Onc 4

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AML peripheral smear - The 3 blasts have a high N:C ratio and prominent nucleoli (pale area in nucleus)

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Front 2

AML - blast cell w/ auer rod

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Front 3

normal bone marrow - Heterogeneous mixture of myeloid and erythroid cells

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Front 4

AML bone marrow - increased numbers of blasts (note prominent Golgi area in cytoplasm of blasts)

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Front 5

AML - MPO stain - MPO is present in immature and mature granulocytes and stains black

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Front 6

AML Esterase Stain - CAE & ANAE - granulocytes and monocytes - will stain mature and immature granulocytes blue

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Front 7

ANAE - Monoblasts/Monocytes - will stain mature and immature monocytes brown

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Front 8

AML – note the absence of normal hematopoietic cells

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Front 9

AML – some of the nuclei are folded - Consistent with monocytic differentiation

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Front 10

AML - Blast with folded nucleus

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Front 11

Blast with Auer rods

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Front 12

AML

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Front 13

AML - Bone marrow clot section - not a lot of megas, not a lot of diff – very bad

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Front 14

bone marrow in Lekukmia – sheets of blasts, maked reduction in normal hemapoitic cells

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Front 15

L1 - high N/C ratio

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L2 – looks like myelobasts

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Front 17

L3

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Front 18

ALL smear

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Front 19

ALL - bone marrow aspirate

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Front 20

ALL Bone marrow clot section - too monotonous - Note the absence of normal hematopoietic precursors

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Front 21

ALL - Lymphoblast in CSF

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Front 22

Leukemia - def

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- cancer of BM progenitor cells
- malignant, monoclonal prolif of hematopoietic cells from the BM
- abnormalities of cell prolif, diff, and termination

Front 23

Decreased apoptosis in leukemia

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- common in lymphoid
- BCL2 overexpression in some NHL

Front 24

Blocked differentiation in leukemia

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- common in myeloid
- t(15;17) is classic example

Front 25

Pancytopenia - definition and causes

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- decreased production of BM cells
- if BM infiltrated, its probably leukemias, mets solid tumors, MF
- If BM hypoplastic (decdevelopment), its prob aplastic anemias, infection, or metabolics

Front 26

AML - Histologic subtypes

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M1 - M7 - just know that M3 is common and associated w/ DIC

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AML - diagnosing BM failure

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- Neutropenia
- Anemia
- Thrombocytopenia

Front 28

AML - diagnosing

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- Peripheral blood and BM - increased blasts (>20%) and auer rods
- Cytochemistry - MPO, SBB, or esterase stains

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AML - genetics

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- t(15;17) - APL - good prog
- t(8;21), t(16;16) and inversion 16 - good prog
- -7, -5 have poor prog

Front 30

AML - WHO classification

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1) AML with recurrent genetic abnormalities
2) AML with multilineage dysplasia
3) AML therapy related
4) AML no otherwise specified (M0-M7)

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AML - treatment

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- Allogenic transplantation > autologous trans > intensive chemo
- Drugs include all-trans-retinol, all-trans-retinoic acid, and #s w/ retinoic acid
- 6 months in patient

Front 32

ALL - classifications

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- L1 - Small cells, no granules TdT+ - most common
- L2 - larger cells w/ big nucleoli – common in adults
- L3 (ass w/ EBV) - vacuolated cells – poor prognosis – t(8;14), t(8;22), t(2;8)

Front 33

ALL - diagnosing

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- Flow cytometry!! - most kids have CD10 mophology – precursor B cell
- look for ITP, aplastic anemia, Reactive Lymphocytosis
- In BM - inc blasts, (>30%) - decreased hematopoiesis

Front 34

ALL - causes

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- almost always an unusual reaction to a common viral infection
- disease of childhood

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ALL - Immunophenotyping

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- Low numbers - T-cell phenotype (CD 1-8)
- Midteens - Myelomonocytic 13 and 15 - Granulocyte, 14 - Monocytic
- 19-23 - B-cell phenotype
- 38 - B-cells/plasma cells
- 34 - stem cell
- 33 - myeloid

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ALL - Precursor B-cell flow cytometry

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- + for CD10, CD19, CD34
- usually neg for k & l and B cell markers in mature B-cells (CD20, CD22)

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ALL - Mature B-cell flow cytometry

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- + for CD10, 19, 20, 22
- + for either the k or l light chain
- Negative for CD34

Front 38

ALL - Precursor T-cell flow cytometry

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- + for CD3, CD4 and CD8

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ALL cytogenetics

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- good prognosis - hyperdiploidy (50 or greater chromosomes)
- bad - Philadelphia chromosome (t(9;22)), t(4;11), t(8;14), hypodiploidy

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ALL - Treatment

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- 2-3 years outpatient
– augmented therapy does better than standard therapy
- do best if 2-10 – want WBC to be low

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ALL - 9-22 translocation

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- mainly in adults – looks like CML – 3-5% - do horribly

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ALL - 4-11 translocation

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– babies and high WBC – do very bad

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ALL - 8-14 translocation

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- in c-myc
- burkitts lymphoma