Leukemia Flashcards
What is cytogenetics
Cytogenetic testing is the examination of chromosomes to determine chromosome abnormalities such as aneuploidy and structural abnormalities.
What is Immunophenotype
Immunophenotyping is a technique that couples specific antibodies to fluorescent compounds to measure specific protein expression within a cell population.
The protein expression is used to identify and categorize the tagged cells.
What are the two types of leukemia
Acute
- Sudden onset
- Bone marrow blasts ≥ 20%
- Progress quickly with devastating clinical course if untreated
Chronic
- Insidious onset
- Bone marrow blasts <20%
- May persist for years even without treatment
What is the age differnce for Acute Myeloid vs Acute Lymophoblastic Leukemia
AML: OLD
ALL: KIDs
All kids get leukemia
If you see Auer Rods…
Think
AML
Auer Rods + Anemia+ Thrombocytopenia
Think
AML
What the age for AML
OLD
Think “Old Mamma Aymel”
What is the WHO classification for AML
- AML with recurrent genetic abnormalities
- AML with myelodysplasia-related changes
- Therapy-related AML
- AML, not otherwise specified (NOS)
- Myeloid sarcoma
- Myeloid proliferations related to Down syndrome
What are the 4 most common variants for AML
Four most common
-T(8;21)
—Good prognosis
—Most frequent genetic abnormality in kids with AML
-APL with the PML-RARA fusion gene
—Acute promyelocytic leukemia (APL)!!
—Good prognosis; responsive to treatment
-Inv(16)
—Good prognosis
-T(9;11)
—poorer prognosis
What is APL
Acute Promyelocytic Leukemia
Variant of AML
-Infiltration of the marrow by promyelocytes
Has a vary good prognosis
A pt presents with fatigue, pallor, weakness, palpitations, and dyspnea on exertion
+bruising, petechiae, epistaxis, and gingival bleeding
+GINGIVIAL HYPERTROPHY!!
Think
Acute Myelogenous Leukemia
Look for (Auer Rods) (Acute is > 20% Blasts)
Treatment: relative emergency
Lymphoblastic that are accumulating in the meninges!!, gonads, thymus, liver, spleen or lymph nodes
Think
ALL
Acute Lymophoblastic Leukemia
Etiology of ALL
Originates in a single B- or T-lymphocyte progenitor
Proliferation and accumulation of clonal blast cells in the marrow result in suppression of hematopoiesis
How do you determine the subtype of ALL
Immunophenotyping
Classifications of ALL
B-ALL
- With recurrent genetic abnormalities
- Not otherwise specified
T-ALL
Early T Cell Precursor ALL
NK Cell ALL
Clinical presentation for ALL
Typically abrupt onset of symptoms
Variable presentation however, may also present insidiously
Fever
-Either from infection or from the leukemia itself
Pallor, fatigue, lethargy, weakness
Bone pain!!!!, arthralgia
-Leukemic expansion of the marrow or infiltration of the periosteum
Hepatomegaly, splenomegaly
Lymphadenopathy
Signs of bleeding
-Petechiae, purpura, epistaxis, gingival bleeding
What is an essential Dx procedure for a kid with ALL
Examination of the cerebrospinal fluid (CSF) is an essential diagnostic procedure
Requires lumbar puncture to evaluate for potential leukemic involvement of the CNS
Presence of leukemic blasts in CNS requires intrathecal chemotherapy
A WBC above 100,000 is indicative of…
Acute Leukemia
Emergency treatment is required witching 48hours
CLL is considered identical to…
Non-Hodgkin Lymphoma
Clinical presentation for CLL
Most common CA in western countries
As/s
Lymphadenopathy
(Cervical, Supraclavicular, and axillary)
Splenomegaly/Hepatomegaly
Immune Hemolytic Anemia
What is the hallmark of CLL
Hallmark of CLL is isolated
Lymphocytosis
Cytopenias may be present but not severe
-Neutropenia, anemia, thrombocytopenia
Peripheral smear for CLL
Small mature-appearing lymphocytes
+ smudge cells
What is Richters Transformation
An isolated lymph node transforms into a diffuse large B cell lymphoma (very aggressive)
Sudden clinical deterioration characterized by:
- Rapid development of B symptoms
- Rapidly progressive lymphadenopathy
- Increased splenomegaly
- Increased lactate dehydrogenase (LDH)
- Anemia and thrombocytopenia
5-8 months of survival
Most cases of Therapy related AML are 2/2 s
Most cases associated with two classes of chemotherapeutic agents
-Alkylating agents (e.g., cyclophosphamide, cisplatin)
Treat solid tumors, CML, leukemia, lymphoma
Latency period 5-7 years
-Topoisomerase II inhibitors (e.g., etoposide, doxorubicin)
Treat solid tumors
Breast cancer, testicular cancer, small cell lung tumors
