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Block F: Immunnology > Leukemia > Flashcards

Leukemia Flashcards

1
Q

Acute lymphoblastic leukemia (ALL) sites of involvement? (4)

A
  • Bone marrow
  • CNS (usually the meninges)
  • Lymph nodes and spleen
  • Testicles
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2
Q

Acute myeloid leukemia (AML): classifications? (7)

A

 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

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3
Q

What is Leukostasis syndromes? This is seen in what?

A

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

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4
Q

What are the subtypes of Myeloproliferative neoplasm? (4)

A
  • Chronic myeloid leukemia
  • Essential Thrombocytosis: mainly platelets affected
  • Polycythemia Vera (Rubra Vera): mainly RBC affected
  • Myelofibrosis: accumulation of bone marrow fibroblasts
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5
Q

What is acute leukemia? What are the symptoms? (4)

A
  • 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
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6
Q

Acute myeloid leukemia (AML): immunochemistry? (3)

A

Immunophenotyping: AML blast are positive for:
 Early markers CD34 and CD177
 Myeloid markers CD13 and CD33
 Cytoplasmic myeloperoxidase (cMPO)

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7
Q

What is included in acute leukemias? (3)

A

Acute promyelocytic leukemia (M3) (APL)
Acute myeloid leukemia (AML)
Acute lymphoblastic leukemia (ALL)

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8
Q

Translocation of chromosome 17 and 15 is indicative of what in Acute promyelocytic leukemia (APL)?

A

Translocation of chromosome 17 and 15 is indicative of microgranular variant APL and not classic APL

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9
Q

What is chronic myeloid leukemia?

A

A subtype of myeloproliferative neoplasm where blood cell function and numbers are usually preserved

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10
Q

Acute lymphoblastic leukemia (ALL) classifications (5)

A 
•	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
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11
Q

What is chronic myeloid leukemia? What are the three different phases?

A
  • 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
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12
Q

Acute myeloid leukemia (AML): mostly present in what population?

A

> 65yrs old

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13
Q

Clinical features of acute leukemia? (10)

A 
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
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14
Q

What is Myelodysplastic syndromes/Myelodysplasia?

A

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

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15
Q

Laboratory features of acute leukemias? (10)

A 
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
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16
Q

What is chronic lymphocytic leukemia?

A

Indolent subtype of B cell lymphoma with atypical CD5 expression

17
Q

What are Myeloid malignancies? What are the 6 symptoms seen in the blood?

A 
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
18
Q

Acute promyelocytic leukemia (M3) (APL): what is it and what are the symptoms (2)

A

Acute promyelocytic leukemia (M3) (APL): fatal subtype of acute myeloid leukemia
o Symptoms:
 Pancytopenia
 Coagulation disturbances

19
Q

What is leukemia?

A

Myeloid or lymphoid cancer where the bone marrow is the primary site

20
Q

Acute myeloid leukemia (AML): morphology of cells?

A

Morphology of cells: presence of Auer rods, and cells stain positive for Sudan black or myeloperoxidase

21
Q

Acute lymphoblastic leukemia (ALL) symptoms? (4)

A
  • Cytopenia: anemia, thrombocytopenia, neutropenia
  • Bone and joint pain, fever
  • Splenomegaly
  • Lymphadenopathy
22
Q

Acute lymphoblastic leukemia (ALL) subtypes?

A
  • B lineage (most common, and most common malignancy in children)
  • T lineage
23
Q

What are the treatments for Myelodysplastic syndromes/Myelodysplasia? (6)

A
  • 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
24
Q

Acute promyelocytic leukemia (M3) (APL): Treatments (3)

A

Treatment:
 Institution of All-trans Retinoic Acid
 Arsenic Trioxide
 Chemotherapy

25
Q

What is Myeloproliferative neoplasm? What are the symptoms (3)

A

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

Block F: Immunnology (9 decks)

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