Hematologic part 2 Flashcards
What is the difference between acute myeloid leukemia and chronic myeloid leukemia?
Instead of having a blast issue, there’s a Philadelphia chromosome section missing.
Explain the Philadelphia chromosome issue with Chronic Myeloid Leukemia or CML.
The section known as Philadelphia chromosome will be missing from #22 and put on #9 - and fused to crease rapid division of leukocytes or wbcs due to an abnormal protein that was formed.
What is the name of the protein that causes wbc division in Chronic myeloid leukemia?
tyrosine kinase protein
What portion of the #22 was taken?
Where was it put specifically?
BCR - breakpoint cluster
It was put on the ABL viral of #9.
Who does CML typically happen to?
Its uncommon in people younger than 20, so usually older. Like 67 old.
What are the phases of Chronic Myeloid Leukemia?
Chronic > Transformation > Acute form
What is chronic CML like?
Very few symptoms. Very subtle.
What is the transformation phase of CML?
What might they start to notice sypmtom wise?
It’s when the chronic form of the myeloid leukemia is transforming into the acute form.
Symptoms of bone pain, fevers, and weight loss.
What is the Acute phase of CML?
Since they are in this phase, what are they likely to die from?
Well at this point the CML is no longer chronic. It’s transformed into AML and they are at a blast crisis.
They can die from bleeding and infection due to the Pancytopenia.
When the CML is still in the chronic phase, what are the treatment options?
Gleevec
Add on another dose of the Gleevec
Add another inhibitor
Bone marrow transplant (BMT)
What does Gleevec do to stop the CML?
Inhibits the tyrosine kinase protein that started the leukocyte issue by blocking the signal to divide.
What do patients need to avoid when taking Gleevec so that they don’t ruin absorption?
Antacids
Grapefruit juice
What is treatment like for CML that phases into the AML?
Follow treatment for AML.
Induction > Consolidation, BMT.
You are giving your CML patient Gleevec PO. What do you need to before opening the medication?
Gloves to protect yourself.
How long does a patient have to be in remission for to be considered cured?
At least 5 years
During remission, what do patients need to do?
Continue to do check ups.
Does everyone qualify for BMT?
Nope.
Should probably be under the age of 65 and otherwise healthy. But, it’s not a hard rule.
What is Acute Lymphocytic Leukemia?
Proliferation or replication of immature lymphoid stem cells that we call lymphoblasts which causes the pancytopenia.
What age will we not see Acute Lymphocytic Leukemia in?
We won’t see ALL in middle aged adults. It is common in those under 15 and also common in those above 50.
When we say the Acute Lymphocytic Leukemia causes pancytopenia, what are we referring to?
The ALL impedes on the growth of our myeloid cells like rbcs, wbcs, and platelets.
What do patients with pancytopenia look like again?
Anemic, bruising, petechiae, cold. - remember they are at a bleeding risk fyi.
In Acute lymphocytic leukemia, where do we generally see it travel to?
Where else will it go?
Liver & Spleen
Bones
CNS
We generally don’t see infiltration of leukemia cells into other organs and areas of the body with Acute Lymphocytic Leukemia.
True or false?
False.
ALL infiltration into other organs is the most common.
When you assess a patient and are trying to discover if there’s any infiltration of the liver, spleen, bones, etc. What will you be looking for?
Liver/spleen infiltration may have tenderness and rebound pain
Bone pain which may be mistaken for just being old.
How do we decrease the CNS infiltration in Acute Lymphocytic Leukemia?
Prophylactic cranial irradiation or intrathecal chemo
What is the expected outcome of ALL?
Remission but that doesn’t always happen. But the ones with other health probelms may not
What are lymphoid blast cells sensitive to during induction?
Corticosteroids
Vinca alkaloids
What is treatment like for Acute Lymphocytic Leukemia?
Induction > Testing for residual leukemia > then Consolidation
- can go back to induction if there is a relapse and include Hemo stem cell transplant
How long is Consolidation for ALL?
3 years
When do we start counting years for remission?
We start counting years after consolidation - remember 5 years at least is required.
What is ALL patients relapse?
Induction therapy is done. Then they can do HSCT or hemo stem cell transplant.
What is Chronic Lymphocytic Leukemia?
Cloning of mature & malignant B lymphocytes because they were able to escape apoptosis.
Avg age of onset for Chronic Lymphocytic Leukemia?
72 years old
Where do the the leukocytes get trapped in with Chronic Lymphocytic Leukemia?
What does it cause?
And where do you assess?
Where does it spread?
They get trapped in lymph nodes which causes enlarged nodes that are sometimes painful.
Check clavicular chain
Spreads to the liver and spleen
What is Immunophenotryping?
A work up to figure out the best treatment for the patients.
What can develop in the later stages of Chronic Lymphocytic Leukemia?
Anemia
Thrombocytopenia
- both related to autoimmune response
What presentation do those with Chronic Lymphocytic Leukemia show?
What about later on?
Often no symptoms or the type that go unnoticed or mistaken for something else. Found on physical bc of lymph nodes tho.
Later on can have B symptoms of fever, sweating at night, and weight loss. Often mistaken for flu.
What are those with chronic lymphoytic leukemia at risk for?
What does the treatment put them at risk for?
Infection risk already
With treatment, risk for bone marrow suppression and more infection.
What supportive medications will they use for those with Chronic Lymphocytic Leukemia? And for how long?
Antivirals and Antibiotics
They will use these for months after treatment to make sure to protect form infection.
