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Block 7 Week 1 > Usera: Acute and Chronic Leukemias > Flashcards

Usera: Acute and Chronic Leukemias Flashcards

1
Q

Who gets ALL?

A

children (0-14yo)

**75% of cases in children under 6yo

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2
Q

Who gets AML?

A

adolescents to middle-aged adults (15-59)

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3
Q

Who gets AML/CML?

A

adult 40-60+

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4
Q

Who gets CLL?

A

elderly adults

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5
Q

Where are cells arrested in acute myelogenous leukemia?

A

maturation arrest in granulocyte development, leads to proliferation of malignant precursor cells

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6
Q

What are 4 clinical features of AML (acute myelogenous leukemia)?

A
  1. anemia
  2. thrombocytopenia
  3. neutropenia
  4. leukocytosis with increased blasts
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7
Q

What are 4 signs and symptoms of acute myelogenous leukemia?

A
  1. fatigue
  2. bleeding/bruising
  3. DIC
  4. gum infiltration
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8
Q

What are auer rods? What cells are they unique to?

A

primary granules; unique to myeloid lineage

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9
Q

Acute promyelocytic leukemia makes up 5-8% if AML. What chromosome translocation is common?

A

t(15:17)(q22:q12)

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10
Q

Who usually gets acute promyelocytic leukemia (APML)?

A

any age, usu 3-5th decade of life

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11
Q

What are some clinical features of acute promyelocytic leukemia?

A

frequently presents with DIC (acute hypercoagulative state)
rapid doubling time
large numbers of Auer rods

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12
Q

What genes are translocated in a t(15;17) translocation in pts with APL?

A

PML and RARA (retinoic acid receptor)

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13
Q

What do you use to treat acute promyelocytic leukemia?

A

ATRA and alkylating agent

**80-90% remission

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14
Q

What is a characteristic feature of acute monocytic leukemia? Are auer rods common?

A

gum infiltration (malignant cells deposit themselves in the gingiva); no auer rods are rare

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15
Q

What chromosome abnormality is associated with chronic myelogenous leukemia?

A

de novo mutation in Philadelphia chromosome

**balanced translocation in (9;22) BCR-ABL fusion gene

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16
Q

Explain how the de novo mutation in the Philadelphia chromosome leads to chronic myelogenous leukemia.

A

BCR-ABL fusion gene produces a tyrosine kinase which is ALWAYS active, leading to dysregulation of proliferation and normal apoptosis

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17
Q

What are some clinical features of chronic myelogenous leukemia (CML)?

A 
all the different granulocytes present; 
fever, night sweats, weight loss;
splenomegaly;
bleeding/ecchymoses
<10% blasts
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18
Q

What are characteristics of the blast phase crisis in chronic myelogenous leukemia?

A

progression to acute leukemia
>20% blasts
large aggregates in bone marrow and extramedullary tissue
usu fatal

19
Q

What does the prognosis of chronic myelogenous leukemia depend on?

A

the response to TKI’s (ex: imatinib aka Gleevec)

20
Q

What is the most common leukemia in children?

A

B cell acute lymphoblastic leukemia

21
Q

Do most cases of acute lymphoblastic leukemia affect T cells or B cells?

A

most affect B cells (80-85%)

22
Q

What cell markers are expressed in acute lymphoblastic leukemia?

A

CD10 (B cell marker) and tdt

23
Q

Describe what the cells look like in acute lymphoblastic leukemia.

A

primitive, undifferentiated lymphoblasts; cells are smaller than myeloblasts; no auer rods;

24
Q

What are some clinical features of acute lymphoblastic leukemia?

A
  1. marrow failure: anemia, thrombocytopenia, neutropenia
  2. WBC may be low, normal, or very high
  3. commonly spreads to CNS
25
Q

Where does acute lymphoblastic leukemia most commonly spread to?

A

CNS

26
Q

What are 3 factors that give a good prognosis for ALL?

A
  1. ages 1-10 = best prognosis
  2. t(12;22)
  3. hyperdiploidy (really diverse, crazy cells are more susceptible to chemo)
27
Q

What do T cell acute lymphoblastic leukemias frequently present with?

A

mediastinal mass or acute leukemia

28
Q

What are the T cell markers for T cell acute lymphoblastic leukemias?

A

CD10-, tdt+

29
Q

Overall, this is the most common human leukemia

A

chronic lymphocytic leukemia

30
Q

What type of leukemia is CLL (chronic lymphocytic leukemia)? What is unique about this leukemia?

A

clonal B cell neoplasm, only light chains; unique to B cells

31
Q

What are the two markers present in chronic lymphocytic leukemia?

A

CD5 and CD23

**combo of T cell marker (CD5) and B cell marker (CD23)

32
Q

What are some morphological features of chronic lymphocytic leukemia?

A

high white cell count

small mature lymphocytes w clumped chromatin and occasional smudge cells

33
Q

What is the prognosis for chronic lymphocytic leukemia?

A

good! indolent disease - treatment is usu withheld bc these patients are likely to live

34
Q

What is the UNFAVORABLE marker that you should know for chronic lymphocytic leukemia?

A

ZAP-70

35
Q

Mutation in this gene is FAVORABLE in CLL

A

IGVH

36
Q

What develops in 2-8% of cases of chronic lymphocytic leukemia? What is this referred to as?

A

lymphomas;

Richter transformation - bad prognosis - less than 1 year :(

37
Q

Who gets hairy cell leukemia?

A

older caucasian males

38
Q

What are two features to remember in hairy cell leukemia?

A
  1. monocytopenia (or pancytopenia)

2. splenomegaly (cancer cells infiltrate red pulp of spleen)

39
Q

What markers are present in hairy cell leukemia?

A

CD11, CD25, CD103

40
Q

Where does hairy cell leukemia usually infiltrate?

A

the RED pulp of the spleen - causes splenomegaly

41
Q

What does the bone marrow look like in hairy cell leukemia?

A

fried egg appearance

42
Q

What is the bone marrow biopsy like in hairy cell leukemia?

A

dry tap - can’t get good bone marrow sample

43
Q

This leukemia is a CD4 T cell neoplasm caused by HTLV; it is endemic in Japan, West Africa, and the Caribbean; causes hepatosplenomegaly and lymphocytosis; rapidly progressive and fatal

A

adult T cell leukemia

44
Q

What are the characterstic cells in adult T cell leukemia?

A

clover leaf cells

Block 7 Week 1 (9 decks)

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