(M1) AML-NOS Without Maturation - Blast percentage - MPO/SBB stain? - Auer rods?

- > 90% of non-erythroid cells - MPO/SBB > 3% (positive) - Auer rods (+/-)

- Prescribe ATRA - Manage coagulopathy

Acute Leukemias Flashcards by Liz Haywood

BM failure causes what 3 things in acute leukemia?

Anemia
Infection
Hemorrhage

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Acute vs. chronic

- Organomegaly

Acute: mild
Chronic: prominent

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Which of the two types of APL has hypergranular promyelocytes and nuclei that are often bi-lobed or kidney shaped?

Typical

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Treatment/Therapy: type of medication that blocks growth of cancer cells by interfering with specific target molecules. More effective and less harmful than traditional methods

Targeted treatment

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While oncogenes act in a dominant fashion, tumor suppressor genes transform cells into a malignant phenotype only after _______ _______ have been lost or inactivated. WHAT theory is this?

BOTH alleles (2 hit theory by Knudson)

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Acute lymphoblastic leukemia (ALL)

- Immunophenotying for B cell leukemias and T cell leukemias

B: CD10+, CD19+, CD20+/-
T: CD2+, CD3+, CD4+, CD5+, CD7+; CD8+

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Acute lymphoblastic leukemia (ALL)

- what percentags fall w/in different white cell ranges?

Normal WBC → 25%
5-25 x 10^9/L → 50%
> 100 x 10^9/L → 10%

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Acute vs. chronic

- Clinical onset

Acute: sudden
Chronic: slow/insidious

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Acute lymphoblstic leukemia (ALL) is most common in who?

Children

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FAB nomenclature for AML-NOS Acute monocytic leukemia

M5b

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Acute leukemia BM production

Reduced BM production

Erythrocytes → anemia
Granulocytes → neutropenia
Platelets → thrombocytopenia

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Acute vs. chronic

- Anemia

Acute: mild to severe
Chronic: mild

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AML w/ abnormal marrow eosinophils in the peripheral blood

Myeloblasts (other immature myeloid cells)
Monocytoid cells
Thrombocytopenia
Normal eos

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AML w/ myelodysplasia-related changes

- Lab findings

Presents w/ severe pancytopenia

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(M1) AML-NOS Without Maturation

Blast percentage
MPO/SBB stain?
Auer rods?

> 90% of non-erythroid cells
MPO/SBB > 3% (positive)
Auer rods (+/-)

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Genes that cause dominant-acting cancer mutations (one copy)

Oncogene

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Treatment/Therapy: Replacement of the patient’s hematopoietic stem cells

Stem cell transplant

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AML w/ maturation in the bone marrow

Dysplasia in the neutrophil line (monos, eos, and erythroids, components not affected)

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Malignancies of the hematopoietic system are usually ____

Acquired

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What does it mean if you have > 20% blasts in the PB or BM?

That is the WHO classification for acute leukemias

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AML w/ maturation

- Cytogenetic abnormality

t(8;21)(q22;q22)

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Two types of stem cell transplants

Allogenic

- Autologous

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(M5a) AML-NOS-Acute Monoblastic AND (M5b) Monocytic Leukemia
- Problems

Bleeding problems common at presentation
Cutaneous and gingival infiltration
CNS involvement common

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APL treatment

Prescribe ATRA

- Manage coagulopathy

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After chemotherapy patients often develop severe leukcytopenia so what do we do to concentrate the cells for a differential?

We make a buffy coat smear by adding EDTA-anticoag blood into a WINTROBE tube

Treatment/Therapy: oral or parenteral cancer treatment with compounds that posses anti tumor properties

Chemotherapy

(M7) AML-NOS- Megakaryoblastic | - BM and stains

- Usually dry tap - MBO/SBB- negative - Factor VIII stain-pos

When a slide from a patient with APL is stained with MPO, what will it look like?

Strongly positive

The platelet count of a patient w/ an untreated acute leukemia is characteristically ____

Decreased

AML w/ abnormal marrow eosinophils | - Age group affected

Primarily young adults

Treatment/Therapy: use of ionizing energy to kill malignant cells by damaging DNA

Radiation

AML w/ maturation | - Prognosis

- Good in adults but poor in children | - Responds well w/ chemotherapy

Acute lymphoblastic leukemia (ALL) | - Onset b/w what years of age?

1-5 years (peaks b/w 2-3 years of age)

FAB nomenclature for AML-NOS acute monoblastic leukemia

M5a

Acute lymphoblastic leukemia (ALL) | - Purpose of immunophenotyping

- Distinguish blasts as lymphocytic in origin and not myeloid - Distinguish between B Cell or T Cell - Determines maturity of B or T cells

AML Therapy-related myeloid neoplasms | - Why does it occur

Occurs as a result of therapy-related cytotoxic chemotherapy and/or radiation therapy

(M4) AML -NOS Myelomonocytic | - Stains

Blasts will be positive for both myeloid and monocytic markers (MPO+) (ANBE +)

In Acute Promyelocytic Leukemia (APL), t(15;17) creates a fusion gene. What is it?

PML-RARA

Acute Myeloid Leukemia (AML) affects elements in which cell lineages?

- Granulocytic - Monocytic - Erythroid - Megakaryocytic

Will APL have Auer rods?

YES!! They'll have multiple Auer rods (faggot cells)

FAB nomenclature for AML-NOS acute megakaryocytic leukemia

Patient's own stem cells are removed, conditioned, and transplanted back into the patient

Autologous stem cell transplant

APL lab results

- DIC/fibrinolysis coagulation - Thrombocytopenia - Hyper or microgranular promyelocytes

AML-NOS Erythroleukemia (erythroid/myeloid) | - PAS stain

PAS- positive in RBC precursors, chunky

AML w/ Myelodysplasia-Related Changes | - AMLs are in this category

- AML evolving from previous myelodysplastic syndrome | - AML with cytogenetic abnormalites that marrow those of MDS syndromes

FAB nomenclature for AML-NOS acute erythroleukemia

What six immature cells will you find in AML?

- Myeloblasts - Promyelocytes - Monoblasts - Promonocytes - Erythroblasts - Megakaryoblasts

AML affects what age group?

All ages, predominated in adults around 65 years of age

Acute vs. chronic | - Course if treated

Acute: < 6 month survival Chronic: 2-6 years

Two different types of APL

- Typical (60-70%) | - Atypical (30-40%)

T cell leukemias always involve the _____ ______ and frequently develop lesions in _____ _____or other organs

Bone marrow | Lymph nodes

(M2) AML-NOS With Maturation - MPO - Auer Rods? - age affected

- MPO positive - Frequent Auer rods - All age groups

(M4) AML -NOS Myelomonocytic | - Bone marrow

- Myeloblasts > 20% | - Monocyte components

AML-NOS Acute Panmyelosis with Myelobibrosis (APMF) - clinical - increase in what?

- Bone pain and extensive myelofibrosis | - INcreased blasts of all myeloid lines

T-ALL patients have increased risk for what?

- Risk for induction failure - Early relapse - Isolated CNS relapse

(M4) AML -NOS Myelomonocytic - Peripheral blood - Auer rods?

- Myeloblasts - Monocytoid cells - thromobcytopenia - Auer rods +/-

AML w/ maturation | - Age affected

- 25-30 years old | - Predominant in children and young adults

What type of cancer is the most common cancer of childhood?

B-cell ALL

Acute Myeloid Leukemia (AML) will have recurrent cytogenic abnormalities: _______ - addition or deletion of part of - or entire- chromosome _______ primarily translocations and inversions

Numerical; structural

FAB nomenclature for AML-NOS Acute myelomonocytic leukemia (AMML)

Acute lymphoblastic leukemia (ALL) | - Terminology used in B cell leukemia list in order

- Pro B-Cell - Pre-Pre B-Cell - Pre B-Cell

Acute lymphoblastic leukemia (ALL) | - Prognosis

- Depends upon lineage, cytogenetics, cell burden, and organomegaly - survival is >85% - poor prognosis if <1 year of age

AML w/ abnormal eosinophils | - Cytogenetic abnormality

inv(16)(p13.1;q22) | t(16;16) (p13.1;q22)

If a patient has an untreated leukemia, his/her BM is most likely ____

Hypercellular

AML not otherwise specified (NOS) | - Divisions within this category are based primarily off of what?

Morphological and cytochemical/immunophenotypic features

(M7) AML-NOS- Megakaryoblastic | - PB

- Micromegakaryocytes | - Pleomorphic blasts, blasts with agranular cytoplasm

AML w/ abnormal marrow eosinophils in the bone marrow

- Myeloblasts and promyelocytes (30-80%) - Monocytic component (>20%) - >5% eosinophils (all stages of maturation)

Acute vs. chronic | - Maturity of cells

Acute: immature Chronic: mature

Donor is genetically different than the patient

Allogenic stem cell transplant

(M0) AML-NOS Minimal Differentiation | - What stains are negative?

MPO and most other stains are negative

Acute vs. chronic | - Thrombocytopenia

Acute: mild to severe Chronic: mild

AML- Therapy-Related Myeloid Neoplasms - Age affected - Prognosis

- Age affected: median age 61 | - Poor prognosis (< 10% 5 year survival rate)

Genes that code for proteins that help cells resist malignant transformation

Tumor suppressor gene

AML w/ maturation in the peripheral blood

- Blasts with numerous azurophilic granules - Some may have very large granules (Pseudo-Chediak-Higashi) - Auer Rods likely

(M0) AML-NOS Minimal Differentiation - MPX/SBB stains - Auer rods?

Negative/no Auer rods

Acute vs. chronic | - WBC count

Acute: variable Chronic: increased

Two types of chemotherapy

- Phase specific | - Phase nonspecific

Codes for a protein found in normal cell cycle regulation. Mutation my form an oncogene and result in disruption of normal cell cycle

Proto-oncogene

Acute leukemia etiology

- Oncogenic viruses - Genetic and congenital factors - Ionizing radiation - Chemical agents - Unknown

Which of the two types of APL has microgranular promyelocytes and nuclei that are predominantly deeply notched/bilobed (butterfly)?

Atypical

The PML-RARA fusion gene leads to what?

Uncontrolled proliferation and inhibition of cellular differentiation

(M0) AML-NOS Minimal Differentiation in the peripheral blood

Blasts: medium, round (1-2 nucleoli), fine chromatin, cytoplasm is AGRANULAR and BASOPHILIC

AML-NOS-Basopilic Leukemia | - increased what?

Blasts and immature basos

Morphology of acute leukemias

- Decreased platelets, anemia (due to BM failure) - Blast Cells - Auer Rods (in some MYELOID never LYMPHOID)

Acute promyelocytic leukemia (APL) | - Cytogenetic abnormality

t(15;17)(q24;q21)

FAB nomenclature for AML w/ reuccrent cytogenetic abnormalities--AML w/ abnormal marrow eosinophils

M4eo

AML immunophenotyping

CD34+, HLA-DR+, CD117+, CD13+, CD33+ | the last two are very specific to AML

FAB nomenclature for AML-NOS w/ maturation

Acute lymphoblastic leukemia (ALL) | - Cytochemistry

- Myeloperoxidase: Negative - Sudan Black B: Negative - ANBe: Positive/Negative focal - Periodic Acid Schiff: may be positive with BLOCK positivity

AML w/ myelodysplasia-related changes | - Prognosis

Poor

AML in the peripheral blood

- Variable leukocytosis - variable displasia - myeloblasts present in 95% of patients - Leukemic hiatus

(M0) AML-NOS Minimal Differentiation | - Age affected

Infants and older adults

AML w/ abnormal marrow eosinophils | - Prognosis

Favorable to average risk

Tumor suppressor genes cause cancers such as acute leukemias when mutations result in what?

Failure to prevent malignant processes

Having too many myeloblasts and some segs w/ no intemediate stages is known as what?

Leukemic hiatus

How will someone present clinically w/ AML?

- Pallor, fatigue - Fever/infection - Bruising/bleeding - Malignant cell infiltration into other tissues

FAB nomenclature for AML w/ recurrent cytogenetic abnormalities--Acute Promyelocytic Leukemia t(15;17) (APL)

Cell growth occurs in what 4 tissues in acute leukemias?

- Parenchymal organs/skin - Thymus - Cerebral meninges - Testes

FAB nomenclature for AML-NOS w/ minimal differentiation

AML w/ maturation | - Fusion gene

RUNX1-RUNX1T1

Acute vs. chronic | - Age of onset

Acute: all ages Chronic: adult

AML-NOS Acute Erythroid Leukemia | - Two subclasses

- Erythroleukemia (erythroid and myeloblasts in BM) | - Pure Erythroid leukemia (only erythroid precursors in BM)

Acute lymphoblastic leukemia (ALL) | - Morphology

- Anemia - Thombocytopenia - Blasts +/- - small blasts, more common usually pre B-Cell - large blasts, usually pre T-Cell

(M5a) AML-NOS-Acute Monoblastic AND (M5b) Monocytic Leukemia - ANBE stain

ANBE: positive

FAB nomenclature for AML-NOS w/o differentiation

AML in the BM

- Hypercellular increased blasts - >20% blasts with limited maturation - variable dysplasia

AML w/ myelodysplasia-related changes | - Age range affected

Elderly population

Treatment/Therapy: Involves the use of pharmaceuticals to manage symptoms of malignancies and malignancy treatments including colony stimulating factors and erythropietin

Supportive therapy

Acute Leukemias Flashcards

(108 cards)