Leukemia Flashcards by Mario Luna | Brainscape

Q

Leukemia

Which has a better cure rate?
Adult ALL vs. pediatric ALL

A

pediatric

Childhood ALL can now be cured in 80% to 89% of cases, with initial
remissions generally occurring in about 90%.
In adults, initial remission rates
are generally equally high, but cure rates are only in the 30% to 45% range.

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

Leukemia

Which has a better cure rate?
Pediratric ALL vs. pediatric AML

A

ALL

In
contrast to the situation in pediatric ALL, pediatric acute myeloid leukemia
(AML) generally fairs less well, with 60% cure rates, although this represents a
marked improvement since the 1970s when cure rates were roughly 20%.

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

Leukemia

This type of leukemia has the ability to progress to a more acute disease in its terminal phase (blast crisis)

A

CML

chronic myelogenous leukemia

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

Leukemia

Which of the statments is/are true?

Pathologically, CNS leukemia originates as a perivascular infiltrate along the subpial blood vessels.

As disease progresses, the leukemia infiltrates preferentially into the subarachnoid space as well as into the brain parenchyma.

A

both

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

Leukemia

Because
subdural space extends as a sheath along the optic nerve, it is standard to
include the posterior half of the eye globes within cranial radiation fields

TRUE or FALSE?

A

False.

It’s the subarachnoid not subdural

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

Leukemia

What is the role of intrathecal chemotherapy in combination with CSI?

A

cover spinal subarachnoid space

2. allows spine to be treated with a lower RT dose

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

Leukemia

Identify the FAB classification:

undifferentiated AML

A

M0, M1

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

Leukemia

Identify the FAB classification:

acute myeloid leukemia

A

M2

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

Leukemia

Identify the FAB classification:

acute promyelocytic leukemia

A

M3

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

Leukemia

Identify the FAB classification:

acute myelomonocytic leukemia with eosinophilia

A

M4Eo

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

Leukemia

Identify the FAB classification:

acute monocytic leukemia

A

M5

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

Leukemia

Identify the FAB classification:

acute erythroblastic leukemia

A

M6

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

Leukemia

Identify the FAB classification:

acute megakaryocitic leukemia

A

M7

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

Leukemia

Characteristic cell seen in AML

A

Auer rods

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

Leukemia

AML stains positively for

A

myeloperoxidase or monocyte-associated esterases.

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

Leukemia

How much blasts in the blood or marrow is required to confirm a diagnosis of AML?

A

20% (WHO classification)

30% (older FAB criteria)

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

Leukemia

This antigen is expressed in about 85% of ALL.

A

CALLA, CD10

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

Leukemia

Chromosomal abnormalities are more common in pediatric than in adult population.

TRUE or FALSE?

A

False

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

Leukemia

What is the translocation in Philadelphia chromosome?

A

t(9;22) BCR/ABL

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

Leukemia

The Philadelphia chromosome is associated with higher risk of CNS involvement but overall good prognosis

TRUE or FALSE?

A

False

poorer prognosis in general.

but if you consider TKIs, outcomes are improved.

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

Leukemia

In, ALL, hyperdiploidy (>51 chromosomes per gene) confers a favorable prognosis.

TRUE or FALSE?

A

depends.

yes in pediatric
no in adults

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

Leukemia

In, ALL, hypodiploidy (<45 chromosomes per gene) confers a favorable prognosis.

TRUE or FALSE?

A

False

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

Leukemia

B-Cell ALL

identify standard-risk population

A

1-10 years
<50,000uL presenting WBC count
no CNS involvement

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

Leukemia

B-Cell ALL

identify standard-low population

A

standard-risk
(1-10 years
<50,000uL presenting WBC count
no CNS involvement)

+ rapid early response to induction chemotherapy

Q

Leukemia

B-Cell ALL

identify high-risk population

A

opposite of standard-risk

<1 yr/>10 years
high WBC at presentation >50k uL
+CNS involvement

Q

Leukemia
ALL

CNS-1

A

no blast cells on CSF cytology

regardless of WBC

Q

Leukemia
ALL

CNS-2

A

<5 WBC/uL + blast cells in CSF cytology

but negative for Steinherz/Bleyer algorith

Q

Leukemia
ALL

CNS-3

A

<5 WBC/uL + blast cells in CSF cytology or + cranial nerve palsy

Q

Leukemia

Blasts counts of >50,000/uL are worrisome for ALL as they may cause leukostasis particularly in the vessels of the brain and lung.

TRUE or FALSE?

A

false.

up to 400k is usually tolerated for ALL.

It should be AML.
lymphoid blasts are less adhesive than myeloid blasts.

Q

Leukemia

What is the classic induction therapy for AML?

A

anthracycline (d1-3)

ctyarabine x 7d.

Q

Leukemia

What is the treatment for acute promyelocytic leukemia?

A

ATRA (all trans retinoic acid)

arsenic trioxide

Q

Leukemia

Which statement is false?

Patients younger than age 60 have CR rates of 70% to 80%, whereas older
patients tend to have lower CR rates of 30% to 50%.

Patients who develop
secondary AML following chemotherapy for other cancers have CR rates in the
30% to 50% range.

A

None

Q

Leukemia

What is the consolidative treatment for AML after remission?

or is therapy still needed?

A

4 cycles of high-dose ARA-C

or additional cycles of anthracyclines plus conventional dose cytarabine

Q

Leukemia

The role of CNS prophylaxis is not well defined for AML, particularly
because CNS relapse rates are relatively infrequent (at roughly 5% to 10%).
Some studies show no difference in relapse rates with cranial radiation.

What are the characteristics of high-risk patients that may benefit with prophylactic cranial RT?

A

high WBC count (>40.000/μL) at diagnosis

extramedullary involvement

high-risk APML

mixed phenotype acute
leukemia

or monocytic variants of AML

Q

Leukemia

What is the usual toxicity from ara-C?

A

neurotoxicity

Q

Leukemia

What is the RT dose for chloroma?

A

24 Gy / 2 / 12

Q

Leukemia

What are the four components/goals of treatment for ALL?

A

induction of remission

intensification and/or consolidation

maintenance

CNS prophylaxis

Q

Leukemia

Among high-risk
pediatric patients with ALL, allogeneic hematopoietic stem cell transplantation
was not affected by donor type

However, what is the benefit of using related-donors?

A

faster engraftment

Q

Leukemia

What are the minimum required drugs for ALL induction therapy?

A

glucocorticoid
anthracycline
vincristine
L-asparaginase

(L-a VAG)

Q

Leukemia

What is the medication added to anthracycline that serves as a cardioprotectant?

A

dexrazoxane

Q

Leukemia

What dose was used in the CSI for the studies V and VI from SJCRH that established it as the standard in the 1960s?

A

24 Gy/15-16 fx

Q

Leukemia

Due to the concerns for myelosuppresion, this trial compared and found equivalence between PCI + IT MTX vs. CSI

A

SJCRH Study VII

Q

Leukemia

What is the standard maintenance therapy for ALL following PCI + IT MTX that showed the least incidence of treatment-related leukoencephalopathy?

A

oral MTX + 6-mercaptopurine

SJCRH study VIII

Q

Leukemia

What was the PCI dose in the St. Jude Total XV trial?

A

none

they eliminated cranial RT

Q

Leukemia

The European BFM-ALL trials reduced the doses of cranial radiation.

What are their dose prescriptions?

A

12 Gy

for CNS3
24 Gy (BFM90) 18 Gy (BFM95)

Q

Leukemia

Identify patient/disease characteristics that would be considered for cranial RT prophylaxis

A

for ALL
older patients (>10)

T-cell phenotype (especially with WBC over 100k, CNS-2/3)

B-cell with MRD and adverse cytogenetics

for AML
monocytic variant

Q

Leukemia

Unless
otherwise indicated, in a specific treatment protocol, the radiation prescription
for prophylactic cranial radiation to prevent ALL relapse is:

A

18 Gy in 9 or 10 fractions.

depends on chemo, if BFM chemo is used, it can be 12 Gy.

Q

Leukemia

Richter syndrome is an agressive large B-cell lymphoma occasionally seen from a transformed CLL.

What are the characteristic findings?

A

asymmetric adenopathy,

splenomegaly,

B symptoms,

and elevated LDH.

Q

Leukemia

What chronic leukemia is characterized by the t(9;22) which results in a BCR-ABL1 fusion protein that leads to leukemic transformation?

A

CML

Q

Leukemia

Poor prognostic factors in CML

A

age >60 years

spleen >l0 cm below the costal margin

blasts >3% in blood or marrow

basophilia >7% in blood or marrow

platelets >700,000/μL.

Q

Leukemia

First line targeted agent used in the upfront therapy of CML

A

Imatinib (Gleevec)

Q

Leukemia

Poor responders to Gleevec, as well as tose with poor prognostic features are given second generation TKIs namely _____ & ______.

A

dasatinib and nilotinib

Q

Leukemia

What is the RT dose prescription for a palliative RT to CLL patients with massive splenomegaly?

A

10 to 20 Gy or lower using 25 to 100 cGy per fraction

Q

Leukemia

What is the most important predictor of survival in patients with CLL?

A

Clinical stage

There
have been many staging systems proposed, but the most widely used are those
modified by Rai et al. and Binet et al., the former used in the United States
and the latter in Europe

Q

Leukemia

What medication is the backbone of CLL treatment?

A

fludarabine

Q

Leukemia

Identify

This is a selective irreversible inhibitor
of Bruton tyrosine kinase, part of the B-cell receptor signaling cascade has been FDA approved for the upfront treatment of older
patient with CLL based on the results of the RESONATE-2 trial.

This has also been FDA approved for patients with relapsed/refractory CLL and for the upfront treatment of patients with CLL harboring a deletion in the chromosome 17p or a deletion on p53 who have
historically a poor response to traditional chemoimmunotherapy.

A

Ibrutinib

Q

Leukemia
RT

What is the typical dose prescription for testicular RT?

A

24 to 26 Gy/1.5-2

4x1 or 2x2 (if with TBI)

Q

Leukemia
RT

What is the typical dose prescription for splenic RT?

A

4 to 10 Gy (usually no more than 20)

0.25 to 1 per fraction.

titrated to until response is achieved.