Salil Goorha acute leuk lecture 3/25/13

Question 1

Define Leukemia

Answer 1

Group of heterogenous (different) diseases relating to accumulation of malignant myeloid derivatives (WBCs)

Question 2

Why does Leukemia cause a problem

Answer 2

Bone Marrow screw ups lead to anemia, neutropenia, thrombocytopenia (low plateletts.

Question 3

What classification system is used in AMerica?

Answer 3

FAB. based on morphology

Question 4

What is the most common form of leukemia in children>

Answer 4

ALL—St. Jude

Question 5

What is the distinction b/w primary and secondary AML?

Answer 5

Primary= De Novo
Secondary= develops from Myelodysplasia or something else
secondary is more difficult to treat.

Question 6

Etiology (Causes) of Acute Leukemia?

Answer 6

Mostly idiopathic, some prior radiation and chemo, benzene exposure,myelodysplastic and myeloproliferative, downs, Fanconi’s anemia, aplastic and PNH

Question 7

Where does malignant transformation arise in acute leukemia?

Answer 7

Hematopoeitic Stem Cell

Question 8

Genetic damage leads to what three things:

Answer 8

Increased proliferation, lack of differentiation, lack of apoptosis

Question 9

What does genetic damage in hematopoeitic stem cells culminate in? Something we can see under the microscope

Answer 9

Accumulation of blast cells…these are undifferentiated myeloid precursors.

Question 10

What blast cell number defines leukemia?

Answer 10

Greater that 20% in bone marrow or peripheral blood.

Question 11

How are lymphoblastic leukemias distinguished from myeloblastic?

Answer 11

Depends on whether the blasts are myeloblasts or lymphoblasts

Question 12

How do you tell a myeloblast from a lymphoblast?

Answer 12

Do immunophenotyping (flow cytometry). Look at antigen expression.

Question 13

Auer Rods are associated with what type of Acute Leukemia?

Answer 13

Acute myeloid leukemia

Question 14

BIG: What immunological markers are associated with Myeloid

Answer 14

CD33, CD13, MPO, HLA-DR

Question 15

BIG: What immunological markers are associated with Lymphoblastic Leukemia?

Answer 15

CD 10, CD 19, CD 20, TdT

Question 16

Acute Promyelocytic Leukemia is associated with which translocation

Answer 16

t (15;17)

Question 17

t (15;17) is associated with which gene fusion

Answer 17

PML-RARA.

Question 18

t (8;21) gene fusion

Answer 18

ETO-AML1

Question 19

What are the two core binding factor leukemias?

Answer 19

t(8;21) t/inv (16;16)

Question 20

Poor risk is associated with how many chromosomal changes?

Answer 20

greater than 3

Question 21

What cytogenetics are associated with good risk?

Answer 21

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

Question 22

intermediate:

Answer 22

t(9;11)

Question 23

Remission Therapy is what?

Answer 23

1 to 2 courses of intensive therapy to to achieve a complete response.

Question 24

Post-remission

Answer 24

intensive short course therapy

Question 25

Maintenance therapy

Answer 25

months to years of less intense therapy

Question 26

AML is treated with what?

Answer 26

Chemo: Remission induction therapy, post-remission, maintenance

Question 27

What drug is often used in treating older pts with AML

Answer 27

Azacitidine

Question 28

Two divisions of ALL

Answer 28

T cell and B cell

Question 29

What are the common genetic abnormalities in adults with ALL

Answer 29

MLL-AF4 and BCR-ABL…..Poor prognosis

Question 30

Common genetic abnormality in children with ALL

Answer 30

E2A-PBX and TEL-AML…..good prognosis

Question 31

What is the 3 phase treatment of ALL

Answer 31

Remission induction, Consolidation, Maintenance

Question 32

What drug counters TUmor Lysis syndrome?

Answer 32

Allopurinol