Path/Leukemia Flashcards
Immunomarkers for AML
MPO
CD33 (myeloid transmem receptor)
CD13
HLA-DR
Immunomarkers for ALL
TdT
CD10 (Neprilysin/ CALLA)
CD19
CD20
AML inv(16) prognosis?
Good, use induction + ARA-C
AML t(8;21) ETO-AML prognosis?
good, use induction + ARA-C
AML t(9;11) prognosis?
intermediate
AML t(9;22) prognosis?
poor
AML t(15;17) PML-RARa treatment?
ATRA +/- ARA-C –> induction +/- arsenic
5- or 7- AML prognosis?
poor risk, start induction and allograft
FLT3-ITD+ mutation AML - prognosis and treatment?
poor, start allograft
FLT3-ITD- AML prognosis?
ARA-C (Cytarabine) and then allograft
t(9;22) BCR-ABL ALL prognosis?
poor
MLL-AF4 ALL prognosis?
poor
E2A-PBX ALL prognosis?
good
TEL-AML ALL prognosis?
good
Remission induction treatment for ALL?
VCR L-Asp ARA-C DEX or PRED \+/- Daunorubicin
Consolidation treatment for ALL?
Daunorubicin ARA-C Etoposide Etoposide Thioguanine or 6-MP Cyclophosphamide, L-ASP
Maintenance therapy for ALL
6-MP
MTX
Prednisone
TdT is a marker for these cells
Early B cells in marrow
These markers are expressed continuously throughout B cell development
CD19, CD20
What are the 5 criteria for defining a blast?
Big, high nucleus:cytoplasm, smudgy chromatin, large nucleolus, all look alike
What is basophilic stippling?
Dark dots of RNA left behind in RBCS; always pathological
What should a normal bone marrow aspirate show?
Blasts below 4.5%; myeloid:erythroid precursor ratio at least 2:1
myeloid being granulocyte + monocyte
What is the relationship between cellularity of BM and age?
100% - Age = Normal % cells
What CD marker is on both B and T cells?
CD45
WHat is a weakness of flow cytometry?
cannot assess erythroid line malignancies because RBCs are lysed
What does forward scatter measure?
cell size
How do you plot flow results initially?
CD45 (aka all lymphocytes) vs SSC
What marker is used for maturing granulocytes in flow?
CD33
What marker is best for HSCs in flow?
CD34
What are two advantages of IHC over flow?
Stain background lightly allows you to still see cell types
Better for larger cells
What is a requirement for doing cytogenetics? (not FISH)
cell must be dividing
Advantage of FISH?
Cells can be in interphase
Normal myeloid blasts would have this immunophenotype
CD33+ CD34+
Normal lymphoid blasts would have this phenotype
CD10 CD19+
What is the best way to categorize/prognosticate AML types?
Genotype
What are Class I mutations?
Proliferation and survival advantages
What are Class II mutations?
Impaired differentiation/apoptosis
What is Gilliland’s hypothesis?
Both a Class I and II mutation are needed to generate a neoplasm
Way to remember the AMLs that only need genetic analysis for diagnosis (4)
MYH INVerted Pml RUNs away
RUNX1-RUNX1T1
inv(16)
CBFB-MYH1
PML-RARA
Almost all of the AMLs we talked about are caused by these mutation types
Class II + I (Gilliland fulfilled)
t(8;21) AML - everything
Inhibited myeloid differentiation, aka backup
Gilliland fulfilled Kids/young adults Pancytopenia Blast diff blocked! CD13+ CD33+ CD34+ Auer rods, lots of blasts, Smudgy Good to chemo
t(8;21) is ETO-AML1 (RUNX1-RUNX1t1) - the blasts are “running and running” but can’t go any further down the road, so they just keep multiplying like rabbits in the summer (8/21)
APL
t(15;17)
PML-RARA fusion protein with TF+retinoic acid receptor causes INHIBITED GRANULOCYTE DIFFERENTIATION
How fix? Help it grow! –> ATRA induction
Arsenic if necessary
Presents w/ thrombocytopenia, DIC!!
CD34- (no blasts!)
HLA-DR
CD13+ CD33+ (myeloid blast markers)
BAT WING nuclei
Big blasts, few bc all are myeloid now
Auer rods
Cytoplasmic granules
Acute myelomonocytic leukemia
inv(16) or t(16;16) CBFB-MYH11
Inhibited myeloid maturation
Younger/kids
Mixed granulo/mono morphology
Inc eosinophilia
CD14+ CD11 = monocyte
CD13+ CD33+ = granulocyte
ARA-C otherwise poor prog
AML normal cytogenetics
Any age; pediatric is uncommon
Gingival hypertrophy
Molecular genetics > cytogenetics
CD34+
Lots of blasts
Undifferentiated
May affect any non-lymphatic cell type
Tell me about stratifying cytogenetically normal AML to predict helpfulness of BMT
NPM1+ or
[CEBPA+,FLT3-ITD-]
–> BMT doesn’t help
FLT3-ITD+ or
[NPMN1-,CEBPA-,FLT3-ITD-]
–> BMT helps
So remember [all negative ] means BMT and [FLT3+] also means BMT, otherwise BMT is not helpful
Markers of early B cell development
CD34
TdT
Markers of middle B cell development
CD10
CD19
Markers of late B cell development
CD20
Cyto
TFs involved in early B cell development from stem cell
SPI1
IKZF1
TF involved in middle B cell development
Pax5
ALL t(9;22) (B cell)
BCR-ABL1 fusion of two kinases (Class I)
IKZF1 TF inhibition (Class II)
Older adults + kids
(early b cell immunophenotype)
CD10+
CD19+
TdT+
Large agranular blasts
Poor prognosis
Anthracycline+Vinc+Prednisone induction
MTX + 6MP maintenance
t(v 11q23) ALL
Rearranged MLL–>decrease diff
Kids <1 yr
CD10- (helps diff between t(9;22)
CD19+
TdT+
ALL t(12;21)
TEL-AML1
Class II - inhib diff
Doesn’t support Gilliland
Kids
Big agranular blasts
Tdt+
CD20-
CD34+
Good prognosis 90% cure
T-ALL
Usually oncogene translocates to TCR promoter
Kids - thymus/lymph nodes/spleen involved
Big agranular blasts
TdT+
CD5+/CD3+ (T cell markers)
High risk