Hubbard leukemia Flashcards
what toxin is linked to AML
benzene
Treatment related AML in patients who received chemo for prior cancers . . what kind of agents?
alkylators
What kind of leukemia is NOT caused by radiation
CLL
in older patients with mild pancytopenia and macrocytosis, if you offer the diagnosis of these 2 things you will look like a rockstar
- myelodysplasia
- early AML
transfustion for APL
t(15;17)
in the acute leukemias (especially ALL) patients often complain of what
bone pain
- cutaneous manifestation of AML
- biopsy demonstrates myeloblasts in the dermis
- can be confused with pyoderma gangrenosum
Sweet’s syndrome aka acute febrile neutrophilic dermatosis (AFND)
how do you treat Sweet’s syndrome (AFND)
manage the AML
azurophilic rods in the cytoplasm of patients with AML
Auer rods
when Auer rods resemble a bundle of sticks in some patients with APL
faggot cells
What types of AML most commonly have gingival hypertrophy
M4 (acute myelomonocytic)
M5 (Acute monocytic)
Multiple smudge cells are seen in what
CLL
remnant of mitiotic spindle usually in erythrocytes
cabot rings
foamy big cells in bone marrow and not in peripheral blood
Gaucher cells
normal LDH
under 250-300
normal uric acid
7
when are schistocytes seen?
microangiopathic hemolytic anemia like TTP and HUS
normal level of fibrinogen
400
when do you see increased lysozyme levels
monocytic leukemias . . M4 and M5
patient with DIC and APL should be treated with what?
- All-trans retinoic acid (ATRA) or
- arsenic trioxide
what is 2-chlorodeoxyadenosine used for
hairy cell leukemia
what is the backbone of induction therapy for ALL
Vincristine and prednisone
what is a hypomethylating agent used for myelodysplastic syndrome
Decitabine
t(12;21)
All
Trisomy 8
MDS . .better prognosis
t(8;21)
M1 and M2 AML
5q-
MDS . . will respond to an imide drug
neurological symptoms in ALL due to what
Leptomeningeal carcinomatosis . . . 35% of ALL patients
Diplopia can be found in what leukemia?
What nerve is susceptible?
ALL
CN6
t(4;11)
Classic L2 ALL . . most common type of acute leukemia
7q-
MDS
inv(16)
MDS . . . also AML
treatment for diplopia in ALL
intrathecal methotrexate
Catheter inserted b neurosurgeon into a lateral ventricle with a subcutaneous reservoir for delivery of intrathecal therapies. In palliative care, for delivery of intrathecal morphine
Ammaya reservoir
what does kikuchi Disease cause
massive LAD in cervical
man comes in with no complaints. only bilateral small cervical adenopathy and elevated WBC and lymphs. . what best test to further evaluate
peripheral blood lymphocyte flow cytometry . . quick and ease
TRAP stain of peripheral blood lymphocytes
hairy cell leukemia
Rai staging for CLL
0: lymphocytosis only
1: + LAD
2: + organomegaly (spleen and liver)
3: +anemia (Hb less than 11)
4: +thrombocytopenia (less than 100k)
0-1: low risk
2: intermediate
3-4: high risk
77 year old with CLL asymptomatic . . treat how
Observation
trisomies associated with ALL
4, 10, 17
What are the monsomies of AML that carry poor prognosis
5 and 7
Treatment of AML
- most with combo of anthracycline (daunorubicin or idarubicin)
- AML patients who are older and not candidates for traditional therapy: 5-azacitidine or decitabine
treatment of ALL
combo: daunorubicin, vincristine, prednisone, and asparaginase.
- if patient has bcr-abl positivity, a tyrosine kinase inhibitor, dasatinib should be added
after remission, what should ALL patients receive
CNS prophylaxis so that meningeal sequestration of leukemic cells doesn’t develop
diagnosis of chronic leukemia
- B cell lymphocytosis>5000
- Coexpression of CD19, CD5 (only in CLL and mantle cell lymphoma)
- CLL differentiated from mantle cell lymphoma by expression of CD23 and low expression of surface immunoglobulin and CD20
indications for treatment of CLL
- progressive fatigue
- symptomatic lymphadenopathy
- anemia
- thrombocytopenia
initial treatment for CLL in under 70 patients
-combo of fludarabine plus rituximab with or without cyclophosphamide
treatment of older frail patients with CLL that have indications for treatment
chlorambucil orally every 3 weeks for 6 months
What can be used in patients with relapsed/refractory CLL in those with deletion of 17p
ibrutinib
Ph chromosome
9,22 fusion
Treatment of CML
- targeted at bcr abl tyrosine kinase
- first gen: imatinib
- 2nd gen: dasatinib and nilotinib
- pts on TK inhibitors should be monitored with a quantitative PCR assay to check levels of bcr/abl
Treatment for Hairy Cell leukemia
-IV cladribine daily for 7 days