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62 Cards in this Set
- Front
- Back
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Name a few proto-oncogenes mutated in leukemia.
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c-myc
c-ras c-abl |
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Name two tumor-suppressor genes mutated in leukemia.
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RB
p53 |
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Name a well-studied gene that's associated with apoptosis and over-expressed in leukemia?
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Bcl-2
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What is the standard method for diagnosing leukemia?
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Cellular morphology is still the gold standard, however homogeneous expression of surface markers, as well as RFLP analysis are used
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What are the four classes of hematologic malignancies?
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1) Leukemias
2) Lymphomas 3) Plasma cell dycrasias 4) Myeloproliferative disorders |
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What are the three exemplary myeloproliferative disorders?
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1) Polycythemia vera
2) Essential thrombocythemia 3) Chronic myelogenous leukemia |
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Why does total eradication of leukemia become more difficult over time?
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Genetic instability within the tumor population leads to differentiation and resistance in the cells.
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What five factors a have been implicated in the etiology of leukemia?
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1) Hereditary factors
2) Environmental factors 3) Infectious agents 4) Oncogenes 5) Immune factors |
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What chromosomal nondisjunction abnormalities have been linked to leukemia?
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Down's
Turner's Kleinfelter's |
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What environmental hazard has been linked to leukemia?
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Ionizing radiation exposure.
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What infectious agents have been linked to leukemia?
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HIV (B-cell lymphomas)
HTLV-1 (Adult T-Cell Leukemia) EBV (Burkitt's Lymphoma, Hodgkin's) |
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What two blood products are commonly given to leukemia patients?
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RBCs and platelets. Anemia is common. Bone marrow replacement with tumor cells pushes out megakaryocytes.
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Why are leukemia patients at risk for infections if their white cell counts are so high?
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Neoplastic white cells are generally hypofunctional.
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What's the limit for absolute neutropenia?
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500 WBCs per microliter.
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What is a common complication of chemotherapy in advanced leukemia patients?
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Tumor lysis syndrome, resulting in hyperuricemia. Allopurinol or dialysis may be required.
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What types of heme cancers are not curable at this time?
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Indolent lymphomas and Chronic Lymphocytic Leukemia are not curable w/out transplant. "Gentle therapies" and observation are used instead.
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How might drug resistance arise in a leukemia tumor cell?
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Enhanced transportation of chemo drugs out of the cell (MDR)
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When is radiation therapy used in hematologic malignancies?
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For local tumors, such as early stage Hodkins or Non-Hodgekin's lymphoma. (Also used in stem cell transplant.)
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How does antibody therapy such as Rituximab work against leukemias?
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Antibody-coated tumor cells are fixed by complement and destroyed by macrophages and NK cells.
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What are the to major classes of antibody therapy used in leukemia?
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1) Cell Surface antibodies (Rituximab), leading to complement fixation and destruction
2) Protein Kinase Inhibitors (Imatinib) designed as enzyme inhibitors |
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What is a "conditioning regimen?"
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Conditioning Regimen refers to the chemotherapy and total body radiation received prior to bone marrow transplant.
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Why are transplant "conditioning regimens" performed?
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1) to eradicate all residual malignant cells prior to transplant
2) to provide sufficient immunosuppression so that transplanted cells are not immediately rejected |
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How long does transplanted marrow take to to become fully functional?
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3-4 Weeks
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How are peripheral marrow cells harvested?
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Peripheral marrow harvest follows a 3-4 day course of G-CSF to stimulate marrow proliferation.
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What is an Autologous Marrow Transplant?
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Transplant with donor's own stem cells, collected during a time when there are no tumor cells in the marrow.
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What is a Syngeneic transplant?
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Use of an identical twin as a marrow donor.
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What is an Allogenic Transplant?
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Allogenic transplants use HLA-matched donors. Loci are HLA-A HLA-B and HLA-DR
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What is non-myeloablative transplant?
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Newer technique where marrow is not entirely killed off before transplant. Self cells are slowly replaced by graft cells over 2-3 months.
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What are the 4 principal complications of bone marrow transplant?
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1) Chemo-related toxicities
2) Marrow Aplasia 3) Graft rejection and GVHD 4) Relapse |
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How is Marrow Aplasia managed in transplant patients?
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Transfusion support with RBCs and platelets
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In what two heme cancers is relapse a big problem?
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1) Acute Lymphocytic Leukemia
2) Chronic Myelogenous Leukemia |
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How are leukemias classified?
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1) Degree of maturation
2) Original Cell type |
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What are the two main types of leukemia?
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Lymphocytic and Myeloid
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What are major subtypes of Myeloid leukemias?
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Malignant erythroid, megakaryocytic, as well as granulocytes and monocytes.
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What is the predominant cell type in Chronic Lymphocytic Leukemia?
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Mature-appearing lymphocytes (NK, T or B Cells)
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What are the predominant cell types seen in Chronic Myelogenous Leukemia?
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All stages of maturing neutrophils and myeloid cells are seen in CML.
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What is "Induction Therapy?"
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Term used for the FIRST ROUND OF CHEMO administered to destroy leukemic clone cell and achieve complete remission (CR)
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What is "Consolidation Therapy?"
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Chemotherapy administered AFTER COMPLETE REMISSION to diminish the risk of leukemic relapse.
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What is "Maintenance Therapy?"
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Low-dose chemotherapy administered chronically (2-5 years) to eradicate remaining leukemic cells.
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What environmental exposures are acute leukemias associated with?
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What environmental exposures are acute leukemias associated with?
radiation, benzene, cytotoxic drugs, smoking |
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Who gets AML?
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Who gets AML?
bimodal (neonates and adults) |
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What is a t(15;17) ass with?
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What is a t(15;17) ass with?
Acute Promyelocytic Leukemia (PML /RARa) |
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What are Auer rods?
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What are Auer rods?
eosinophillic inclusions condensed granules in AML cells |
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Tx for APL?
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Tx for APL?
alpha Trans Retinoic Acid (ATRA) (to induce maturation) followed by chemo |
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When do you use ARA-C?
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When do you use ARA-C?
if your AML has a t(8; 21) or an inv16 |
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Who gets ALL?
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Who gets ALL?
bimodal (2-5 and >60) |
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Name the dz: fever, bone pain, fatigue, night sweats, high LDH?
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Name the dz: fever, bone pain, fatigue, night sweats, high LDH?
ALL |
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What are the stages of therapy for ALL?
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What are the stages of therapy for ALL?
induction (hematoligic remissionw/anthra, vincri, prednisone) Intensification (antimetabolites in adults) Maintenance (long term MTX) |
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what is the presentation in P with acute leukemia
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what is the presentation in P with acute leukemia
signs of pancytopenia, even WBC may be increased or normal |
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why the infection is frequent presentation in acute leukemia when WBC are increase
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why the infection is frequent presentation in acute leukemia when WBC are increase
because WBC do not function normally ( they are blasts) |
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what history should rise the suspicion that P have leukemia
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what history should rise the suspicion that P have leukemia
h/o myelodysplastic syndrome |
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BIT
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BIT
blood smear. showing the blasts |
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MAT
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MAT
flow cytometry ( will distinguish the different subtypes of acute leukemia) |
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what is characteristic for AML
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what is characteristic for AML
myeloperooxidase |
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tx for both leukemia
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tx for both leukemia
chemo to remove the blasts from the peripheral blood this is induction( for induction the remission) |
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when to do BMT
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when to do BMT
if the prognosis is poor- do BMT if prognosis is good-- give more chemo |
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what is the best indicator for prognosis
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what is the best indicator for prognosis
cytogenetics or assessing the specific chromosomal characteristic found in each patient. good cytogenetics>> less chance for relapse>> more chemo bad cytogenetics>>> more chance to relapse>> give BMT |
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what to add as chemo for ALL
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what to add as chemo for ALL
methotrexat-- will prevent the relapse of ALL in the CNS |
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most testes facts for acute lekemia M3 in AML
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most testes facts for acute lekemia M3 in AML
look for DIC |
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most testes facts for acute lekemia what to add to M3( AML) tx
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most testes facts for acute lekemia what to add to M3( AML) tx
ATRA |
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most testes facts for acute lekemia where are auer roads
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most testes facts for acute lekemia where are auer roads
AML |
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most testes facts for acute lekemia add tx for ALL
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most testes facts for acute lekemia add tx for ALL
metotrexat |
