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37 Cards in this Set
- Front
- Back
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What's the prognosis for AML?
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3/4 of people will die from it.
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What causes AML?
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Environmental factors: chemicals (benzene,carbon tet), radiation
Chemo drugs: topoII inhibitors, alkylating agents Genetic abnormalities: Down's, Fanconi's Spontaneous bone marrow failure disorders: AA, paroxysmal nocturnal hemoglobinuria Malignant bone marrow disorders |
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What are the symptoms of acute myeloid leukemia/
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Too many blasts
Anemia (and symptoms) Neutropenia (and symptoms) Thrombocytopenia (and symptoms) Leukostasis Extramedullary disease DIC Electrolyte abnormalities (hyper everything but calcium) |
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What are the symptoms of leukostasis?
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Headaches
Vision changes Chest pain SOB Neuropathy Abdominal angina Priapism |
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What's the definition of acute myeloid leukemia?
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>20% myeloblasts in either the periphery or the marrow
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What's the definition of acute lymphoblastic leukemia?
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>20% lymphoblasts in the periphery or marrow
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How do you define a myeloid phenotype?
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Auer rods
Myeloperoxidase Monocytic differentiation proteins |
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How do you establish a monocytic differentiation?
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CD11c
CD14 CD64 Lysozyme Don't need to memorize these! |
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What's the difference between FAB and WHO classification?
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FAB: just on morphology
WHO: genetic changes to give prognosis information |
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What should you do if your patient has AML?
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Hospitalize them!
It's a medical emergency. |
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What re the different phases of AML treatment?
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1. Induction: getting them into remission
2. Consolidation: keeping them in remission |
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What drugs are given during the induction phase of AML treatment?
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Anthracycline for 3 days
Cytarabine for 7 days 3+7 regimen You're taking the blood counts to zero. |
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What is the definition of remission from AML?
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1. Return of the counts back to normal
2. No more leukemia cells. |
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What are the complications to AML induction therapy?
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DIC
Tumor lysis syndrome Nausea, vomiting Myelosuppression requiring transfusion support Mucositis (no mucosal regeneration) Neutropenic infections Cardiac toxicity Death in 5% |
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What do you have to do before you can do induction therapy for AML?
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Determine cardiac status
The drugs are cardiotoxic, so you need to make sure that they can handle it. |
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What's the outcome from induction therapy in AML?
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60-70% of people achieve remission
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What happens after induction therapy for AML?
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Almost all of them die, anyways.
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What do you do in consolidative therapy for AML?
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1. Additional chemo
2. alloHSCT |
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What gives someone the best prognosis with AML? Worst?
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Best: t(8,21), i(16); the core binding factor leukemias
Intermediate: normal karyotype Worst: complex karyotype The more mutations to the chromosomes, the worse the prognosis |
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What's the prognosis for people in the core binding facotor mutations in AML?
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40% survival
Still not a success. |
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What are some genes that we look at in AML that determine prognosis? In what scenarios are they impactful?
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Nucleophosmin: NPM1
FMS-like TRK CEBPalpha Good prognosis Normal karyotype: NPM1 with normal FLT3 (75% survival) CEBPalpha Bad prognosis; NPM1 with a FCT3 mutation (25% survival) |
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What's the difference in treatment of AML with a good prognosis vs. bad?
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Good prognosis: chemotherapy
Bad prognosis: bone marrow transplant |
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Who should get transplant with AML?
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Poor risk karyotypes (abnormal karyotype)/molecular diagnostics
Primary refractory disease Secondary AML Therapy-AML |
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What type of leukemia has its own induction therapy?
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Acute promyelocytic leukemia
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What is the karyotypic mutation in acute promyelocytic leukemia?
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t(15;17)
It's necessary and sufficient for diagnosis |
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What is the age of diagnosis in acute promyelocytic leukemia?
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30-40
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What ethnicity gets acute promyelocytic eukemia?
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Spanish people
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What's a common presentationfor acute promyelocytic leukemia?
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Leukopenia
DIC |
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What should you do if you see someone who has acute promyelocytic leukemia?
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HOSPITALIZE THEM!
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What should make you suspect acute promyelocytic leukemia on a smear?
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Multiple auer rods
Sliding plate nuclei Or, promyelocytes |
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What's necessary to diagnose acute promyelocytic leukemia?
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Identification of t(15;17) via
Karyotyping FISH RT-PCR for gene product |
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What's the fusion gene product in acute promyelocytic leukemia?
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A binding protein to the retinoic acid binding region
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What's the treatment for acute promyelocytic leukemia? How does it work?
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All trans retinoic acid
Arsenic trioxde They bind to the protein and don't let it bind to the promoter. |
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What's the secondary problems with treatment of APL?
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Rapid differentiation of the cells causes a capillary leak syndrome, in which the plasma doesn't stay in the blood cells
YOU NEED TO SEE THIS. Discontinue ATRA if you see the capillary leak syndrome |
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What are the symptoms of capillary leak syndrome?
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Weight gain
Fever Hypoxia Pleuro/pericardial effusions Pulmonary infiltrates |
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What are the ways that you can approach a patient with APL?
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ATRA + chemo
ATRA+arsenic Just arsenic The outcomes aren't yet determined for each vs. each other. |
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What's the big problem with 3+ 7 therapy?
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Lots of mortality in people who are old:
20% mortality above 60 40% mortality above 80. |
