Usera: Acute and Chronic Leukemias Flashcards
Who gets ALL?
children (0-14yo)
**75% of cases in children under 6yo
Who gets AML?
adolescents to middle-aged adults (15-59)
Who gets AML/CML?
adult 40-60+
Who gets CLL?
elderly adults
Where are cells arrested in acute myelogenous leukemia?
maturation arrest in granulocyte development, leads to proliferation of malignant precursor cells
What are 4 clinical features of AML (acute myelogenous leukemia)?
- anemia
- thrombocytopenia
- neutropenia
- leukocytosis with increased blasts
What are 4 signs and symptoms of acute myelogenous leukemia?
- fatigue
- bleeding/bruising
- DIC
- gum infiltration
What are auer rods? What cells are they unique to?
primary granules; unique to myeloid lineage
Acute promyelocytic leukemia makes up 5-8% if AML. What chromosome translocation is common?
t(15:17)(q22:q12)
Who usually gets acute promyelocytic leukemia (APML)?
any age, usu 3-5th decade of life
What are some clinical features of acute promyelocytic leukemia?
frequently presents with DIC (acute hypercoagulative state)
rapid doubling time
large numbers of Auer rods
What genes are translocated in a t(15;17) translocation in pts with APL?
PML and RARA (retinoic acid receptor)
What do you use to treat acute promyelocytic leukemia?
ATRA and alkylating agent
**80-90% remission
What is a characteristic feature of acute monocytic leukemia? Are auer rods common?
gum infiltration (malignant cells deposit themselves in the gingiva); no auer rods are rare
What chromosome abnormality is associated with chronic myelogenous leukemia?
de novo mutation in Philadelphia chromosome
**balanced translocation in (9;22) BCR-ABL fusion gene
Explain how the de novo mutation in the Philadelphia chromosome leads to chronic myelogenous leukemia.
BCR-ABL fusion gene produces a tyrosine kinase which is ALWAYS active, leading to dysregulation of proliferation and normal apoptosis
What are some clinical features of chronic myelogenous leukemia (CML)?
all the different granulocytes present; fever, night sweats, weight loss; splenomegaly; bleeding/ecchymoses <10% blasts
What are characteristics of the blast phase crisis in chronic myelogenous leukemia?
progression to acute leukemia
>20% blasts
large aggregates in bone marrow and extramedullary tissue
usu fatal
What does the prognosis of chronic myelogenous leukemia depend on?
the response to TKI’s (ex: imatinib aka Gleevec)
What is the most common leukemia in children?
B cell acute lymphoblastic leukemia
Do most cases of acute lymphoblastic leukemia affect T cells or B cells?
most affect B cells (80-85%)
What cell markers are expressed in acute lymphoblastic leukemia?
CD10 (B cell marker) and tdt
Describe what the cells look like in acute lymphoblastic leukemia.
primitive, undifferentiated lymphoblasts; cells are smaller than myeloblasts; no auer rods;
What are some clinical features of acute lymphoblastic leukemia?
- marrow failure: anemia, thrombocytopenia, neutropenia
- WBC may be low, normal, or very high
- commonly spreads to CNS
