Acute Leukemia Clinical Cases and Correlates

Question 1

What toxic exposure is linked with secondary AML?

Answer 1

benzene

Question 2

How will AML typically present?

Answer 2

Usually in an oder adults (63 mean)

pancytopenia, fever, night sweats, chills, malaise, weight loss

Question 3

What coagulation abnormality will you see with M3 AML?

Answer 3

DIC! Treat rapidly!

Question 4

What are some procedures and labs you’ll do after an AML diganosis/

Answer 4

bone marrow aspirate and biopsy (check cytogenetcis)
check cardiac fuction (before chemo)
lumbar picture to see if extramedullary disease
HLA typing for donor matching
place PICC line

Question 5

What’s the most important prosnostic feature in AML?

Answer 5

the cytogenetics!

Question 6

What are some favorable prognostic features in AML?

Answer 6

age less than 55
absence of infection
absence of antecedent MDS
low WBC
good risk cytogenetics; t8:21, t16:16, t15:17
normal karyotype with NPM+ Flt3-
presence of auer rods

Question 7

What are some unfavorable prognostic features in AML

Answer 7

poor risk cytogenetics: t(11:23)
age over 60
presence of infection
poor performance status
presence of prior MDS
secondary AML
extreme leukocytosis - over 100,00 for example
extramedullary disease in CSF

Question 8

What’s the most faoral karyotype genotyp in AML?

Answer 8

NPM1+ and Flt3-

Question 9

After induction chemotherapy, how do you decide if you want to do consolidation chemo or transplant?

Answer 9

generally speaking, if the risk is more severe (have unfavorable prostnostic indicators) and there is a donor, then do the transplant

if risk of recurrence is low (or if there isn’t a donor), then do the consolidation chemo

Question 10

What’s the main risk with the transplant?

Answer 10

graft vs host