neoplastic cells to pulmonary vascular endothelium

Question 18

What to give for APL Differentiation Syndrome?

Answer 18

Glucocorticoids

Supportive measures

Question 19

Treatment of acute promyelocytic leukemia given during induction therapy and as maintenance therapy

Answer 19

All trans retinoic acid ATRA