Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
14 Cards in this Set
- Front
- Back
|
Definition of leukemia?
How do you distinguish acute from chronic? Benzene has been associated with which leukemia? Radiation causes all leukemias except which type? |
autonomous clonal proliferation of malignant cells of the blood
acute - immature precursors (blasts) chronic - more mature cells AML CLL |
|
|
What is the genetic defect in CML?
What is the cornerstone of diagnosis in all leukemias? Clinical presentation of acute leukemia? What is the median duration of survival for untreated leukemia? |
Philadelphia chromosome - 9q and 22q arms combine - new fusion gene with tyrosine kinase activity
chromosomal studies very rapid onset, clinical course ("I was feeling well until this one day when..."; 3 months |
|
|
Major symptoms of acute leukemia?
How is chronic leukemia usually found? |
history of fever, easy bruisability, fatigue, weight loss, dyspnea; BONE PAIN
found during CBC, workup for another problem |
|
|
Clonal proliferation of malignant myeloblasts in the bone marrow:
What are some causes? Which type involves the least mature myeloblasts? Involves more mature granulocytic-appearing blasts: |
Acute Myelocytic Leukemia (AML)
radiation, chemo drugs, benzene, toluene M1 M2 |
|
|
AML type involving promyelocytes with large granules:
DIC often occurs during induction of treatment for which type? Involves myeloblasts, monoblasts, associated with increased serum/urine lysozyme levels: M5 AML involves what cells? M6 AML is which cells? |
M3
M3 M4 malignant monoblasts occupying 80% of bone marrow erythroblasts (DeGuglielmo's syndrome) |
|
|
Malignant megakaryocytes are which type of AML?
What are some symptoms unique to M4/M5? t(15;17) is pathognomic for which type? |
M7
CNS, Skin (Sweet's syndrome), gingival hypertrophy M3 |
|
|
Treatment is divided into what periods?
Which drugs are used for induction? What % of patients have complete remission with a single course of chemo? What is the major toxicity of induction treatment, and which organ is affected? What other S/S? |
Induction, consolidation, maintenance
anthracycline abx, cytosine arabinoside - 50-70% tumor lysis syndrome - kidneys (ARF, high K+, uric acid) also consumptive coagulopathy, alopecia, lassitude, pancytopenia |
|
|
Explain the effects of pancytopenia on WBC's:
What is the goal for tumor cell death in treatment? What is the role of ATRA in maintenance therapy? |
WBC count drops to <100/mm3 for 2-3 weeks post treatment; watch for infections, thrombocytopenic bleeding
99% kill - 2 log reduction (10^9 --> 10^7) differentiating agent for AML-M3 (APL) |
|
|
What are the three phases of Chronic Myelocytic Leukemia?
Diagnosis? |
Chronic - leukocytosis/indolent disease
Accelerated - leukocytosis increases, more immature granulocytes, decreased platelets/RBC's Blast - morphologically resembles AML, but resistant to treatment Philadelphia chromosome, bone marrow with >3% myeloblasts |
|
|
PE findings in CML? PS findings?
Tyrosine kinase inhibitor, DOC for chronic phase CML: What stage can you do an allogeneic BMT? |
splenomegaly, easy bruising; leukocytosis, anemia, thrombocytopenia, increased basophil/eosinophils, decreased LAP score
STI 571 (Gleevec) chronic |
|
|
Most common malignancy of childhood, proven association with HTLV-1:
Burkitt's is classified as which type of ALL? How is ALL different from AML? |
Acute Lymphocytic Leukemia (ALL)
L3 total WBC and blasts counts are higher, higher incidence of CNS disease, more leukostasis (clumping, sludging); immune system more impaired, lymph node/splenic enlargement |
|
|
What are some favorable prognostic factors in ALL?
Backbone drugs of remission in ALL: What drugs can you add to increase the remission rates? How can you do CNS prophylaxis in ALL? |
young age (2-10 y/o better than 10-25, etc)
low WBC count @ diagnosis (<100,000) L1 morphology (better than L2, L3) vincristine, prednisone add anthracycline, L-asparaginase intrathecal cytosine arabinoside, MTX |
|
|
Backbone drugs of maintenance therapy for ALL?
Most common chronic leukemia, usually B-cell in origin: Most frequent chromosome abnormality seen in CLL? Large cell lymphoma the develops in 10-15% of patients with CLL: |
6-mercaptopurine, MTX
Chronic Lymphocytic Leukemia (CLL) trisomy 12 Richter's syndrome |
|
|
DOC for CLL:
What drug is indicated for patients with B-CLL refractory to alkylating agents: When is treatment indicated for CLL patients? |
chlorambucil
Fludarabine systemic symptoms, lymphoid tissue enlargement causing pain/obstruction, autoimmune hemolytic anemia/thrombocytopenia, progressive marrow failure |
