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48 Cards in this Set

  • Front
  • Back
What is the underlying problem in acute leukemia?
A disruption in the ability of the cells to mature (blasts accumulate)
Acute leukemia is a neoplastic proliferation of __________.
blasts
What is the more technical definition of acute leukemia?
Defined as accumulation of >20% blasts in the bone marrow.
What happens in the marrow in acute leukemia?
Blasts "crowd out" normal hematopoiesis
Acute leukemia results in "acute" presentation with __________.
anemia, thrombocytopenia, or neutropenia.
In acute leukemia, the blasts usually enter _________ resulting in _____________.
the blood; high WBC
Blasts are _______ (small/large), immature cells, often with ______________ on blood smear.
large; punched out nucleoli
large; punched out nucleoli
Is this a lymphoblast or myeloblast? How can we tell?
Is this a lymphoblast or myeloblast? How can we tell?
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)
Accumulation of lymphoblasts is called _________, while accumulation of myeloblasts is called ___________.
ALL; AML
MPO can sometimes crystallize into a special structure called an ______________.
auer rod
TdT is absent in ___________.
mature lymphocytes
ALL most commonly arises in?
Children (perhaps because of higher number of immature cells in the young?)
ALL is associated with what syndrome?
Down syndrome (We ALL fall Down), AFTER the age of 5
Pediatric __________ is one of the great success stories of oncology.
ALL
ALL can be subclassified into? What is this classification based on?
B-ALL and T-ALL.

It is based on surface markers.
What is the MC subtype of ALL?
B-ALL
Lymphoblasts in B-ALL classically express ______, ______, ______.
CD10; CD19; CD20
B-ALL has a/an ______________ (poor/excellent) response to chemotherapy.
excellent
B-ALL requires CTX prophylaxis in some special sites. What are they?
Scrotum and CSF, places where the drug therapy cannot enter easily.
ALL can cause __________ enlargement.
testicular
True or false: AML can spread to meninges and cause CNS manifestations.
False. ALL can do this, not AML.
What do you see?
What do you see?
ALL in meninges
Prognosis of B-ALL is generally __________ (poor/good) an is based on what? Explain.
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+)
T-ALL is categorized by lymphoblasts that express markers ranging from _______ to _______.
CD2;CD8
Blasts in T-ALL does not express _________.
CD10
Mnemonic for T-ALL?
T - Thymic
T - Teenager
T-ALL classically presents as?
a thymic mass in a teenager. May compress vessels and airways in chest.

We call this an acute lymphoblastic lymphoma.
Is this a myeloblast or lymphoblast?
Is this a myeloblast or lymphoblast?
Auer rod is basically an aggregate of MPO, a stain we use for myeloblasts.
AML is most commonly seen in what age group?
Older adults. Average age 55-60.
AML can be subclassified in three ways, what are they?
(1) Cytogenetic abnormalities (predominant way)
(2) Lineage of myeloblasts
(3) Surface markers
The first "goal" in an AML is to determine if there is a recurring ____________________.
cytogenetic abnormality
Acute promyelocytic leukemia is characterized by what translocation?
t(15;17)
A t(15;17) results in a disrupted ________________.
RAR receptor (retinoic acid receptor)
What happens in acute promyelocytic leukemia?
Promyelocytes accumulate due to lack of vitamin A receptor (lack of differentiation).
Promyelocytes contain numerous ____________. There is a risk of __________.
auer rods; DIC
Acute promyelocytic leukemia is a medical ____________.
emergency (risk of DIC)
What is the treatment for acute promyelocytic leukemia?
All-trans Retinoic acid.

Causes blasts to mature.
In acute monocytic leukemia there is a proliferation of _________.
monoblasts
True or false: Cells in acute monocytic leukemia contain MPO.
False. They lack MPO.
In acute monocytic leukemia, cells characteristically infiltrate ___________.
gums
gums
In acute megakaryoblastic leukemia the cells ____________ (contain/lack) MPO.
lack MPO
Acute megakaryocytic leukemia is associated with?
Down syndrome (usually BEFORE the age of 5)
AML may arise from a pre-existing ____________. Explain.
dysplasia.

Prior exposure to alkylating agents or radiotherapy.
Patients exposed to alkylating agents or radiotherapy may develop something called _________________________.
myelodysplastic syndrome.
What is myelodysplastic syndrome? What would we see on inspection of marrow on smear?
Hypercellular bone marrow but cells are not being formed properly (dysplastic) so we see cytopenias.

Blasts are less than 20%
A man receives treatment for a B-cell lymphoma. Many years later he develops fatigue and recurrent infections. What might be going on?
Myelodysplastic syndrome
Most patients with myelodysplastic syndromes will actually die from what?
Infections or bleeding
A subset of patients with myelodysplastic syndromes may progress to?
Acute leukemia (>20 % blasts)