S31 Acute Leukemias

Question 1

CD34 is expressed on

Answer 1

most stem cells

Question 2

TdT expression defines a

Answer 2

lymphoid lineage

Question 3

AML is characterized by what immunological markers usually

Answer 3

CD13, CD33, CD117

Question 4

B-ALL is characterized by what immunological markers

Answer 4

TDT, CD10, CD19, cCD22

Question 5

T-ALL is characterized by what markers

Answer 5

TdT, CD2, CD3, CD7

Question 6

AML can occur with what recurrent genetic abnormalities

Answer 6

t(8;21) inv(16) t(15;17)(q22;q12); PML-RARA

Question 7

AML with recurrent genetic abnormalities and diagnostic criteria

Answer 7

detections of genetic abnormalities means that bone marrow blast cell count does not need to exceed 20% in order to make a diagnosis. have good prognosis.

Question 8

AML with myelodypslasia-related changes

Answer 8

AML associated with microscopic features of dysplasia in a least 50% of cells in at least two lineages.

Question 9

Therapy-related myeloid neoplasms (t-AML)

Answer 9

arises in patients who have been previously treated with drugs such as etoposide or alkylating agents commonly exhibit mutations in MLL gene. clinical response usually poor.

Question 10

AML, not otherwise specified

Answer 10

absence of cryogenic abnormalities and comprises around 30% of all cases. Mutations in NPM! and FLT3 genes r more freq in those with normal cryogenetics

Question 11

Myeloid sarcoma

Answer 11

rare refers to disease resembles a solid tumor but is composed of myeloid blast cells

Question 12

Myeloid proliferations related to down’s syndrome

Answer 12

children w/ Down’s syndrome increased risk of acute leukemia two myeloid variants recognized: - transient abnormal myelopoiesis, self-limiting leucocytosis -AML

Question 13

Mixed phenotype acute leukaemia

Answer 13

express two markers for both myeloid and lymphoid differentiation either on same blast cells or on two different cell populations. poor prognosis.

Question 14

Clinical features of AML

Answer 14

down marrow failure due to accumulation of malignant cells within marrow infections- frequent profound anaemia and thrombocytopenia promyelocytic variant for AML: bleeding tendency due to thrombocytopenia and disseminated intravascular coagulation (DIC) Tumour cells infiltrate variety of tissues Myelomonocytic (involves a proliferation of CFU-GM myeloblasts and monoblasts) and monocytes subtypes: Gum hypertrophy and infiltration by leukemia cells, skin involvement and CNS disease

Question 15

Favorable cytogenetics for AML

Answer 15

t(15:17), t(8;21), inv(16), Trisomy 8 No FLT3 mutation Nucleophosmin-1 mutation CEBPa mutation

Question 16

Unfavorable cytogenetics for AML

Answer 16

11q23 abnormality - MLL gene deletions of chromosome 5 or 7 TP53 mutated Abnormal (3q) t(6;11), (10;11), (9;22) FLT3 internal tandem repeat

Question 17

AML treatment overview

Answer 17

supportive and specific Induction- determine by age, cytogenetics and performance status CR 66-85% no maintenance CNS treatment - neuro deficit or headache - M4, M5 supportive care Hematopoietic cell transplantation: High risk disease, relapsed disease

Question 18

AML treatment drugs

Answer 18

most commonly used drugs: cytosine arabinoside and daunorubicin Idarubicin, mitoxantrone ALL-trans retinoid acid (ATRA) and Arsenic trioxide is used in promyelocytic leukemia (presents with bleeding)

Question 19

Neutropenia

Answer 19

decreased number of circulating neutrophils

Question 20

Causes of Neutropenia

Answer 20

Drug Toxicity (e.g. chemotherapy with alkylating drugs): damage to stem cells results in decreased production of WBCs, especially neutrophils

Severe infection (e.g., gram-negative sepsis)- Increased movement of neutrophils into tissues results in decreased circulating neutrophils

Question 21

What can be used a treatment to boost granulocyte production

Answer 21

GM-CSF

G-CSFf

Question 22

lymphopenia

Answer 22

decreased number of circulating lymphocytes

Question 23

Lymphopenia is caused by

Answer 23

Immunodeficiency (e.g. DiGeorge syndrome or HIV)

High cortisol state (exogenous corticosteroids, or cushing syndrome): induces apoptosis of lymphocytes

Autoimmune destruction (systemic lupus erythematosus)

Whole Body radiation- lymphocytes are highly sensitive to radiation; lymphopenia is earliest change to emerge after whole body radiation.