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M2 Heme/Onc > 1/9 Acute Leukemia, Plasma Cell Disorders - Gharibo > Flashcards

1/9 Acute Leukemia, Plasma Cell Disorders - Gharibo Flashcards

1
Q

classification of leukemia

A
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2
Q

acute vs chronic leukemia

A

acute

  • excess myeloblasts or lymphoblasts
  • short clinical course (weeks/months)

chronic

  • accumulation of mature granulocytes or lymphocytes
  • longer clinical course (years)
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3
Q

hematopoiesis lineage

A
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4
Q

acute leukemia

A

proliferation and accumulation of immature/abnormal blasts in bone marrow and other tissues → bone marrow failure state

  • 20% blasts in marrow

classification

  1. AML
  2. ALL
  3. acute biphenotypic leukemia
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5
Q

multistep pathogenesis of AML

A

1. Class I mutations: confer proliferative/survival advantage to leukemia cell

2. Class II mutations: affect hematopoeitic differentiation → loss of maturation

  • block in differentiation of cells → immature cells or leukemic blast cells
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6
Q

2 hit model of leukemogenesis

A
  1. LOF mutation in transcription factors req for differentiation → blocked differentiation
  2. GOF mutation in Tyr kinases → enhanced prolif
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7
Q

acute leukemia abnormalities

A

point mutation:

  • activated ras oncogene

translocation

  • 2-gene fusions → chimeric gene
    • Bcr-ABL t(9,22) → preB ALL, CML
    • RARalpha-PML → AML M3
    • TEL-AML1 t(12,21) → preB ALL

gene/chr deletion

chromosome duplication, gene amplification

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8
Q

AML M3 and RAR

A

t (15;17)

  • chr 15: PML gene (promeylocytic leukemia)
  • chr 17: RAR gene (retinoic acid receptor)

fusion protein: PML-RARalpha is a transcriptional repressor → blocks differentiation

tx? hi dose ATRA (all-transretinoic acid) → differentiation of abnormal promyelocytes and cell death

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9
Q

three testing techniques and relative sensitivity to catch MRD

A

minimal residual disease

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10
Q

acute leukemia

A

constitutional, metabolic effects

  • weight loss, anorexia
  • fever
  • hyperkalemia
  • hyperuricemia
  • night sweats
  • fatigue
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11
Q

ALL

FAB classification

A

acute lymphoblastic leukemia

FAB classification based on morphology

L1 type: uniform, small blast cells with scant cytoplasm

L2 type: large blast cells, more prominent cytoplasm/nucleoli

L3 type: large blasts with prominent nucleoli, strongly basophilic cytoplasm, cytoplasmic vacuoles

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12
Q

neutropenic fevers

A

temp: 100.4

abs neutrophil count < 1000

48-60% of patients with febrile neutropenia have established or occult infection

tx: broad spectrum antibiotics at first sign of inf

predisposition factors:

  • no granulocytes
  • disruption of skin, mucosal, mucociliary barriers
  • shift of microbial flora
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13
Q

complication of AML

A

BLEEDING/DIC

always present in AML-M3 and others

mediated by sepsis or release of keukemic cell factors

  • procoagulants
  • fibrinolytics
  • plasminogen activators

tx: supportive

  • fresh frozen plasma
  • cryo
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14
Q

tumor lysis syndrome

A

rapid release of intracellular contents into bloodstream → life threatening concentrations of stuff

  • increase in: P, K, LDH, uric acid
  • decrease in: Ca
  • can lead to renal failure, alk of urine + incr output

tx: allopurinol, rasburicase

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15
Q

favorable vs unfavorable prognoses for ALL

WBC

sex

phenotype

age

cytogenetics

A
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16
Q

ALL treatment

A

induction chemotx

combination chemotx: cytotoxic cells that damage leukemic cells → apoptosis

maintenance chemotx

  • 2 years: girls/adults
  • 3 years: boys

cranial radiation tx (if high risk subset)

intrathecal prophylaxis chemotx

17
Q

secondary AML

A

arises from myelodysplasia and/or secondary to previous chemotx

18
Q

AML classic finding

A

Auer rods

19
Q

prognostic factors in AML

A

age

WBC

specific genetic changes

20
Q

pathogenesis of multiple myeloma

A
  1. pick up a mutation, build a clonal population of plasma cells in the marrow: MGUS state
    * monoclonal gammopathy of undetermined significance
  2. addtl mutations → smoldering state
  • > 10% clonal cells
  • abnormal proteins in blood/urine
  • NO SX!!!
  1. higher risk mutations (proliferation, anti-apop) → active state
    * start to experience sx

*plasma cell malignancy characterized by production of abnormal immunoglobulin

3 types:

  1. proteins in serum
  2. proteins in urine
  3. non-secretory
21
Q

intl staging system for MM

A

looks at 2 protein levels:

  • serum beta2M
  • serum albumin
22
Q

criteria for diagnosis of MM

A
  1. monoclonal plasma cells in bone marrow (>10%) and/or presence of plasmocytoma
  2. monoclonal protein present in serum and/or urine
  3. myeloma related organ dysfx
    • hyperCa
    • renal insufficiency
    • anemia
    • lytic bone

M2 Heme/Onc (16 decks)

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