Acute Leukemia

Question 1

A disease involving a neoplastic proliferation of blasts and is defined by a >20% of blasts in the bone marrow…

Answer 1

Acute leukemia

Question 2

What is the acute presentation that occurs with an increased number of blasts seen with acute leukemia?

Answer 2

Anemia (Fatigue)
Thrombocytopenia (bleeding)
Neutropenia (infection)

Question 3

A large, immature cells with a punched out nucleoli seen with acute leukemias?

Answer 3

Blast

Question 4

What are the 2 subdivisions of acute leukemia?

Answer 4

Acute lymphoblastic leukemia (ALL)

Acute myelogenous leukemia (AML)

Question 5

Disease characterized by a neoplastic accumulation of lymphoblasts in the bone marrow…

Answer 5

Acute lymphoblastic leukemia

Question 6

What nuclear stain is characteristic of acute lymphoblastic leukemia?

Answer 6

TdT

Question 7

What is TdT?

Answer 7

A DNA polymerase seen within lymphoblasts

Question 8

Acute lymphoblastic leukemia commonly arises in children and is associated with what disorder?

Answer 8

Down syndrome—usually arises AFTER age 5

Question 9

What are the two subclassifications seen with acute lympoblastic leukemia?

Answer 9

B-ALL

T-ALL

Question 10

What are the characteristics of B-acute lymphoblastic leukemia?

Answer 10

TdT + expressing CD 10, 19, and 20

Question 11

B-acute lymphoblastic leukemia has an excellent response to chemotherapy, but what is required in order to effectively treat this disease?

Answer 11

Prophylactic chemotherapy to the scrotum and CSF due to tight barriers preventing the spread to drug to these areas

Question 12

What are the two chromosomal translocations seen with acute lymphoblastic leukemia?

Answer 12

T(12;21)

T(9;22)

Question 13

Of the two translocations seen in acute lymphoblastic leukemia, which one has a good prognosis and is commonly seen in children?

Answer 13

T(12;21)

Question 14

Of the two translocations seen in acute lymphoblastic leukemia, which one has a poor prognosis and is commonly seen in adults?

Answer 14

T(9;22)

Question 15

What are the characteristics of T-acute lymphoblastic lymphoma?

Answer 15

TdT + with expression of markers ranging from CD2-CD8

Blasts DO NOT express CD10

Question 16

What is the typical presentation for T-acute lymphoblastic lymphoma?

Answer 16

Typically presents in teenagers as a mediastinal thymic mass

Called a lymphoma because a mass is formed

Question 17

A disease involving the neoplastic accumulation of immature myeloid cells in the bone marrow?

Answer 17

Acute myeloid leukemia

Question 18

What is the characteristic cytoplasmic stain that is seen with acute myeloid leukemia?

Answer 18

Myeloperoxidase (MPO)

Question 19

What are the crystal aggregates of MPO seen with acute myeloid leukemia called?

Answer 19

Auer rods

Question 20

What is the average age range associated with the development of acute myeloid leukemia?

Answer 20

50-60 years

Question 21

What sub classifies the different acute myeloid leukemias?

Answer 21

Cytogenetic abnormalities
Lineage of immature myeloid cells
Surface markers

Question 22

What are the most common subtypes of acute myeloid leukemia?

Answer 22

Acute promyelocytic leukemia
Acute monocytic leukemia
Acute megakaryoblastic leukemia

Question 23

What is the characteristic chromosomal translocation seen with acute promyelocytic leukemia?

Answer 23

T(15;17)

Question 24

What does the t(15;17) seen in acute promyelocytic leukemia involve?

Answer 24

Retinoic acid receptor (RAR) on chromesome 17

Question 25

What does the translocation of RAR from chromosome 17 to 15 seen in acute promyelocytic leukemia cause?

Answer 25

Blocks maturation and causes promyelocytes (blasts) to accumulate

Question 26

When promyelocytes accumulate in acute promyelocytic leukemia, what are patients at an increased risk of developing?

Answer 26

DIC

Question 27

What is the treatment for acute promyelocytic leukemia?

Answer 27

All-trans-retinoic acid—ATRA, which is a vitamin A derivative

Question 28

What is the mechanism of action of all-trans-retinoic acid when treating acute promyelocytic leukemia?

Answer 28

The ATRA binds to the altered RAR and causes the maturation of the blast

Question 29

What are the characteristic findings with acute monocytic leukemia?

Answer 29

A proliferation of monoblasts Usually lacks MPO Infiltration of the gums by the blasts

Question 30

What are the characteristic findings with acute megakaryoblastic leukemia?

Answer 30

A proliferation of megkaryoblasts Lack MPO Is associated with Down syndrome and arises BEFORE age 5

Question 31

Myelodysplastic syndromes may develop into acute myeloid leukemia after exposure to what?

Answer 31

Alkylating agents OR Radiotherapy

Question 32

What is the usually presentation seen with myelodysplastic syndrome?

Answer 32

Cytopenias Hypercellular bone marrow Abnormal maturation of cells Increased blasts

Question 33

What does most patients die from before myelodysplastic syndrome progresses into acute leukemia?

Answer 33

Infection or bleeding