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30 Cards in this Set

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