Chapter 87: AML

Question 1

COURSE AND PROGNOSIS:
Definition of Remission

Complete remission after AML therapy is defined as a neutrophil count greater than ____ and platelet count greater than ____, less than _____bone marrow blast and the absence of _____.

Answer 1

Complete remission after AML therapy is defined as a neutrophil count greater than 1 × 109/L and platelet count greater than 100 × 109/L, less than 5% bone marrow blast and the absence of extramedullary AML.

Question 2

COURSE AND PROGNOSIS:
Definition of Remission

What is CRp?

Answer 2

Remission with incomplete platelet recovery CRplatelets (CRp) has all the requirements of CR, but the platelet count does not reach 100 × 109/L.

Question 3

COURSE AND PROGNOSIS:
Definition of Remission

What is Complete Remission with Incomplete Hematologic Recovery (CRi) ?

Answer 3

5% marrow blasts, EITHER absolute neutrophil count less than 1 × 109/L or platelets less than 100 ×
109/L, and transfusion independence

Question 4

COURSE AND PROGNOSIS:
Rates of Remission

Most important predictors of treatment-related mortality

Answer 4

Performance status and age

Question 5

COURSE AND PROGNOSIS:
Rates of Remission

Initial remission rates now approach ___ in children, ___ in young adults, ___ in adults, and ____ in older patients.

Answer 5

90% in children
70% in young adults
60% in adults
40% in older patients

Question 6

COURSE AND PROGNOSIS:
Rates of Remission

Within age groups, remission is related to other variables such as _______and expression of _____ in leukemic cells, but these variables also are correlated with age at onset.

Answer 6

cytogenetic risk category and expression of MDR genes

Question 7

COURSE AND PROGNOSIS:
Rates of Remission

Can decrease the expected remission and survival rates for the age group.

Answer 7

AML evolving from a prior clonal myeloid disease or
Developing as a result of cytotoxic treatment for another cancer or immune disorder

Question 8

COURSE AND PROGNOSIS:
Clonal Remissions

T/F

A small proportion of patients who enter remission have apparently normal hematopoiesis supported by a single clone rather than the expected polyclonal hematopoiesis.

Answer 8

T

Question 9

COURSE AND PROGNOSIS:
Spontaneous Remissions

Spontaneous remissions often are durable and common.

Answer 9

Spontaneous remissions often are short-lived but have lasted up to 3 years in adults and more than 9 years in children.

Question 10

COURSE AND PROGNOSIS: LONG-TERM SURVIVAL

Abnormalities of chromosomes ____ and ____ have negative impact on outcomes after allogeneic transplant.

Answer 10

17p and −5/5q−

Question 11

COURSE AND PROGNOSIS: LONG-TERM SURVIVAL

Considering that the median age at disease onset is approximately 70 years and that 75% of patients are older than 45 years, the overall median survival is approximately ___ months.

Answer 11

12

Question 12

COURSE AND PROGNOSIS: LONG-TERM SURVIVAL

Acute leukemia survivors have been found to have same physical and mental difficulties, anxiety or depression, pain, and financial difficulties than the general population

Answer 12

False

Question 13

COURSE AND PROGNOSIS: LONG-TERM SURVIVAL

Two most compelling determinants of a poor outcome

Answer 13

Older age and less-favorable cytogenetic risk group

Question 14

COURSE AND PROGNOSIS: LONG-TERM SURVIVAL

Relapse in long-term survivors nearly always occurs in the marrow in adults and usually in the marrow in children, with occasional childhood cases of CNS or gonadal relapses occurring initially, followed by relapse in the marrow.

Answer 14

True

Question 15

TABLE 87–14.
Prognostic Factors in Acute Myelogenous Leukemia

Better prognosis than average of all patients (18)

Answer 15

1) Early blast clearance during remission induction therapy
2) Leukemic cells contain t(8;21), t(15;17), inv(16) t(16;16), triso21
3) CEBPα mutations in cytogenetically normal AML
4) Absence of exaggerated dysmyelopoiesis
5) Residual normal metaphases admixed with clonal cytogenetic abnormalities
6) High telomerase activity levels
7) Low levels of TdT expression by flow cytometry (<5%)
8) High BAX expression1419 and high BAX/BCL-2 ratios
9) High expression of integrin CD11b
10) Absence of VLA-4 expression on AML blast cells
11) High levels of soluble VCAM-1 binding to AML blast cells
12) High levels of caspase
13) Mutant CEBPα expression
14) NPM1 gene expression in adults or children (usually present in cytogenetically normal cases)
15) <5% blasts on day 14 marrow predicts for complete remission but not for overall survival
16)MiR-181a expression in NK AML
17) High methylation levels of polycomb group genes
18) Higher neutrophil and higher platelet counts at time of complete remission

Question 16

Expression of this gene product can result in decreased accumulation of anthracyclines, amsacrine, mitoxantrone, and etoposide.

Answer 16

P-glycoprotein

Question 17

TABLE 87–14.
Prognostic Factors in Acute Myelogenous Leukemia

Factors with no or uncertain prognostic findings (7)

Answer 17

1) Complex karyotype or secondary aberrations in patients with t(8;21), inv(16) t(16;16), or t(9;11)
2) Myeloid antigens: CD11b expression may be predictive of shorter survival
3) Detection of the WT1 (Wilms tumor) transcript
4) FLT3-ITD or Asp835 mutations in APL
5) Levels of initiator caspase
6) Persistent thrombocytopenia after remission induction
7) Lung resistance protein: Functional test is needed to assess activity. Expression may predict poor outcome in de novo AML

Question 18

T/F

The impact of prognostic factors is the same in patients
treated with allogeneic transplantation compared with conventional cytotoxic treatment.

Answer 18

False. The impact of prognostic factors may change in patients
treated with allogeneic transplantation compared with conventional cytotoxic treatment.