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30 Cards in this Set
- Front
- Back
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What are the presenting symptoms of AML?
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* Recent onset fatigue (anemia)
* Weakness (anemia) * Fever/infection (neutropenia) * Bleeding (thrombocyto.) |
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What causes the presenting symptoms of AML?
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Marrow infiltration and replacement of normal blood precursor cells.
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What are the tell-tale signs of AML on a peripheral blood smear?
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* High white cell count (may be normal or low)
* Leukemic blast cells (>20% is diagnostic) |
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What is the diagnostic test for AML?
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Bone marrow aspirate, showing a hypercellular blast count >20%
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Other than blood, are other tissues involved in AML?
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Yes. Leukemic infiltration of the GUMS (gingival hyperplasia), skin or CNS. Site tumors are CHLOROMAS.
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[Peripheral Smear] What are these cells called? What are their characteristics?
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Myeloblast Cells from AML
* Mononuclear * Scant cytoplasm * Prominent pale nuclei |
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What are the two classification schemes for AML?
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1) French-American-British (FAB - Older)
2) WHO (newer) |
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How are AML sub-type diagnoses performed?
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1) Histologically (FAB)
2) Molecular subtypes 3) Cytogenetics (WHO) |
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What two disorders often lead to AML
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1) Myelodysplastic Sydrome
2) Myeloproliferative Disorders (P Vera, ET, etc.) |
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What is the CR rate for AML treated with combination chemo?
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60-80% within 9-15 months
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What is the induction therapy used for AML?
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1) Cytosine Arabinoside (antimetabolite)
2) Idarubicin or Daunorubicin (anthracycline) |
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What is the consolidation therapy for AML?
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High-dose Cytosine Arabinoside (HiDAC)
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When would stem-cell transplant be used in AML?
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During the FIRST REMISSION can achieve a 60% cure rate, however it is limited to 65 years or under, with an HLA-matched donor
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What are indicators of a poor prognosis in AML?
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1) Preceding myelodysplastic disease
2) Age >60 3) Certain cytogenetic problems (bcr-abl) 4) Failure to achieve CR with first round induction therapy |
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What is the major factor used to predict AML outcome and the need for transplant?
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Tumor cell cytogenetics
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What is a potential complication of a very high WBC count?
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Leukostasis may occur with WBC counts >100K. Large cells clog caps, cause tissue hypoxia.
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What are the critical complications of LEUKOSTASIS?
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1) CNS -> intracranial hemorrhage
2) Pulmonary -> respiratory failure |
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What is the treatment for leukostasis?
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Leukapheresis
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What disease is responsive to All Trans Retinoic Acid?
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Acute Promyelocytic Leukemia
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Acute Promyelocytic Leukemia
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All Trans Retinoic Acid (ATRA)
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What critical complication often accompanies APL presentation?
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DIC, likely due to the release of thrombogenic substances by the leukemic promyelocytes.
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What disease is associated with this cell type? Describe the cell's characteristics.
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Acute Promyelocytic Leukemia.
* Azurophilic granues |
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What is the main fungal infection in AML?
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Aspergillus
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What viral reactivations must be prevented in AML?
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CMV and HSV. Run serology tests as part of an AML workup.
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On the blood smear, what WBC cytoplasmic clue is closely linked with AML?
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Auer Rods
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What disease may be diagnosed based on this finding?
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These blast cells contain AUER RODS, indicating Acute Myelogenous Leukemia.
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What monoclonal antibody drug may be given for good-prognosis AML?
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Gemtuzumab (anti-CD33 antibodies)
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What chromosomal translocation leads to Acute Promyelocytic Leukemia?
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Specific t (15;17) translocation juxtaposes retinoic acid receptor gene (RARα) next to PML gene.
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How is an allo stem cell transplant performed for AML?
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High dose chemoradiotherapy:
* Cytoxan +Total body irradiation for 4 day OR High Dose Chemo: * Cytoxan + Busulfan |
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What's the full name for the condition FAB-M3?
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Acute Promyelocytic Leukemia
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