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IHO Week 4 > Nikcevich- Acute Leukemia Cases > Flashcards

Nikcevich- Acute Leukemia Cases Flashcards

1
Q

What is the definition of AML?

A

Uncontrolled clonal proliferation and accumulation of neoplastic hematopoietic precursor cells of myeloid lineage

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2
Q

What happens in AML that results in the sxs experienced?

A

Inhibition of normal hematopoiesis
Defective maturation
Dissemination into blood and other tissues

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3
Q

What are clinical features of AML?

A 
Pancytopenia
B symptoms
Extramedullary disease
Hyperleukocytosis
Coagulation abnormalities
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4
Q

What is pancytopenia?

A

Anemia
neutropenia
Thrombocytopenia

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5
Q

What are B symptoms?

A

Fever, night sweats, chills, malaise, weight loss

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6
Q

What is hyperleukocytosis? What AMLS is it seen with?

A

> 100,000 blast count/ml
APML, monocytic AML
inv(16), 11q23)

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7
Q

DIC is seen w/ what AML?

A

M3

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8
Q

What are favorable prognostic features associated w/ AML?

A

<55
absence of infection
low WBC
presence of auer rods

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9
Q

What are “good risk” cytogenetics?

A

t (8;21)
t (16;16)
t (15,17)

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10
Q

What are unfavorable diagnostic features?

A 
>60
presence of infection
poor performance status
extreme leukocytosis
extramedullary disease
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11
Q

What is the single most important prognostic factor?

A

Cytogenetics

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12
Q

What are intermediate risk genotypes?

A

NPM1

FLT3

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13
Q

What are unfavorable risk genotypes?

A

del 5
del 7
trisomy 8
11q23

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14
Q

How do you treat AML?

A

7 and 3 regimen

Anthracycline plus cytosine arabinoside

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15
Q

What happens if remission is obtained w/ AML?

A

Then consolidation chemo or transplantation

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16
Q

What is consolidation chemotherapy? and who is it given to

A

High dose cytosine arabinoside x 4 cycles

Pts w/ good risk/normal cytogenetics

17
Q

Why would you have a pt sign their name before receiving chemo tx w/ cytosine arabinoside?

A

To check for cerebellar toxicity

18
Q

When is allogneic stem cell transplantation used?

A

Poor risk cytogenetics
Intm risk cytogenetics w/ matched sibling donor
Extramedullary disease
1st or 2nd relapse
Donor sources include siblings, children, parents, MUD, umbilical cord blood

19
Q

What is the common presentation of leukemia?

A

Fevers, malaise, fatigue

20
Q

What labs are indicative of M3?

A 
HIGH WBC
HIGH INR
LOW Hg
LOW platelets
LOW fibrinogen--being consumed
21
Q

What translocation is associated w/ M3 and what does it result in?

A

t(15,17)

fusion gene PML/RAR alpha

22
Q

How do you treat M3?

A

Induction therapy w/ ATRA plus anthracycline based chemo

2 years maintenance chemo w/ ATRA, 6 MP and MTX

23
Q

How do you treat someone who has a relapse w/ M3?

A

arsenic trioxide

24
Q

What is the AML that you don’t want to miss?

A

M3

Pts can bleed out and die if you miss it

25
Q

What is a common histological finding of M3?

A

Stacked auer rods

26
Q

What is a common presentation associated w/ DIC?

A

Coagulopathy
depressed fibrinogen
thrombocytopenia
fatal hemorrhage

27
Q

If pt has M3 and DI than it’s impt to start ATRA….

A

in < 6 hrs

28
Q

Hyperleukocytosis is a common finding in what AML?

A

AML-M4

29
Q

What is hyperleukocytosis and what are the clinical features associated with it?

A

VERY elevated WBC

Hyperviscosity–>HA and blurred vision

Sludging in vasculature w/ ischemia and/or infarct

30
Q

In a pt w/ hyperleukocytosis, what do you do to reduce WBC to < 100K?

A

Leukophoresis

31
Q

Normal WBC
LOW Hb
Little low platelets is associated w/ what AML?

A

M4

32
Q

What is Quizartinib?

A

drug effective in relapsed
AML
May be effective bridge to transplant strategy

33
Q

What are side effects of Quizartinib?

A

Prolonged QT

puts them at risk for ventricular ectopy

IHO Week 4 (15 decks)

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