OnlineMedEd: Hematology Oncology - "Leukemia"

Question 1

Chronic leukemia is what kind of cell?

Answer 1

Mature cells (not blasts)

Question 2

A WBC greater than ________ is highly suggestive of cancer. So suggestive that you know it’s cancer.

Answer 2

60,000

Question 3

When you see an extremely high WBC, first look at the _______________, then do ____________.

Answer 3

differential; a bone marrow biopsy

The differential can tell you if it is CML (indicated by PMN predominance) or CLL (indicated by lymphocyte predominance). Bone marrow biopsy will allow cytogenetic analysis.

Question 4

Chronic leukemia causes what symptoms?

Answer 4

•Usually, it is asymptomatic.

Question 5

How is CLL treated?

Answer 5

• Stem-cell transplant (for younger than 65, otherwise healthy people)
• Chemotherapy (for older people with symptoms)
• Observation (for old, asymptomatic people)

Question 6

What symptoms do those with acute leukemia have?

Answer 6

Acute leukemia crowds out the bone marrow and thus patients will present with
•Infections (due to low WBCs)
•Anemia (due to low RBCs)
•Bleeding (due to low platelets)

Question 7

Greater than ___% blasts is diagnostic of acute leukemia.

Answer 7

20

This can be on bone marrow biopsy or peripheral smear. Though the test wants you to say bone marrow biopsy.

Question 8

Review the treatment protocols for ALL and AML.

Answer 8

• AML:

• M3 variant: vitamin A (think of MS3s with acne cause they’re so young); note: this is also the 15:17 translocation
• Other variants: chemotherapy

•ALL:

• Chemotherapy
• CNS chemotherapy (“You need to put chemo on your bALL.”)

Question 9

List three risk factors that predispose to development of AML.

Answer 9

• Benzene
• Radiation
• CML

Question 10

ALL has what two markers?

Answer 10

• cALLa

* TDT

Question 11

True or false: ALL needs CNS chemotherapy even if the LP didn’t show malignant cells.

Answer 11

True

Question 12

What is the 9;22 translocation?

Answer 12

BCR-ABL

Question 13

True or false: imatinib cures CML.

Answer 13

False

Eventually, the CML cells develop resistance to imatinib and undergo blast crisis.

Question 14

Arrange CML, CLL, AML, and ALL by age, oldest-to-youngest.

Answer 14

• CLL: 87
• AML: 67
• CML: 47
• ALL: 7

Question 15

Which cells have a higher N:C ratio, acute or chronic?

Answer 15

Chronic

Acute (immature) cells typically have large cytoplasms.