Introduction to Leukocyte Neoplasms (Part 2 Acute Leukemias ALL)

Question 1

Acute Leukemia

- Etiology (5)

Answer 1

• Oncogenic Viruses
• Genetic and congenital Factors
• Ionizing Radiation
• Chemical Agents
• Unknown

Question 2

Acute Leukemia

- Bone marrow production

Answer 2

Reduced Bone Marrow Production

• Erythrocytes —-> Anemia
• Granulocytes —> Neutropenia
• Platelets ———-> Thrombocytopenia

Question 3

Bone Marrow Failure causes what three things in acute leukemia

Answer 3

• Anemia
• Infection
• Hemorrhage

Question 4

Cell Growth occurs in what 4 tissues in acute leukemias

Answer 4

• Parenchymal Organs/Skin
• Thymus
• Cerebral Meninges
• Testes

Question 5

What is the most common cancer of childhood (what type)?

Answer 5

B-Cell ALL

Question 6

Acute Leukemias:

- Morphology

Answer 6

• Decreased platelets, anemia (due to BM failure)
• Blast Cells
• Auer Rods (in some MYELOID never LYMPHOID)

Question 7

If you have greater than 20% blast in the PB or BM what does that mean?

Answer 7

That is the WHO classification for Acute Leukemias

Question 8

ACUTE LYMPHOBLASTIC LEUKEMIA (ALL)

- Most common in who?

Answer 8

Children

Question 9

ACUTE LYMPHOBLASTIC LEUKEMIA (ALL)

- onset between what years of age?

Answer 9

1-5 years of age

Question 10

ACUTE LYMPHOBLASTIC LEUKEMIA (ALL)

- What percentages fall within different white cell ranges

Answer 10

Normal WBC ———> 25%
5-25 ———————> 50%
>100 ———————> 10%

Question 11

ACUTE LYMPHOBLASTIC LEUKEMIA (ALL)

- Purpose of immunophenotyping

Answer 11

• Distinguish blasts as lymphocytic in origin and not myeloid
• Distinguish between B Cell or T Cell
• Determines maturity of B or T cells

Question 12

ACUTE LYMPHOBLASTIC LEUKEMIA (ALL)

- Cytochemistry

Answer 12

• Myeloperoxidase: Negative
• Sudan Black B: Negative
• ANBe: Positive/Negative focal
• Periodic Acid Schiff: may be positive with BLOCK positivity

Question 13

ACUTE LYMPHOBLASTIC LEUKEMIA (ALL)

- Morphology

Answer 13

• Anemia
• Thombocytopenia
• Blasts +/-
  - small blasts, more common usually pre B-Cell
  - large blasts, usually pre T-Cell

Question 14

ACUTE LYMPHOBLASTIC LEUKEMIA (ALL)

- Immuntophenotyping for B Cell Leukemias and T Cell Leukemias

Answer 14

B: CD10+, CD19+, CD20+/-
T: CD2+, CD3+, CD4+, CD5+, CD7+; CD8+

Question 15

ACUTE LYMPHOBLASTIC LEUKEMIA (ALL)

- Terminology used in B Cell Leukemia list in order

Answer 15

Pro B-Cell
Pre-Pre B-Cell
Pre B-Cell

Question 16

T cell leukemias always involve the _____ ______ and frequently develop lesions in _____ _____or other organs

Answer 16

Bone Marrow

Lymph Nodes

Question 17

T-ALL patients have increased risk for what?

Answer 17

• risk for induction failure
• early relapse
• isolated CNS relapse

Question 18

ACUTE LYMPHOBLASTIC LEUKEMIA (ALL)

- Prognosis

Answer 18

• Depends upon lineage, cytogenetics, cell burden, and organomegaly
• survival is >85%
• poor prognosis if <1 year of age