Leukemia

Question 1

CML

Answer 1

Granulocytic leukocytosis
Less than 5% blasts on peripheral blood smear review

WBC generally >50K

Philadelphia Chromosome 9;22 BCR-ABL

Usually transforms to AML but can do ALL

Imatinib, nilotinib, dasatinib

Question 2

AML

Answer 2

Can form de novo or evolve from other entities (PV, CML)

Symptoms of fatigue, pallor, bleeding, lymphadenopathy (rare)

Auer rods, hypercellular bone marrow with 20% blasts of more.

Pancytopenia can be presenting, thrombocytopenia with bleeding/brusing is common

Most common presentation: elevated WBC, anemia, thrombocytopenia, blasts on smear

Non-APL: 7d of cytarabine, 3d of anthracycline (doxo/daunorubicin, idararubicin, epirubicin)

Question 3

APL

Answer 3

DIC!!!!, t(15;17)

Treat with ATRA

During tx, monitor for differentiation syn (hypoxia, pulm infiltrates, fever), tx for this is steroids.

Question 4

ALL

Answer 4

Rapidly rising blast count, bulky lymphadenopathy (mediastinal), younger age, and secondary cytopenia due to BM involvment.

25% lymphoblasts in blood or bone marrow.

Frequent CNS involvement –> evaluate CSF, prophylactic intrathecal chemo

Philadelphia (9;22) is poor prognostic, but can tx with dasatinib (with dexamethasone).

Age <30, tx with aspariginase

HSCT is option

Presentation: rapidly rising blast cells, bulky lymphadenopathy (mediastinal), younger age at onset is typical.

Question 5

CLL

Answer 5

B Cell disorder, most common adult leukemia

Generally asymptomatic early, dx by lymphocytosis on cbc.

Flow cytometry CD5/23

Smudge Cells!!!!

Observe if asymptomatic, ibrutinib is first line, also rituximab and multi-agent chemo

monitor for concomitant AI disease (MAHA, ITP)

Transforms to large cell lymphoma in richter transformation.