Leukemia Flashcards by Angeline Samrajakumar

Define acute leukemia

leukocytic neoplasm - cells can’t mature fast enough
> 20% blast cells (immature forms)
bone marrow failure
cancer of the bone marrow
increased number of cells in blood smear
myeloblasts and lymphoblasts

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State the cutoff percentage of blasts for the diagnosis of acute leukemia

> 20% blast cells in bone marrow

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Discuss the clinical presentation in patients with acute leukemia

CBC = increased leukocytes
bone marrow failure secondary to leukemia infiltration = pancytopenia
functional leukopenia, anemia, thrombocytopenia
tiredness due to anemia
susceptibility to infections

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Identify the etiologies of acute leukemia

chromosomal abnormalities (E.g. Down syndrome)
ionizing radiation
topoisomerase agents (chemotherapy) - receiving therapy for one type of cancer and this causes another type of cancer
Age
chemical exposure

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Differentiate between acute myeloid leukemia (AML) and acute lymphocytic leukemia (ALL) based on WBC morphology and age group affected

AML - acute myeloid leukemia
- immature granulocytes (all cells other than t, b and natural killer cells)
- myeloid cells
- FAB classification - 8 subtypes (M0 - M7)
- M3 - acute promyelocytic leukemia
- M5 - monocytic
- M6 - RBCs
- M7 - megakaryocytes
- Age 15-60 y/o
- 7 different methods of developing myeloid cells

ALL - acute lymphocytic leukemia
- lymphocytes
- T cells and B cells
- age 0-15y/o

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Identify the first progenitor cell in the bone marrow giving rise to the different hematopoietic cells

pluripotent stem cell

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Describe how the lymphoid progenitor gives rise to the B and T lymphocytes and natural killer cells

Lymphoid progenitor -> depending on which interleukin is involved -> differentiate into T or B cells

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Describe the cytokines necessary for the colony-forming unit to give rise to monocytes and neutrophils

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Describe the cytokines necessary for the colony-forming unit to give rise to basophils, eosinophils, platelets, and erythrocytes

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Which of the following is responsible for the maturation and release of eosinophils from the bone marrow?

Interleukin-5

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Which of the given interleukin families stimulates the differentiation of multipotent hematopoietic stem cells into myeloid progenitor cells?

Interleukin-3

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Define acute myeloid leukemia (AML) and its clinical presentation

> 20% blast cells
Myeloid cell leukemia
leukocytic neoplasm

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Define acute myeloid leukemia (AML) and its clinical presentation

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Identify the different types of cytogenetic abnormalities and the type of AML associated with each

t(15;17) - M3 acute promyelocytic leukemia - treated with a vitamin - ATRA (all-trans retinoic acid)
- t(15;17) gives rise to RARA (retinoic acid receptor alpha)
t(8;21) - M2 acute myeloblastic leukemia with maturation
11q23 abnormalities

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Describe the clinical presentation in myelodysplastic syndrome (MDS)

may precede AML
seen in bone marrow
pre-leukemia
probably due to treatment for cancer
blast count >10% blast but <20%
seen in patients treated with prior chemotherapy
seen in older individuals

clinical symptoms:
- pancytopenia (neutropenia = susceptible to infections)
- shift to immaturity in granulocytes (<20%)
- dysplasia in one or more lineages

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Describe the appearance of myeloid blasts in AML

abnormal myeloblast
large nuclei
prominent nucleoli
contain Auer Rods

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Describe the appearance of myeloid blasts in acute promyelocytic leukemia (APL or M3 AML)

occasional Auer rods (cytoplasmic granules) - bundles in promyelocytic leukemia
Auer rods stain for myeloperoxidase
needle-like structure

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Identify the antibody against which the azurophilic granules in APL myeloid blasts stain positive

MPO (myeloperoxidase)

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Identify the antibody against which the azurophilic granules in APL myeloid blasts stain positive

MPO (myeloperoxidase)

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Describe the FAB classification of AML

M0 - undifferentiated
M1 - AML without differentiation
M2 - AML with differentiation
M3 - acute promyelocytic leukemia (APL)
M4 - Myelomonocytic
M5 - Monocytic/ monoblastic
M6 - Erythroleukemia
M7 - Megakaryoblastic leukemia

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Identify the treatment of APL associated with disseminated intravascular coagulation (DIC)

all-trans retinoic acid alpha

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Which of the following cytogenetic abnormalities are associated with acute promyelocytic leukemia?

t(15;17)

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Which of the following translocations is associated with acute myeloblastic leukemia?

t(8;21)

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Which of values represents the percentage of blast cells in pre-leukemic conditions?

less than 20%

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Which of the following is seen in acute promyelocytic Leukemia-M3?

Auer rods

What does the FAB classification categorize M6 as?

Acute erythroid leukemia

Which of the following subtypes corresponds to acute promyelocytic leukemia?

FAB subtype M3

Which of the following classes of acute myeloid leukemia can be treated with all-trans retinoic acid?

Acute promyelocytic leukemia

What are the symptoms of AML?

- weakness, pallor, fatigue (normocytic anemia) - infection susceptibility (leukopenia) - Easy bleeding/ bruising (thrombocytopenia) - bone pain (marrow infiltration)

Describe the pathogenesis and metastatic potential of acute lymphocytic leukemia (ALL)

- defective maturation of lymphocyte precursors - can be pre-T or pre-B - can be extramedullary (lymphoblastic lymphoma) - metastasis to CNS and testicles

Define ALL

- lymphoblasts >20% - acute - two types - T cell and B cell

Describe the appearance of lymphoblasts in ALL

- scant, basophillic cytoplasm - large nuclei - smaller than myeloblasts

Differentiate between pre-B and pre-T ALL in terms of frequency, age at onset, site, WBC count, prognosis, and symptoms

pre-B - frequency: 80% - age at onset: childhood - site: bone marrow/ blood - WBC count: low/normal - prognosis: good - symptoms: pancytopenia, anemia, neurological symptoms, bone pain pre-T - frequency: 20% - age at onset: adolescence - site: mediastinal mass (hyperplasia - crushes lungs and heart) - WBC count: high - prognosis: poor - symptoms: pancytopenia, anemia, neurological symptoms, bone pain

Define chronic leukemia

- Myelocytic and Lymphocytic - cells mature in bone marrow - <10% blast cells

Give examples of chronic leukemias

- Chronic myelogenous Leukemia - Chronic lymphocytic leukemia - Hairy cell leukemia - Adult T cell leukemias/ lymphomas

To which of the following body parts is lymphoblastic lymphoma more likely to metastasize?

testicles

Which of the given factors is associated with a good prognosis in acute lymphoblastic leukemia?

Precursor B acute lymphoblastic leukemia

Identify the genetic abnormality in chronic myelogenous leukemia (CML)

- characterized by the presence of the Philadelphia chromosome t(9;22) - results in the fusion of BCR and ABL genes - ABL gene product is tyrosine kinase - which controls cell growth - the BCR/ABL fusion protein results in increased, unregulated activity of the ABL leading to uncontrolled growth of maturing myeloid cells.

Explain the pathogenesis of CML focusing on BCR and ABL genes

Describe the expected findings on peripheral blood smear in patients with CML

- increased myeloid cells - leukocytosis (mature myeloid cells) - absolute basophilia (WBC elevated) - increased immature granulocytes - myelocytes, metamyelocytes, bands, etc. - do not find blasts (as in AML)

Describe the clinical presentation and disease progression in patients with CML

- 40 y/o - insidious (most of the time) - anemia - splenomegaly - abdominal fullness - can have blast crisis - fast-paced onset

Describe the accelerated phase and the blast crisis in CML

- disease slowly progresses over years - accelerated phase - Blast crisis: identical to AML how can you tell the difference? won't see Auer rods, translocation is different, BCR/ABL gene fusion protein, tyrosine kinase

Identify the primary pharmacologic treatment option in CML

Imatinib - tyrosine kinase inhibitor drug - imatinib-resistant disease

Explain the alternative treatment options for CML

imatinib-resistant disease treated with bone marrow transplant

Which of the following translocations is associated with chronic myelogenous leukemia?

Philadelphia chromosome t(9;22)

Which of the given enzymes is a product of the BCR-ABL fusion gene?

Tyrosine kinase

Which of the following drugs is used in the treatment of chronic myelogenous leukemia?

Imatinib

Define chronic lymphoid leukemia (CLL)

- neoplasm of maturing peripheral lymphocytes - associate with SLL (small lymphocytic lymphoma) - cancer at bone marrow - circulation - lymph node (SLL) - a common cause of non-Hodgkin lymphoma is CLL/SLL - find smudge cell of cracked chromatin - spleen and liver involved - disrupts normal immune function

Describe the clinical presentation of patients with CLL

- - associate with SLL (small lymphocytic lymphoma) - cancer at bone marrow - circulation - lymph node (SLL) - a common cause of non-Hodgkin lymphoma is CLL/SLL - find smudge cell of cracked chromatin - spleen and liver involved

Discuss how CLL can disrupt normal immune function and result in autoimmune hemolytic anemia and immune thrombocytopenic purpura

- hypogammaglobinemia and increased infections - autoimmune hemolytic anemia (AIHA) - immune thrombocytopenic purpura (ITP) - affects bone marrow - B cells are reduced

Explain how CLLs can transform to more aggressive forms

Define Richter syndrome

CLL transforms into diffuse large B-cell lymphoma

Describe the appearance on peripheral blood smear of lymphocytes in CLL

- small, monomorphic lymphocytes with "cracked" chromatin - "smudge" cells - won't find reed sternberg - if it affects lymph node, it will be non-hodgkin lymphoma

Identify the age group commonly affected by CLL

- above 60 y/o

Describe the clinical presentation and prognosis in patients with CLL

- WBC count varies from normal to very high (>100,000) - insidious onset with non-specific symptoms - lymphadenopathy and hepatosplenomegaly - slow progression - death within 1 year if disease transforms

Which conditions are likely to be associated with chronic lymphoid leukemia?

Immune thrombocytopenic purpura Small lymphocytic lymphoma Hypogammaglobulinemia Autoimmune hemolytic anemia

Which cells are most often associated with chronic lymphocytic leukemia?

Smudge cells

Into what kind of aggressive lymphoma is chronic lymphocytic leukemia most commonly transformed in Richter syndrome?

Diffuse large b-cell lymphoma

Into what kind of aggressive lymphoma is chronic lymphocytic leukemia most commonly transformed in Richter syndrome?

Diffuse large b-cell lymphoma

Which of the following age groups is most frequently affected by chronic lymphocytic leukemia (CLL)?

> 60 y/o

A patient with a history of chronic lymphocytic leukemia (CLL) who now presents with new lymphadenopathy and new systemic symptoms may be experiencing what?

Richter's transformation

What best describes chronic lymphocytic leukemia (CLL)?

B cell neoplasm

Which of the following diseases or disorders is most commonly associated with chronic lymphocytic leukemia (CLL)?

Cold IgM autoimmune hemolytic anemia

What is most likely associated with chronic lymphocytic leukemia (CLL)?

often asymptomatic

Which microscopic findings is most likely associated with chronic lymphocytic leukemia (CLL)?

smudge cells - CLL cells are fragile and get damaged when the slide is prepared

Which diseases or disorders is most commonly associated with chronic lymphocytic leukemia (CLL)?

Warm autoimmune IgG hemolytic anemia

Which chromosomal translocations associated with acute lymphoblastic leukemia (ALL) most commonly has a better prognosis?

t(12;21)

Most B-cell acute lymphoblastic leukemias express which of the following?

CALLA positive common acute lymphoblastic leukemia antigen

Which of the following is a typical clinical presentation of T-cell acute lymphoblastic leukemia (ALL)?

mediastinal mass in adolescents

What is the patient demographic of acute lymphoblastic leukemia (ALL)?

< 15 y/o

Acute lymphoblastic leukemia (ALL) is most commonly known to spread to which of the following anatomical site(s)?

CNS and testicles

Leukemia Flashcards

(71 cards)