Friday - krafts 2 - Acute Myeloid Leukemias

Question 1

Clinical Sx in acute leukemia

Answer 1

Fatigue
infections
bleeding
bone pain
organ infiltration (liver, spleen, brain)

Question 2

Lab finding in acute leukemia

Answer 2

Blasts/immature cells in blood
Leukocytosis (elevated WBC)
Anemia
Thrombocytopenia

Question 3

In the context of abnormal marrow

If less that 20% of your cells in the bone marrow are nucleated cells, you have =

if its greater than 20, you have=

Answer 3

less than 20 = acute myeloid leukemia

greater = Myelodysplastic syndrome

Question 4

How do you know if a leukemia is myeloid?

Answer 4

Dysgranulopoiesis - no granules in nucleated cells, neutrophils show improper segmentation and dys- or agranulation.

Auer Rods - long needle structures that are sometimes seen in malignant myeloid blast cells.

Question 5

What type of stain can you use when studying the cytochemistry of a myeloid leukemia?

Answer 5

NSE - non-specific esterase stain - stains monocytic cells

Also myeloperoxidase for neutrophils

Question 6

What does immunophenotyping look for in cancer

Answer 6

translocations of chromosomes

Question 7

What mutation is particularly bad in AML

Answer 7

FLT-3

Question 8

AML-M0

hallmarks

Answer 8

Large increase in myeloblasts (99% of WBCs)
No maturation, Bland blast cells, no auer rods
Myeloperoxidase negative
You need markers to diagnose via flow cytometry (but this is how you Dx)

Question 9

AML-M1

hallmarks

Answer 9

Large increase in myeloblasts (99% of WBCs)
No maturation
Auer rods
Myeloperoxidase positive

Question 10

AML-M2

hallmarks

Answer 10

Increase in myeloblasts with maturing neutophils

t(8;21) in some cases - indicator of better prognosis

Question 11

AML-M3

hallmarks

Answer 11

LARGE increase in PROMYELOCYTES
Faggot cells (tons of auer rods)
Associated with Disseminated vascular coagulation (DIC)
t(15;17) in all cases
Abnormal retinoic acid receptor prevents maturation

BEST prognosis of all AML’s due to new drug all trans retinoic acid (ATRA) which prevents DIC

Question 12

AML-M4

hallmarks

Answer 12

increase in myeloblasts
increase in monocytic cells
*extramedullary tumor casses (consisting of monocytes in places like the gums. give special therapy to prevent this from going to the brain/CNS)
inv(16) in some cases - indicates better prognosis

Question 13

AML-M5

hallmarks

Answer 13

increase in monocytic cells (usually promonocytes - nucleus looks like tissue paper)
Non specific esterase positive (detects monocytes)
Extramedullary tumor masses

Question 14

AML-M6

hallmarks

Answer 14

increase in erythroblasts
increase in myeloblasts
dyserythropoiesis (abnormal looking RBCs)

Question 15

AML-M7

hallmarks

Answer 15

increase in megakaryoblasts
bland
MPO neg
Need markers and need to Dx with flow cytometry

Question 16

New classification
AML with genetic abnormalities

4 main ones

Answer 16

-good prognosis-
t(8;21) - AML-M2
t(15,17) - AML-M3
inv(16) - AML-M4

-meh-
11q23

Question 17

AML with FLT-3 mutation

Answer 17

mutation of FLT-3 causes defective tyrosine kinase - prevents maturation
very high WBC
Monocytic cells
poor prognosis

Question 18

AML with multilineage dysplasia

Answer 18

not very common
>20% blasts + dysplaisa in 2 or more cell lines
Severe pancytopenia - only leukemia that does this
chromosome 5,7 abnormalities
poor prognosis

Question 19

AML therapy related

Answer 19

Previous chemo - occurs 2-5 years later
**alkylating agents (busulfan) or topo II inhibitors (etoposide)
poor prognosis

Question 20

MDS (myelodysplastic syndrome)
hallmarks
clinical and lab findings
Tx

Answer 20

abnormal stem cells
dysmyelopoiesis
maybe increase in blast cells
can evolve into leukemia

older patients
asymptomatic or BM failure
macrocytic anemia

Tx: if low grade, support and follow. if high grade, Treat agressively. treat like AML

Question 21

hallmarks of dysplasia of bone marrow cells:

red cells
neutrophils
magakaryocytes

Answer 21

red cells: megaloblastic nuclei, fragmentation

neutrophils: hypogranulation, hyposegmentation
megakaryocytes: small, non lobulated cells