Acute Myeloid Leukemia

Question 1

Generally, what are the big differences between acute and chronic leukemias?

Answer 1

1. acute have sudden onset (days), chronic have longer onset (months)
2. acute is in both kids and adults, chornic is only in adults
3. acute has a more rapid course
4. acute is composed of blast cells, chronic composed of mature cells

Question 2

Besides acute and chronic, what are the two types of leukemias/

Answer 2

myeloid and lymphoid (lymphoblastic)

Question 3

Leukemia is a malignant proliferation of immature myeloid or lymphoid cells in the bone marrow or lymph nodes?

Answer 3

bone marrow

Question 4

As for the cause, what are the two general things the cells do in leukemias?

Answer 4

1. clonal expansion

2. maturation failure

Question 5

Why are leukemias bad?

Answer 5

1. crowd out normal cells from the bone marrow
2. inhibit normal cell function
3. infiltrates other organs

Question 6

What will the general symptoms of an acute leukemia be?

Answer 6

sudden onset of bone marrow failure symptoms: fatigue, infections, bleeding, etc. and bone pain
potentially organ infiltration - so confusion if in the CNS

Question 7

What will the general lab findings be in acute leukemia

Answer 7

1. blasts/immature cells in blood smear
2. leukocytosis (all bad cells)
3. anemia
4. trombocytopenia

Question 8

What percentage of the blood cells need to be blasts to get the AML diagnosis?

Answer 8

at least 20%

Question 9

AML: good or bad progrnosis in general?

Answer 9

bad

Question 10

What’s the old classification system for AML?

Answer 10

M0-M7

Question 11

What cells are involved in M0?

Answer 11

myeloblasts (neutrophilic series) - minimally differentiated.

Question 12

M1?

Answer 12

myeloblasts (neutrophilic series) - without maturation

Question 13

M2?

Answer 13

myeloblasts (neutrophilic series) - with maturation

Question 14

M3?

Answer 14

promyelocytes (neutrophilic series)

Question 15

M4?

Answer 15

myelomonocytes

Question 16

M5?

Answer 16

monocytes

Question 17

M6?

Answer 17

erythroblasts

Question 18

M7?

Answer 18

megakaryoblasts

Question 19

What are some of the ways you can tell a leukemia is myeloid?

Answer 19

1. dysgranulopoiesis
2. AEUR RODS!
3. cytochemistry - use specific stains
4. immunophenotyping
5. cytogenetics

Question 20

What are the categories in the “new” classificaiton for AML?

Answer 20

AML with genetic abnormalities
AML with FLT-3 mutstion
AML with multilineage dysplasia
AML, therapy related
AML, NOC

Question 21

For AML M0, what’s the only way you can diagnose it?

Answer 21

you need to do immunophenotyping - you need to use markers

Question 22

What’s the main difference between AML M0 and M1?

Answer 22

In M1 they have committed themselves to a lineage, but still minimal to no maturation

Question 23

What’s the diagnostic tipoff for M1?

Answer 23

auer rods!

Question 24

What enzyme does M1 have that M0 doesn’t?

Answer 24

myeloperoxidase (MPO)

Question 25

What genetic abnormaltiy occurs in some cases of M2 and leads to a better prognosis?

Answer 25

translocation of chromosone 8 and 21

Question 26

What cells are diagnostic of AML M3?

Answer 26

Faggot cells (bundle of sticks - just TONS of Auer rods)

Question 27

Why is treatment of M3 different from all the others?

Answer 27

The promyelocytes have pro-thrombotic granules that will cuase DIC if treated like normal leukemias, so you give a drug that removes the block to maturation, so the malignant cells just mature out and disappear!

Question 28

What genetic abnormality is present in ALL cases of M3?

Answer 28

a translocation of chromosone 15 and 17

Question 29

Why do you need to worry about extramedullary tumor masses in M4?

Answer 29

Because it's a leukemia of monocytes, which travel through the body

Question 30

What genetic abnormality is present in some cases of M4 and leads to better prognosis?

Answer 30

inversion of chromosome 16

Question 31

Why is M4 sometimes considered a dual leukemia?

Answer 31

You can get an increase in both myeloblasts and monocytic cells

Question 32

What enzyme will M5 be positive for?

Answer 32

nonspecific esterase (from the monoblasts)

Question 33

Will M7 be positive for myeloperoxidase?

Answer 33

no - it's not in the monocyte series

Question 34

Of the AMLs with genetic abnormatlities, which one confers a poor prognosis?

Answer 34

11q23

Question 35

What AML technically has a genetic abnormality but is in a group all it's own?

Answer 35

FLT-3 mutation: present in a third of all AML cases!

Question 36

Does the FLT3 mutation lend a good or bad prognosis? Why?

Answer 36

bad - they're so much more likely to relapse and relapse rapidly (this was the case)

Question 37

What are the characteristics of AML with multilineage dysplasia?

Answer 37

you have dysplasia in at least 2 different cell lines typically in elderly patients you get severe pancytopenia

Question 38

What chromosomes are often abnormal in AML with multilineage dysplasia?

Answer 38

5 and 7

Question 39

multilineage dysplasia: good or bad prognosis?

Answer 39

bad

Question 40

What drugs are particular cultprits for AML, therapy related?

Answer 40

alkylating agents like busulfan and topo 2 ihibitors like etoposide

Question 41

What's the typical onset for AML, therapy related?

Answer 41

2-5 years

Question 42

therapy related - easy or hard to treat?

Answer 42

VERY hard

Question 43

What is the treatment for AML?

Answer 43

chemo and bone marrow transplant

Question 44

In general, what is myelodysplastic syndrome? Why is this included in this discussion?

Answer 44

there's something abnormal about the stem cells in the marrow so you get dysmyelopoiesis and maybe increased blasts - but not as high as 20% sometimes can evolved into acute leukemia

Question 45

What sort of anemia is usually present in myelodysplastic syndrome?

Answer 45

macrocytic, but often asymptomatic

Question 46

Who gets MDS?

Answer 46

elderly