Leukemia Flashcards
Acute lymphoblastic leukemia (ALL) sites of involvement? (4)
- Bone marrow
- CNS (usually the meninges)
- Lymph nodes and spleen
- Testicles
Acute myeloid leukemia (AML): classifications? (7)
Good risk:
• Translocation between chromosomes 8 and 21
• Translocation between two chromosmes 16 (yes, I know)
• Inversion of chromosome 16
• Translocation between chromosomes 15 and 17 (acute promyelocytic leukemia)
Moderate risk: normal karyotype or trisomy 8 or 21
Poor risk:
• Abnormalities of chromosomes 5, 7 or 11q23
• “Complex”: 3 or more abnormalities
What is Leukostasis syndromes? This is seen in what?
o Leukostasis syndromes: accumulation of blasts in microcirculation with impaired perfusion. This is seen in most acute leukemia, but not seen in acute lymphoblastic leukemia and chronic leukemias
Lungs: hypoxemia, pulmonary infiltrates
CNS: altered mental states, stroke
What are the subtypes of Myeloproliferative neoplasm? (4)
- Chronic myeloid leukemia
- Essential Thrombocytosis: mainly platelets affected
- Polycythemia Vera (Rubra Vera): mainly RBC affected
- Myelofibrosis: accumulation of bone marrow fibroblasts
What is acute leukemia? What are the symptoms? (4)
- Acute leukemia: rapid proliferation of abnormal clone that overtakes bone marrow to prevent normal hematopoiesis
For something to be acute leukemia, there must be a blast cell count >20% in the bone marrow
Symptoms:
o Severe anemia
o Thrombocytopenia
o Neutropenia
o Impaired differentiation of cells: immature appearance and little functionality
Acute myeloid leukemia (AML): immunochemistry? (3)
Immunophenotyping: AML blast are positive for:
Early markers CD34 and CD177
Myeloid markers CD13 and CD33
Cytoplasmic myeloperoxidase (cMPO)
What is included in acute leukemias? (3)
Acute promyelocytic leukemia (M3) (APL)
Acute myeloid leukemia (AML)
Acute lymphoblastic leukemia (ALL)
Translocation of chromosome 17 and 15 is indicative of what in Acute promyelocytic leukemia (APL)?
Translocation of chromosome 17 and 15 is indicative of microgranular variant APL and not classic APL
What is chronic myeloid leukemia?
A subtype of myeloproliferative neoplasm where blood cell function and numbers are usually preserved
Acute lymphoblastic leukemia (ALL) classifications (5)
• Favourable prognosis: o Hyperdiploidy (more than 46 chromosomes in metaphase) o Translocation of 12 and 21 o Trisomy 4, 10 and 17 • Poor prognosis: o Translocation of chromosomes 9 and 22 o Mutation in MLL gene
What is chronic myeloid leukemia? What are the three different phases?
- Chronic myeloid leukemia: mainly WBC affected following transformation of hematopoietic stem cell that produce uncontrolled granulocytes
o Translocation of chromosomes 9 and 22 (c-ABL for c-BCR)
Phases:
o Chronic phase: asymptomatic with occasional constitutional symptoms
o Accelerated phase: increase number of immature blast cells, rising of falling platelets, enlarging spleen
o Blast phase: acute illness when blasts >20%, collapse of bone marrow with pancytopenia similar to AML
Acute myeloid leukemia (AML): mostly present in what population?
> 65yrs old
Clinical features of acute leukemia? (10)
o Pancytopenia Bleeding, bruising Infection, sepsis Fungal infection Disseminated intravascular coagulation o Constitutional symptoms o Direct tissue infiltration by blast cells: Enlargement of liver Gum hypertrophy Bone pain o Tumour Lysis syndrome o Coagulation disturbances
What is Myelodysplastic syndromes/Myelodysplasia?
Cancerous stem cell disorder causing impaired differentiation. This cause increased growth inside the marrow, but decreased growth outside the marrow
Symptoms: cytopenia (anemia)
This can evolve to acute myeloid leukemia
Laboratory features of acute leukemias? (10)
o High or low WBC count o High PT, PTT and D-Dimers o Hyperuricemia o Increased K, PO4, Creatinine o Decreased calcium o Increased livre function tests
What is chronic lymphocytic leukemia?
Indolent subtype of B cell lymphoma with atypical CD5 expression
What are Myeloid malignancies? What are the 6 symptoms seen in the blood?
Myeloid malignancies: cancers derived from the hematopoietic stem or progenitor cell that mostly affect bone marrow Symptoms (seen in the blood): - Cytopenias o Anemia, thrombocytopenia, neutropenia o Pancytopenia (decrease in all cell lines) - Elevation in one or more line: o Erythrocytosis o Thrombocytosis o Leukocytosis o Neutrophilia
Acute promyelocytic leukemia (M3) (APL): what is it and what are the symptoms (2)
Acute promyelocytic leukemia (M3) (APL): fatal subtype of acute myeloid leukemia
o Symptoms:
Pancytopenia
Coagulation disturbances
What is leukemia?
Myeloid or lymphoid cancer where the bone marrow is the primary site
Acute myeloid leukemia (AML): morphology of cells?
Morphology of cells: presence of Auer rods, and cells stain positive for Sudan black or myeloperoxidase
Acute lymphoblastic leukemia (ALL) symptoms? (4)
- Cytopenia: anemia, thrombocytopenia, neutropenia
- Bone and joint pain, fever
- Splenomegaly
- Lymphadenopathy
Acute lymphoblastic leukemia (ALL) subtypes?
- B lineage (most common, and most common malignancy in children)
- T lineage
What are the treatments for Myelodysplastic syndromes/Myelodysplasia? (6)
- Growth factor support: ESA, G-CSF
- Demethylating agents: aza-C, decitabine
- Immunosuppression with ATG & CyA
- Lenalidomide (Revlimid) for patients with del5q karyotype
- High-dose chemotherapy
- Allogeneic stem cell transplantation
Acute promyelocytic leukemia (M3) (APL): Treatments (3)
Treatment:
Institution of All-trans Retinoic Acid
Arsenic Trioxide
Chemotherapy
What is Myeloproliferative neoplasm? What are the symptoms (3)
Myeloproliferative neoplasm: cancerous stem cells disorder of the marrow
Symptoms:
- Excessive production of one or more cell lines (WBC, RBC, platelets)
- Intact differentiation
- After several years may develop such that it mimics acute leukemia
