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31 Cards in this Set
- Front
- Back
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Which test is usually required to determine the lineage of an acute leukemia?
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Flow cytometry
(Immunophenotyping) |
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List some ways to differentiate between the lineage of an acute leukemia.
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1. Morphology
2. **Flow cytometry 3. Cytochemical stains 4. Cytogenic and molecular tests |
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Which is a more important prognostic factor-- cytogenetics or cell morphology?
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Cytogenetics
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Describe the prevalence of AML and ALL in children and adults.
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Children --> 85% of acute leukemias = ALL
Adults --> 85% of acute leukemias = AML |
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Is AML predominantly a disease of younger or older people?
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Older
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What are some complications associated with acute leukemias?
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1. Suppression of normal hematopoiesis (anemia, neutropenia, thrombocytopenia)
2. Infections 3. Hemorrhage 4. Metabolic complications 5. Hyberviscosity due to leukostasis |
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Death in acute leukemias is typically due to..?
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Suppression of normal hematopoiesis= infection and hemmorrhage
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Is hyperviscosity due to leukostasis more common in AML or ALL?
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AML
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Which metabolic complications are associated with acute leukemias?
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1. Hyperuricemia
2. Hyper- or hypokalemia 3. Hyperphosphatemia 4. Tumor lysis syndrome with acute renal failure (precipitation of uric acid in renal tubules) |
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How can tumor lysis syndrome be prevented?
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BEFORE STARTING CHEMOTHERAPY:
1. Start patients on allopurinol (or rasburicase if the uric acid is high to begin with). 2. Alkalinize urine. 3. Keep patient hydrated |
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What is the treatment for hyperviscosity syndrome in acute leukemias?
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Leukapheresis, followed by chemotherapy
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Tumor lysis syndrome is very often seen in which leukemia?
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Burkitt cell leukemia
(Remember: not considered a lymphoblastic leukemia since it is a proliferation of mature cells. It is the leukemia stage of Burkitt lymphoma) |
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What age range represents the best prognosis for ALL?
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Age 2 - 10
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Which phenotype is the best prognosis for ALL?
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early precursor- B cell
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Which cytochemical stain is used routinely in the diagnosis of AML?
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Myeloperoxidase stain
(black-staining blasts indicates presence of a myeloperoxidase enzyme, which is diagnostic of AML) |
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What feature is the only absolute morphologic indication of myeloblasts on a routine blood or bone marrow stain?
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Auer rod
(made up of primary granules, which form a linear stack) |
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The FAB system of classification requires what percentage of blasts in the blood or bone marrow to make the diagnosis?
How does this differ from the WHO requirement? |
FAB requires > 30%
WHO requires >20% |
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What is the the chromosome translocation and gene involved in acute promyelocytic leukemia?
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t(15;17)
PML-RARa <-- retinoic acid receptor) |
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What is unique about Acute promyelocytic leukemia compared to the other AMLs?
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It has a unique therapy-- ATRA
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What are the "core binding factor leukemias?"
Do they have a favorable or unfavorable prognosis? |
AML with t(8;21) and AML with inv(16)
Relatively favorable prognosis |
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Does acute promyelocytic leukemia (APL) have a favorable or unfavorable prognosis?
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Favorable
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What kind of prognosis does AML with t(9;11) have?
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Intermediate prognosis
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Is AML with myelodysplasia-related changes generally favorable or unfavorable?
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Unfavorable
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What type of therapy places patients at the highest risk for therapy-related myeloid neoplasms?
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Alkylating agents
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List some therapies that are associated with therapy-related myeloid neoplasms.
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1. Chemotherapy or radiation
2. Alkylating agents 3. Topoisomerase II inhibitors |
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What is the difference between myeloid neoplasms induced by alkyllating agents/ radiation or topoisomerase II inhibtiors?
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Alkyllating agents or radiation = may go through myelodysplastic stage. Onset several years after treatment
Topoisomerase II inhibitors = no dysplastic stage (usually begins as AML). Onset may be quicker. |
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What is the treatment for AML?
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1. Induction therapy (cytosine arabinoside + anthracycline)
2. Consolidation therapy (high-dose cytosine arabinoside OR stem cell transplant) |
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Does acute promyelocytic leukemia typically affect younger or older people?
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Younger
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Which acute leukemia is strongly associated with coagulopathy resembling DIC?
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Acute promyelocytic leukemia (APL)
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What is the unique therapy for APL?
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All-trans-retinoic acid (ATRA)
*Should be started ASAP in patients with coagulopathy |
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What is the function of ATRA?
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Induces differentiation of leukemic promyelocytes in APL
(**Improves DIC) |
