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56 Cards in this Set
- Front
- Back
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Acute leukemias are?
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neoplastic proliferation of immuature (blast) recapitulating progenitor cells of the hematopoietic sys
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What are the 2 main categories of acute leukemias?
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myeloblastic
lymphoblastic |
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Typical AML pt?
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adult ~60
1:1 M:F |
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Typical ALL pt?
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children (75% under 18)
1.4:1 M:F |
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Cytological features of AML
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large uniform blasts
finely dispersed chromatin abundant cytoplasm AUER RODS myelodysplasia |
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Cytologice features of ALL?
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small blasts
coarse chromatin absent nucleoli scant cytoplasm |
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What does meyloperoxidase ID?
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myeloblasts
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What does esterase ID?
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monoblasts in AML with monocytic differentiation
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What are the immunophenotypes for T cells
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CD:1, 2, 3, 4, 5, 7, 8
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What are the immunophenotypes for B cells
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CD: 19, 20, 22
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What are the generic myeloid antigents immunophenotypes?
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CD: 13, 15, 33, 117, MPO
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What are the megakaryocytes immunophenotypes?
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CD: 41 & 61
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What are the monocyte immunophenotypes?
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CD 14
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What are the immunophenotype markers of immaturity?
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CD 34 - ALL & AML
TdT - ALL CD 117 - AML CD1a - Tcells |
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What is AML?
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systemic neoplasms of myeloid progenitor cells
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What does AML involve?
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blood & BM
maybe extramedullary sites |
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What are clinical features of AML?
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weakness, fatigue, petechiae, infection -> cytopenias
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What is the diagnositic criteria for AML?
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>20% blasts in blood or BM
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What does the marrow look like in AML?
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hypercellular
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What is maturation like in AML?
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dysplastic
variable toward any myeloid lineage |
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What are the hematologic features of AML?
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anemia & thrombocytopenia
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What are the 4 WHO classifications of AML?
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1. recurrent cytogenic abnormalities
2. multilineage dysplasia 3. therapy related 4. NOS |
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What are the main characteristics of AML with recurrent cytogenic abnormalities?
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reciprocal translocations
flat incidence over age no prominent dysplasia no antecedent MDS favorable prognosis |
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What are the main translocation in AML with recurrent cytogenetic abnormalities?
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t8:21
inv 16 t15:17 11q23 |
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AML t8:21
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AML1/ETO
prominent granulcytic maturation auer rods! extramedullary involvement favorable |
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AML inv 16
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CBFB/MYH11
inc marrow eosinophils w dysplasia extrameduallary involvement favorable |
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AML t15:17!!!
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acute promyelocytic leukemia!
abnormla promyelocytes hypergranular reniform nuclei multi auer rods - faggot cells |
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How does promyelocytic leukemia present?
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DIC
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How do you tx promyelocytic leukemia?
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all-trans retinoic acid
t15:17 favorable |
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AML 11q23
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infantile AML
monocytic features hyperleukocytosis extramedullary involvement intermediate to poor prognosis |
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Characterisitics of AML with multilineage dysplasia
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losses of chromosomes
inc incidence with age related to MDS poor prognosis |
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What is therapy related AML?
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occurs in pts previously tx with chemotherapy &/or radiotherapy
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Alkkylating agent related AML?
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5 yrs after tx
risk related to dose & age multilineage dysplasia MDS cytogenic abnormalities in 100% v. poor prognosis |
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Topoisomerase II inhibitor related AML
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3 yrs after tx
rarely MDS monocytic or myelomonocytic 11q23 poor prognosis |
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What is Myeloid sarcoma?
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extramedullary tumor of immature myeloid cells
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What are the 2 new markers for AML?
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FLT-3
Nucleophosmin NPM |
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What is FLT3
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receptor tyrosine kinase impt in progenitor survival & proliferation
confers poor prognosis |
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What is NPM
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shuffling protein
favorable prognosis w/out FLT |
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What is the most common age to get ALL?
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2-10
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What are common sx of ALL?
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lethary, malaise, fever, infection, join or bone pain, petechiae, ecchymosis, epistaxis, LA, hepatosplenomegaly
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What are some clinical features of ALL?
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CNS inflitration 5%
mediastinal mass in Tcell ALL |
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Hematologic features of ALL
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thrombocytopenic
leukocyte count low anemia |
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What percent of ALL is Bcell?
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80-85
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What are Bcell markers?
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CD 10 - CALLA in 90%
also CD 19, 20, 22 immaturitiy: CD 34 & TdT |
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What percent of ALL is T cell?
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15-20%
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What are Tcell markers for ALL?
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CD 2, 3, 4, 5, 7, 8
immaturity: CD1a, CD 34, TdT |
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T-ALL pts:
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older males
mediastinal mass in 50% lymphomatous @ presentation hyperleukocytosis less favorable outcome in kids |
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Cytogenic abnormalities in ALL
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impt for risk stratification
75% have chromosomal abnormailites |
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What are the cytogenic abnormalities in pre-B ALL?
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hyperploidy
t 12:21 t 9:22 t 4:11 |
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What is the most common translocation in childhood pre-B ALL?
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t 12:21
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What is t 12:21
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TEL/AML
diploid childhood ALL |
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What is t 9:22
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philadelphia BRC/ABL (CML)
hyperleukocytosis CNS |
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What translocation is seen in 70% of infantile ALL?
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t 4:11
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What is t 4:11?
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AF4/MLL
frequent CNS hyperleukocytosis |
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What are some of the poor prognostic factors in ALL?
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T 9:22
T 4:11 hypoploidy slow response to therapy |
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What are some good prognostic factors in ALL?
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hyperploidy (trisomy 4,10, 18)
t 12:21 |
