Lukemia

Question 1

Myelogenous Leukemia

Answer 1

Leukemia characterized by proliferation of myeloid tissue (as of the bone marrow and spleen) and an abnormal increase in the number of granulocytes, myelocytes, and myeloblasts in the circulating blood

Question 2

Development of Leukemia in the Bloodstream

Answer 2

Stage 1- Normal
Stage 2- Symptoms
Stage 3- Diagnosis
Stage 4- Worsening
Stage 5a- Anemia
Stage 5b- Infection

Question 3

Acute myeloid leukemia (AML) Etiology

Answer 3

Genetic damage to the DNA of a single cell in the bone marrow that primarily affects older people.

Question 4

Acute myeloid leukemia (AML)

Answer 4

cancer of the blood-forming tissue (bone marrow).

causes bone marrow to produce too many immature white blood cells (blast cells).
Suppresses normal blood cell production.
…leads to Anemia, leukopenia, thrombocytopenia

Question 5

Acute Myeloid Leukemia (AML) Physical Findings

Answer 5

Fever (unexplained for >3 weeks)
Multiple bruises
Unexplained infections
Bleeding/bruising/petechiae (gingivae, GI bleed)
Splenomegaly
Sternal tenderness

Question 6

Treatments for AML

Answer 6

Chemotherapy
	Phase One – Induction therapy
	Phase Two – Intensification therapy
	Phase Three – Maintenance
Radiation therapy for certain cases
Bone marrow transplantation

Question 7

Acute Lymphoid Leukemia (ALL) Incidence

Answer 7

Mostly affects children, accounts for 3/4 of childhood leukemia (peak age 4 years)

Comprises less than 30% of leukemia in young adults

May be B-cell, T-cell, or null-type (non-B, non-T cell)

Question 8

Acute Myeloid Leukemia (AML) Presenting Symptoms

Answer 8

Fatigue
Shortness of breath on exertion
Easy bruising
Bleeding in the nose or from the gums
Prolonged bleeding from minor cuts
Recurrent minor infections or poor healing of minor cuts
Loss of appetite or weight loss
Mild fever

Symptoms usually present for 3 or more months before diagnosis is made

Question 9

ALL Common Sx with children:

Answer 9

Fever
Bleeding
Easy bruising
Petechiae
Bone pain
Fatigue
Shortness of breath
Weight loss / failure to thrive

Question 10

Acute Lymphoid Leukemia (ALL)

Answer 10

Clonal proliferation and accumulation of blast cells in blood, bone marrow and other organs

Disorder originates in single B or T lymphocyte progenitor

Heterogenous disease with different biological subtypes

Incidence in adults : 20% of acute leukemias
Etiology - unknown

Question 11

Acute Lymphoid Leukemia (ALL) Hematological Findings

Answer 11

Anemia (normochromic, normocytic)

WBC < 5,000 (or > 25,000)
Leukocytosis (median = 15,000)

Thrombocytopenia

Smear, Blast cells (< 50,000)

Question 12

Immunologic classification of ALL

Answer 12

B- lineage (85%) Markers:
Typically is CD10+, CD19+, and sometimes CD20+

T-lineage (15%):
Positive for CDs 2, 3, 4, 5, 7, and 8.

Question 13

Chronic Myeloid Leukemia (CML)

Answer 13

Proliferative disorder of hematopoietic stem cells

Well-characterized clinical course

Philadelphia (Ph) chromosome (Unique chromosomal abnormality)

Bcr-Abl tyrosine kinase: A single molecular abnormality that causes transformation of a hematopoietic progenitor into a malignant clone

Question 14

Chronic Myeloid Leukemia (CML) Incidence

Answer 14

1-2 cases per 100,000 people/year

Higher among men than women

Median age of presentation is 50 yo

Question 15

Chronic Myeloid Leukemia (CML) Clinical Features

Answer 15

40% asymptomatic
Chronic phase
Splenomegaly often massive (Increasing abdominal girth)
Features of anaemia
Abnormal platelet function (Bruising, epistaxis, menorrhagia)
Hyperleukocytosis 
Chronic infection
Fever

Question 16

Chronic Lymphoid Leukemia (CLL)

Answer 16

Overall median survival is 10 years

Individual prognosis is highly variable

Clinical staging systems:
Mainstay of assessing prognosis
Only requires examination and blood count
Used to determine when to start therapy

Question 17

Chronic Lymphoid Leukemia (CLL) Incidence

Answer 17

4-7 new cases per 100,000 people per year

Comprises 30% of all cases of leukemia

Most common lymphoid leukemia

Question 18

Chronic Lymphoid Leukemia (CLL) Common Symptoms

Answer 18

Note: approximately 25% of patients are asymptomatic at the time of diagnosis
 Fever 
 Night sweats 
 Fatigue
 Pallor
 Shortness of breath
 Easy bruising
 Gingival bleeding
 Weight loss
 Frequent infections
 Fever
 Splenomegaly and/or hepatomegaly
 Lymphadenopathy

Question 19

Rai Staging

Answer 19

0. Lymphocytosis (>5 G/L)
   I. Lymphocytosis + lymphadenopathy

II.Lymphocytosis + splenomegaly +/-lymphadenopathy

III. Lymphocytosis + anemia (Hb <100G/L) +/- anemia +/-lymphadenopathy +/- splenomegaly

Question 20

Binet Staging

Answer 20

A. < 3 involved areas, Hb > 10g%, Plt > 100G/L
B. > 3 involved areas, Hb > 10g%, Plt > 100G/L
C. Any number of involved areas, Hb < 10g%, Plt < 100G/L

Question 21

Hairy Cell Leukemia

Answer 21

2% of all adult leukemias
Usually in males > 40 years old
Chronic disease of lymphoproliferation
B lymphocytes that infiltrate the bone marrow and liver

Question 22

Hairy Cell Leukemia Incidence

Answer 22

Rare
Men….55 yo
Decreased WBC’s/platelets

Question 23

Hairy Cell Leukemia Clinical Presentation

Answer 23

Splenomegaly
Pancytopenia
Infection
Vasculitis