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Hematology > Leukemia > Flashcards

Leukemia Flashcards

1
Q

Define acute leukemia

A
  • 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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2
Q

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

A

> 20% blast cells in bone marrow

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3
Q

Discuss the clinical presentation in patients with acute leukemia

A
  • 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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4
Q

Identify the etiologies of acute leukemia

A
  • 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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5
Q

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

A

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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6
Q

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

A

pluripotent stem cell

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7
Q

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

A

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

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8
Q

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

A

.

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9
Q

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

A

.

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10
Q

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

A

Interleukin-5

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11
Q

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

A

Interleukin-3

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12
Q

Define acute myeloid leukemia (AML) and its clinical presentation

A
  • > 20% blast cells
  • Myeloid cell leukemia
  • leukocytic neoplasm
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13
Q

Define acute myeloid leukemia (AML) and its clinical presentation

A
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14
Q

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

A

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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15
Q

Describe the clinical presentation in myelodysplastic syndrome (MDS)

A
  • 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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16
Q

Describe the appearance of myeloid blasts in AML

A
  • abnormal myeloblast
  • large nuclei
  • prominent nucleoli
  • contain Auer Rods
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17
Q

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

A
  • occasional Auer rods (cytoplasmic granules) - bundles in promyelocytic leukemia
  • Auer rods stain for myeloperoxidase
  • needle-like structure
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18
Q

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

A

MPO (myeloperoxidase)

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19
Q

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

A

MPO (myeloperoxidase)

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20
Q

Describe the FAB classification of AML

A

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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21
Q

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

A
  • all-trans retinoic acid alpha
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22
Q

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

A

t(15;17)

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23
Q

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

A

t(8;21)

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24
Q

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

A

less than 20%

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25
Q

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

A

Auer rods

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26
Q

What does the FAB classification categorize M6 as?

A

Acute erythroid leukemia

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27
Q

Which of the following subtypes corresponds to acute promyelocytic leukemia?

A

FAB subtype M3

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28
Q

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

A

Acute promyelocytic leukemia

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29
Q

What are the symptoms of AML?

A
  • weakness, pallor, fatigue (normocytic anemia)
  • infection susceptibility (leukopenia)
  • Easy bleeding/ bruising (thrombocytopenia)
  • bone pain (marrow infiltration)
30
Q

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

A
  • defective maturation of lymphocyte precursors
  • can be pre-T or pre-B
  • can be extramedullary (lymphoblastic lymphoma)
  • metastasis to CNS and testicles
31
Q

Define ALL

A
  • lymphoblasts >20%
  • acute
  • two types - T cell and B cell
32
Q

Describe the appearance of lymphoblasts in ALL

A
  • scant, basophillic cytoplasm
  • large nuclei
  • smaller than myeloblasts
33
Q

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

A

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

34
Q

Define chronic leukemia

A
  • Myelocytic and Lymphocytic
  • cells mature in bone marrow
  • <10% blast cells
35
Q

Give examples of chronic leukemias

A
  • Chronic myelogenous Leukemia
  • Chronic lymphocytic leukemia
  • Hairy cell leukemia
  • Adult T cell leukemias/ lymphomas
36
Q

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

A

testicles

37
Q

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

A

Precursor B acute lymphoblastic leukemia

38
Q

Identify the genetic abnormality in chronic myelogenous leukemia (CML)

A
  • 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.
39
Q

Explain the pathogenesis of CML focusing on BCR and ABL genes

A
  • 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.
    (too much tyrosine kinase produced)
40
Q

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

A
  • 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)
41
Q

Describe the clinical presentation and disease progression in patients with CML

A
  • 40 y/o
  • insidious (most of the time)
  • anemia
  • splenomegaly
  • abdominal fullness
  • can have blast crisis - fast-paced onset
42
Q

Describe the accelerated phase and the blast crisis in CML

A
  • 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
43
Q

Identify the primary pharmacologic treatment option in CML

A

Imatinib
- tyrosine kinase inhibitor drug
- imatinib-resistant disease

44
Q

Explain the alternative treatment options for CML

A

imatinib-resistant disease treated with bone marrow transplant

45
Q

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

A

Philadelphia chromosome
t(9;22)

46
Q

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

A

Tyrosine kinase

47
Q

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

A

Imatinib

48
Q

Define chronic lymphoid leukemia (CLL)

A
  • 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
49
Q

Describe the clinical presentation of patients with CLL

A
    • 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
50
Q

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

A
  • hypogammaglobinemia and increased infections
  • autoimmune hemolytic anemia (AIHA)
  • immune thrombocytopenic purpura (ITP)
  • affects bone marrow
  • B cells are reduced
51
Q

Explain how CLLs can transform to more aggressive forms

A
52
Q

Define Richter syndrome

A

CLL transforms into diffuse large B-cell lymphoma

53
Q

Describe the appearance on peripheral blood smear of lymphocytes in CLL

A
  • small, monomorphic lymphocytes with “cracked” chromatin
  • “smudge” cells
  • won’t find reed sternberg - if it affects lymph node, it will be non-hodgkin lymphoma
54
Q

Identify the age group commonly affected by CLL

A
  • above 60 y/o
55
Q

Describe the clinical presentation and prognosis in patients with CLL

A
  • 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
56
Q

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

A

Immune thrombocytopenic purpura
Small lymphocytic lymphoma
Hypogammaglobulinemia
Autoimmune hemolytic anemia

57
Q

Which cells are most often associated with chronic lymphocytic leukemia?

A

Smudge cells

58
Q

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

A

Diffuse large b-cell lymphoma

59
Q

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

A

Diffuse large b-cell lymphoma

60
Q

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

A

> 60 y/o

61
Q

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

A

Richter’s transformation

62
Q

What best describes chronic lymphocytic leukemia (CLL)?

A

B cell neoplasm

63
Q

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

A

Cold IgM autoimmune hemolytic anemia

64
Q

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

A

often asymptomatic

65
Q

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

A

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

66
Q

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

A

Warm autoimmune IgG hemolytic anemia

67
Q

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

A

t(12;21)

68
Q

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

A

CALLA positive
common acute lymphoblastic leukemia antigen

69
Q

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

A

mediastinal mass in adolescents

70
Q

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

A

< 15 y/o

71
Q

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

A

CNS and testicles

Hematology (2 decks)

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