Flashcards in Acute Leukemia Deck (62)
What is acute leukemia?
Clonal, neoplastic proliferation of immature myeloid or lymphoid cells.
What are the two major categories of acute leukemia?
1. Acute myeloid leukemia (AML)
2. Acute lymphoblastic leukemia (ALL)
What is the cause for the signs and symptoms of acute leukemia?
The loss of normal hematopoietic elements, and subsequently a loss of normal peripheral blood cells
True or False:
Acute leukemia is rapidly fatal without treatment
What is the most common etiology of acute leukemia?
What are two consequences of chromosomal abnormalities in acute leukemias?
1. Maturation/ differentiation is blocked
2. Cells are not dependent on external factors for growth stimulation
Acute myeloid leukemia includes which types of cells?
Acute lymphoid leukemia includes which types of cells?
B or T-cell lineages
Name some risk factors for acute leukemia.
Can acute lymphoblastic leukemia present as a solid mass?
Yes. It is called lymphoblastic lymphoma or LBL
What are the two main types of ALL?
1. B-lymphoblastic ALL (B-ALL)
2. T-lymphoblastic ALL (T-ALL)
What patient population does ALL most commonly present in?
Children under 6
What would you expect the peripheral white blood cell count to be in a patient with ALL?
It could be increased, normal, decreased
What cell surface marker can be found on the surface of lymphoblasts?
What enzymes do lymphoblasts express that can be used to identify them?
Hint: It is not expressed in mature lymphocytes & it adds nucleotides to V(D)J exons during antibody recombination
Terminal deoxynucleotidyl transferase (TdT)
Are the majority of ALL cases B-ALL or T-ALL?
What three B-lineage antigens are found on B-lymmphoblasts?
Do B-lymphoblasts express CD20?
What are three cytogenetic changes seen in B-ALL?
1. B-ALL with t(9;22)(q34;q11.2); BCR-ABL1
2. B-ALL with translocations of 11q23; MLL
3. B-ALL with t(12;21)(p13;q23); ETV6-RUNX1
What protein product is produced by t(9;22)?
This is called the Philadelphia Chromosome
BCR-ABL fusion protein 190kd
Only 25% of cases of adult B-ALL involve the Philadelphia chromosome. How does the presence of this protein effect the prognosis?
B-ALL with Philadelphia chromosome has the worst prognosis of all subtypes of ALL.
B-ALL with abnormalities of MLL is frequently seen in what patient population?
What is the prognosis?
Neonates and young infants
B-ALL with ETV6-RUNX1 is seen in what patient population?
25% cases of childhood B-ALL
Very favorable prognosis
What type of leukemia is more often seen in adolescents and young adults?
T-ALL more frequently presents with a component of lymphoblastic lymphoma (T-LBL). Where does this mass most often present?
It presents as a large mediastinal mass.
How does T-ALL present?
High white blood count
Does T-ALL/ T-LBL favor males or females?
What T-lineage antigens are expressed on T-lymphoblasts?
CD2, CD3, &/ or CD7
CD4 and CD8 CONCURRENTLY
CD99 and CD1a
What factors influence the prognosis of ALL?
AGE: worse in infants (10, and adults
WHITE BLOOD CELL COUNT: worse for markedly elevated WBC count
SLOW RESPONSE TO THERAPY/ SMALL AMOUNTS OF RESIDUAL DISEASE AFTER THERAPY
NUMBER OF CHROMOSOMES: very favorable prognosis for hyperdiploidy; poor prognosis for hypodiploidy
B VS. T LINEAGE: T-ALL seems to have a worse prognosis than B-ALL