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48 Cards in this Set
- Front
- Back
What is the underlying problem in acute leukemia?
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A disruption in the ability of the cells to mature (blasts accumulate)
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Acute leukemia is a neoplastic proliferation of __________.
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blasts
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What is the more technical definition of acute leukemia?
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Defined as accumulation of >20% blasts in the bone marrow.
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What happens in the marrow in acute leukemia?
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Blasts "crowd out" normal hematopoiesis
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Acute leukemia results in "acute" presentation with __________.
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anemia, thrombocytopenia, or neutropenia.
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In acute leukemia, the blasts usually enter _________ resulting in _____________.
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the blood; high WBC
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Blasts are _______ (small/large), immature cells, often with ______________ on blood smear.
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large; punched out nucleoli
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Is this a lymphoblast or myeloblast? How can we tell?
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We can't tell just by looking on a smear.
We can tell by using markers: (1) Lymphoblasts are tDt positive (DNA polymerase in nucleus of lymphoblasts only) (2) Myeloblasts are MPO positive (think auer rod in some cases) |
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Accumulation of lymphoblasts is called _________, while accumulation of myeloblasts is called ___________.
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ALL; AML
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MPO can sometimes crystallize into a special structure called an ______________.
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auer rod
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TdT is absent in ___________.
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mature lymphocytes
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ALL most commonly arises in?
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Children (perhaps because of higher number of immature cells in the young?)
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ALL is associated with what syndrome?
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Down syndrome (We ALL fall Down), AFTER the age of 5
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Pediatric __________ is one of the great success stories of oncology.
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ALL
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ALL can be subclassified into? What is this classification based on?
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B-ALL and T-ALL.
It is based on surface markers. |
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What is the MC subtype of ALL?
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B-ALL
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Lymphoblasts in B-ALL classically express ______, ______, ______.
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CD10; CD19; CD20
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B-ALL has a/an ______________ (poor/excellent) response to chemotherapy.
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excellent
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B-ALL requires CTX prophylaxis in some special sites. What are they?
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Scrotum and CSF, places where the drug therapy cannot enter easily.
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ALL can cause __________ enlargement.
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testicular
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True or false: AML can spread to meninges and cause CNS manifestations.
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False. ALL can do this, not AML.
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What do you see?
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ALL in meninges
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Prognosis of B-ALL is generally __________ (poor/good) an is based on what? Explain.
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good; cytogenetic abnormalities
t(12;21) has a good prognosis - more commonly seen in kids t(9;22) has a poor prognosis - more commonly seen in adults (Ph+) |
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T-ALL is categorized by lymphoblasts that express markers ranging from _______ to _______.
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CD2;CD8
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Blasts in T-ALL does not express _________.
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CD10
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Mnemonic for T-ALL?
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T - Thymic
T - Teenager |
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T-ALL classically presents as?
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a thymic mass in a teenager. May compress vessels and airways in chest.
We call this an acute lymphoblastic lymphoma. |
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Is this a myeloblast or lymphoblast?
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Auer rod is basically an aggregate of MPO, a stain we use for myeloblasts.
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AML is most commonly seen in what age group?
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Older adults. Average age 55-60.
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AML can be subclassified in three ways, what are they?
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(1) Cytogenetic abnormalities (predominant way)
(2) Lineage of myeloblasts (3) Surface markers |
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The first "goal" in an AML is to determine if there is a recurring ____________________.
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cytogenetic abnormality
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Acute promyelocytic leukemia is characterized by what translocation?
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t(15;17)
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A t(15;17) results in a disrupted ________________.
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RAR receptor (retinoic acid receptor)
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What happens in acute promyelocytic leukemia?
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Promyelocytes accumulate due to lack of vitamin A receptor (lack of differentiation).
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Promyelocytes contain numerous ____________. There is a risk of __________.
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auer rods; DIC
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Acute promyelocytic leukemia is a medical ____________.
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emergency (risk of DIC)
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What is the treatment for acute promyelocytic leukemia?
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All-trans Retinoic acid.
Causes blasts to mature. |
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In acute monocytic leukemia there is a proliferation of _________.
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monoblasts
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True or false: Cells in acute monocytic leukemia contain MPO.
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False. They lack MPO.
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In acute monocytic leukemia, cells characteristically infiltrate ___________.
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gums
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In acute megakaryoblastic leukemia the cells ____________ (contain/lack) MPO.
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lack MPO
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Acute megakaryocytic leukemia is associated with?
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Down syndrome (usually BEFORE the age of 5)
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AML may arise from a pre-existing ____________. Explain.
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dysplasia.
Prior exposure to alkylating agents or radiotherapy. |
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Patients exposed to alkylating agents or radiotherapy may develop something called _________________________.
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myelodysplastic syndrome.
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What is myelodysplastic syndrome? What would we see on inspection of marrow on smear?
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Hypercellular bone marrow but cells are not being formed properly (dysplastic) so we see cytopenias.
Blasts are less than 20% |
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A man receives treatment for a B-cell lymphoma. Many years later he develops fatigue and recurrent infections. What might be going on?
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Myelodysplastic syndrome
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Most patients with myelodysplastic syndromes will actually die from what?
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Infections or bleeding
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A subset of patients with myelodysplastic syndromes may progress to?
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Acute leukemia (>20 % blasts)
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