Myeloid Leukemia Clinical

Question 1

If a patient is found to have leukemoid reaction with elevated leukocytes with a specific increase of lymphocytes, what is likely non-neoplastic condiction?

Answer 1

Bordetella Pertussis

Question 2

If a patient has a neutrophil prominent leukemoid reaction, what is most common cause?

Answer 2

Infection of bacteria/virus

Question 3

What is a common mutation similar between Polycythemia Vera and Essential Thrombocytosis?

Answer 3

JAK2 Mutation V617F – over-activation

Question 4

What is “toxic change” seen histologically?

Answer 4

An increase in primary granules, compared to secondary. This is a nonspecific finding indicating neutrophil production could be occurring.

Question 5

What is most common associated with nonspecific leukocytosis of all myelocytes?

Answer 5

Chronic Myelogenous Leukemia (CML)

Question 6

What lab findings would be consistent with polycythemia vera and leukocytosis?

Answer 6

Increased RBC and Hemaglobin (18g+)

Question 7

What myelocyte condition is associated with hyperplastic bone marrow with pancytopenia?

Answer 7

Myelodysplastic Syndrome

Question 8

What myelocyte condition is usually found to have hyperplasia and leukocytosis?

Answer 8

CML, PV, PMF, and ET

Question 9

What would be the chromosomal abnormality associated with CML?

Answer 9

Leukocytes positive for Philadelphia Chromosome

— t(9;22)

Question 10

If a patient becomes diagnosed with CML with a Philadelphia chromosome, what would be the first treatment?

Answer 10

Tyrosine Kinase inhibitors!
– BCR-ABL Fusion – Use Imatinib or Dasatinib
Causes inactivation of tyrosine kinase, resulting in cell death. (Forever Treatment)

Question 11

What kind of myeloproliferative disease would you use an alkylating agent?

Answer 11

Essential Thrombocytosis

Question 12

If an acute myeloproliferative leukemia is found with a t(15,17) what should be done first?

Answer 12

All-trans retinoic acid – ATRA

Question 13

What are the common clinical symptoms of polycythemia vera?

Answer 13

• *Hepatic Venous Thrombosis
• • Pruritus after showering
• • Peptic Ulcer disease

Question 14

If a patient is have bleeding disorder and found to have disseminated intravascular coagulation, what might be a key finding on histology for diagnosis?

Answer 14

Multiple Auer Rods – AML – t(15,17)

Question 15

What are the the common chromosomal abnormalities in AML for good prognosis?

Answer 15

• • t(8,21) AML1/ETO
• • inv(16) CBFbeta/MYH11
• • t(15,17) PML/RARalpha

Question 16

What kind of leukocytic disorder is associated with hypogranular neutrophils, hypolobulated megakaryocytes, with hypercellular marrow?

Answer 16

Myelodysplastic Syndrome (if less than 20% blasts)

• • Typically older aged patient
• • Pre-leukemia disease

Question 17

What is a leading cytogenetic abnormality of Myelodysplastic Syndrome?

Answer 17

Monosomy 7 (or Monosomy 5)

Question 18

What treatment is most common employed to treat myelodysplastic syndrome?

Answer 18

Hypomethylating Drugs (Inhibits DNMT) – Decitabine –
– In theory, allows increased expression of genes allowing more cells to differentiate.
BM Transplant – can cure, but patients are usually old and high risk for them.

Question 19

What is a major risk factor for acquiring MDS later in life?

Answer 19

If the patient had undergone radiation or chemotherapy earlier in life. Can cause long term dysfunction of stem cells leading to MDS.

Question 20

What would the surface markers common seen on MDS blast cells be?

Answer 20

CD34
CD117
CD13 - nonspecific myeloid / monocyte
CD33 - nonspecific myeloid

Question 21

If a patient is found to have highly elevated WBCs with 20%+ blasts, how can you determine if AML or ALL?

Answer 21

Size of Cells / Amount of Cytoplasm
Auer Rods
MPO stain
CD13 Marker

Question 22

What is a common chromosomal abnormality in primary myelofibrosis?

Answer 22

JAK2 V617F Mutation

–treat with JAK2 inhibitor

Question 23

Why is splenomegaly common in primary myelofibrosis?

Answer 23

Since the bone marrow is fibrotic and not able to produce as many cells the spleen tries to help with production.