leukemias

Question 1

acute leukemia main indication

Answer 1

blast/immature cells.

Bone aspirate smear is a must to confirm the diagnosis): >20% blasts in the bone marrow.

Question 2

in myelogenous leukemia what cells are affected

Answer 2

granulocytes or monocytws

Question 3

in lymphocytic leukemia what cells affected

Answer 3

lymphocytes are affected

Question 4

how do u differ btwn chronic and acute leukemias

Answer 4

• By the maturity of cells affected and the rapidity of disease progression:

1-Acute leukemias are characterized by rapid progression and affect immature cells (i.e., immature cells proliferate before maturation)

2-Chronic leukemias progress slowly and affect mature cells

Question 5

what is a symotom specific for AML

Answer 5

gingival hypertrophy

Question 6

specific presentation more specific to ALL

Answer 6

testicular enlargement, lymphadenopathy, bone pain

Question 7

what is the percentage in ppl of ost occurence in acute myeloid leukemia

Answer 7

80% of adult acute leukemias, 20% of childhood (<15 y/o) leukemias

Question 8

risk factors of acute myeloid leukemia

Answer 8

o Exposure to ionizing radiaAon, previous chemotherapy e.g. alkylaAng agents (secondary AML), exposure to chemicals e.g. benzene o MyeloproliferaAve syndrome o Down syndrome o Viral infecAons

Question 9

pathogenesis of AML

Answer 9

1.Loss of function of transcription factors needed for differentiation differentiation block.

2.Gain of function mutations of tyrosine kinases =enhanced proliferation

Question 10

bone marrow biopsy in AML is a defenitive test would show

Answer 10

• >20% myeloid blasts confirms AML
• Checks for Auer rods (needle-like structures in blasts)

Question 11

Chromosomal abnormaliAes in AML

Answer 11

o t (8;21) - AML1

o t (15;17) - PML/RARA

o Inversion 16 - MYH-11/Cbfb

Question 12

acute promeolyctic leukemia

Answer 12

• A variant of AML (10-15% of cases) –> cytogeneAcs: t (15;17)

• May present with pancytopenia

• Associated with coagulopathy (DIC) is almost all cases, due to release of procoagulant/profibrinolytic factors from blast cells. (major cause of early death)

• All-trans-reAnoic acid (ATRA) must be combined to the treatment

Question 13

tx of AML

Answer 13

Chemotherapy, targeted drugs, and bone marrow transplant in severe cases.

Question 14

what are two main prognostic factors in AML

Answer 14

age
cytogenetics

Question 15

gd prognostic factors in AML

Answer 15

o Favorable cytogeneAcs: T (15;17), t (8;21), inv (16)
o NPM1 mutaAon with normal FLT3
o De novo disease

Question 16

poor prognostic factors in AML

Answer 16

o Adverse cytogenetics chromosome 5 del (5q), 7 del, or complex karyotype
o Minimal residual disease posiAvity after chemotherapy
o FLT3 mutation
o Secondary disease e.g. prior MDS or MPN
o Demographics: Age >60, male gender
o High WBC

Question 17

in lymphoid leukemia there is three types of lymphocytes

Answer 17

1. B-cells
2. T-cells
3. NK cells

Question 18

what is the commonest type of leukemia in children more males and high risk in down syndrome

Answer 18

ALL

Question 19

what is the mutation in ALL

Answer 19

A genetic mutation causes uncontrolled growth of lymphoblasts (immature B or T cells).
• These blasts don’t mature or function properly, leading to low normal blood cells and leukemia symptoms.

Question 20

symptoms of ALL

Answer 20

1. Patients present with infections, lymphadenopathy and testicular enlargement and splenomegaly due to extramedullary infiltration), bone pain and arthralgia
2. May present with meningeal signs (headache, N/V, visual symptoms; especially in ALL relapse) > CNS disease

Question 21

ALL -> diagnosis depends on immunophenotyping:

Answer 21

1. B-cell: CD19, CD20, CD10, Tdt (terminal deoxynucleo.de transferase)
2. T-cell: CD3, CD5, CD7, Tdt

Note: Tdt is found in both B-cells and T-cells, help us to differentiate between myeloid & lymphoid leukemia, bcz Tdt is only found in lymphoblast cells

Question 22

in chest x ray of ALL

Answer 22

patients with ALL may have a mediastinal mass

Question 23

ALL prognosis

Answer 23

C. Achievement of first remission: 60-90%

D. Childhood ALL: 75% long-term remission (>5yr) -> better chemo tolerance, lower prevalence of
BCR- Abl fusion gene.

E. Adult ALL: 30-40% 5yr survival

Question 24

tx of ALL

Answer 24

1. Intensive Chemotherapy (Induction Phase)
   • Goal: Destroy leukemia cells and achieve remission
   
   2. CNS Prophylaxis (Prevents Brain Relapse)
      • Intrathecal chemotherapy (Methotrexate) injected into spinal fluid
   3. Consolidation & Maintenance Therapy
      • Several months to years of lower-dose chemotherapy to prevent relapse
   4. Targeted Therapy (For Specific Mutations)

Question 25

CLL

Answer 25

Chronic Lymphocytic Leukemia (CLL) is a slow-growing blood cancer where the bone marrow makes too many abnormal B-lymphocytes (B cells). These cancerous B cells don’t function properly and crowd out healthy blood cells over time. CLL is the most common leukemia in adults, especially in older people (>60 years).

Question 26

why do CLL produce Hypogammaglobulinemia

Answer 26

B cells are important in production of immunoglobulins so if they are affected the level of Igs is lower than normal

Question 27

what is chronic lymphoid leukemia associated with

Answer 27

CLL cells may process red blood cell antigens and act as antigen presenting cells, inducing a T-cell response and the formation of polyclonal antibodies by normal B cells, thus indirectly provoking autoimmune hemolytic anemia )

Question 28

blood smear in CLL

Answer 28

• Smudge Cells (Fragile CLL cells that break during preparation)

Question 29

bone marrow biopsy in CLL

Answer 29

Shows infiltration of CLL cells in the bone marrow

Question 30

Immunophenotyping (flow cytometry): in CLL

Answer 30

Classical combination: CD19, CD20 (weak), CD5, CD23, CD79 (weak) with surface immunoglobulin (Kappa and Lambda light chains)

Question 31

Cytogenetics/FISH: not essential for the diagnosis in CLL but have prognostic value. Karyotypic abnormalities include:

Answer 31

o 13q deletion: good prognosis and response to therapy o 11q or 17p (site of TP53) deletion or CD38+: poor prognosis.

Question 32

hairy cell leukemia

Answer 32

• Subtype of CLL , occurs when BM makes too many B cells , also known as B lymphocytes • Chronic B cell malignancy; occurs primarily age >50, A/W BRAF muta.on

Question 33

blood film in hairy cell leukemia

Answer 33

abnormal circulating lymphocytes with hairy cytoplasmic projection