Nikcevich- Acute Leukemia Cases Flashcards
What is the definition of AML?
Uncontrolled clonal proliferation and accumulation of neoplastic hematopoietic precursor cells of myeloid lineage
What happens in AML that results in the sxs experienced?
Inhibition of normal hematopoiesis
Defective maturation
Dissemination into blood and other tissues
What are clinical features of AML?
Pancytopenia B symptoms Extramedullary disease Hyperleukocytosis Coagulation abnormalities
What is pancytopenia?
Anemia
neutropenia
Thrombocytopenia
What are B symptoms?
Fever, night sweats, chills, malaise, weight loss
What is hyperleukocytosis? What AMLS is it seen with?
> 100,000 blast count/ml
APML, monocytic AML
inv(16), 11q23)
DIC is seen w/ what AML?
M3
What are favorable prognostic features associated w/ AML?
<55
absence of infection
low WBC
presence of auer rods
What are “good risk” cytogenetics?
t (8;21)
t (16;16)
t (15,17)
What are unfavorable diagnostic features?
>60 presence of infection poor performance status extreme leukocytosis extramedullary disease
What is the single most important prognostic factor?
Cytogenetics
What are intermediate risk genotypes?
NPM1
FLT3
What are unfavorable risk genotypes?
del 5
del 7
trisomy 8
11q23
How do you treat AML?
7 and 3 regimen
Anthracycline plus cytosine arabinoside
What happens if remission is obtained w/ AML?
Then consolidation chemo or transplantation
What is consolidation chemotherapy? and who is it given to
High dose cytosine arabinoside x 4 cycles
Pts w/ good risk/normal cytogenetics
Why would you have a pt sign their name before receiving chemo tx w/ cytosine arabinoside?
To check for cerebellar toxicity
When is allogneic stem cell transplantation used?
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
What is the common presentation of leukemia?
Fevers, malaise, fatigue
What labs are indicative of M3?
HIGH WBC HIGH INR LOW Hg LOW platelets LOW fibrinogen--being consumed
What translocation is associated w/ M3 and what does it result in?
t(15,17)
fusion gene PML/RAR alpha
How do you treat M3?
Induction therapy w/ ATRA plus anthracycline based chemo
2 years maintenance chemo w/ ATRA, 6 MP and MTX
How do you treat someone who has a relapse w/ M3?
arsenic trioxide
What is the AML that you don’t want to miss?
M3
Pts can bleed out and die if you miss it
What is a common histological finding of M3?
Stacked auer rods
What is a common presentation associated w/ DIC?
Coagulopathy
depressed fibrinogen
thrombocytopenia
fatal hemorrhage
If pt has M3 and DI than it’s impt to start ATRA….
in < 6 hrs
Hyperleukocytosis is a common finding in what AML?
AML-M4
What is hyperleukocytosis and what are the clinical features associated with it?
VERY elevated WBC
Hyperviscosity–>HA and blurred vision
Sludging in vasculature w/ ischemia and/or infarct
In a pt w/ hyperleukocytosis, what do you do to reduce WBC to < 100K?
Leukophoresis
Normal WBC
LOW Hb
Little low platelets is associated w/ what AML?
M4
What is Quizartinib?
drug effective in relapsed
AML
May be effective bridge to transplant strategy
What are side effects of Quizartinib?
Prolonged QT
puts them at risk for ventricular ectopy
