Adult Leukemias

Question 1

What is leukemia?

Answer 1

leukemia is when there is an abnormality in the blood cells that causes either uncontrollable

Question 2

What is ALL

Answer 2

ALL is the most common leukemia in children age 3-7 years old. 20% of the time it is in adults CAUSE IS UKNOWN BUT THOUGHT… It is due to genetic changes to tumor suppressor genes or environmental exposures.

Question 3

What is the pathogenesis of ALL

Answer 3

some type of damage occurs so that maturation STOPS at the lymphoblast cell. Lymphoblasts then crowd out space in the bone marrow, and depress for the formation of all other cells.

Question 4

How does ALL present?

Answer 4

patient will be ACUTELY ill. Ill for several days to weeks.

1. BLEEDING on skin and mucosal surfaces
2. echymoses, purapura, petechiae
3. PALLOR
4. epistaxis or menorrhagia
5. FATIGUE and DYSPNEA to due to developed ANEMIA
6. INFECTIONS are often due to neutropenia
7. usually see a FEVER

in EXTREME CASES you see CNS confusion.

Question 5

What will PE exam reveal for ALL?

Answer 5

bruising, BONE TENDERNESS, maybe enlargement of the spleen.

Question 6

What will LABS for show ALL

Answer 6

cbc w/diff: LYMPHOBLASTS!!!!!! and pancytopenia.
WBC can LOOK increased due to increased number of blasts. BLASTS MUST BE GREATER THAN 20%.

Flow cytometry: CD19, CD10…mostly will be B cell lineage…
T cell = BAD!

Question 7

What cytogenetics are unfavorable for ALL?

Answer 7

philadelphia chromosome!!!!

Question 8

How should ALL be handled?

Answer 8

EMERGENCY!!!!

Question 9

ALL treatment:

Answer 9

combo of chemo, which produced remission in about 90% of patients.

Patients with philadelphia chromosome should have a tyrosine kinase inhibitor!!!

Question 10

Do ALL and AML present the same way?

Answer 10

YES

Question 11

Describe AML

Answer 11

genetic changes due to tumor supressor genes or environmental exposure to chemo or radiation…but also is unknown.

Question 12

What is the pathogenesis of AML

Answer 12

there is an ARREST development at the MYELOBLASTS!! they proliferate in the bone marrow and crowd out other cells.

Question 13

Is AML common?

Answer 13

yes, it is the most common adult leukemia.

Question 14

How does AML present?

Answer 14

patient will be ACUTELY ill. Ill for several days to weeks.

1. BLEEDING on skin and mucosal surfaces
2. echymoses, purapura, petechiae
3. PALLOR
4. epistaxis or menorrhagia
5. FATIGUE and DYSPNEA to due to developed ANEMIA
6. INFECTIONS are often due to neutropenia
7. usually see a FEVER

in EXTREME CASES you see CNS confusion.

Question 15

What will you see on physical exam for AML?

Answer 15

bruising, BONE TENDERNESS, maybe enlargement of the spleen.

Question 16

What will labs show you in AML?

Answer 16

cbc w/diff: MYELOBLASTS, pancytopenia
anemia
AURER RODS!!!!!!
flow cytometry: CD13 and CD 33

Question 17

What is unfavorable to isolate in AML

Answer 17

5q or 7q, MLL gene or a WBC count over 100K

Question 18

How should AML be approached?

Answer 18

EMERGENT!!!

Question 19

What is the treatment for AML?

Answer 19

chemo.

once in remission then do a allogenic stem cell transplant.

Question 20

What are the two most common sites for extra medullary leukemia?

Answer 20

CNS and testes

Question 21

Describe AML-3 or APL?

Answer 21

It is a type of AML.
T (15:17), results in a fusion transcription gene.
The MOST CURABLE AML!!

Question 22

Are acute leukemias curable?

Answer 22

YES

Question 23

What is CLL?

Answer 23

a monoclonal disorder characterized by progressive accumulation of functionally incompetent lymphocytes. 90% are older than 50. Median age is 70. AN OLD PERSON DISEASE. ALL IS A YOUNG PERSON DISEASE.

Question 24

How does CLL present?

Answer 24

asymptomatic most of the time. 
Fatigue
Lymphadenoapthy
splenomegaly
hepatomegaly

Question 25

What are the lab findings with CLL?

Answer 25

cbc w/diff: lymphocytosis (these cells are well-differentiated though!!!!) >20,000. hypogammaglobinemia PLT counts are typically normal, but if they aren't it is associated with a worse prognosis. Cytogenenics: 14q, 13q, and 11q = BAD

Question 26

What is the treatment for CLL?

Answer 26

MOST PAITENTS DO NOT REQUIRE TREATMENT! | However, if they DO...you need to give them immunoglobin every month to help fight infections along with chemo.

Question 27

What is CML?

Answer 27

increase proliferation of the granulocytic cell line. Accounts for 20% of all leukemia.

Question 28

What are the 3 phases of CML?

Answer 28

chronic - fatigue, weight loss, low grade fever, sweating, splenomegaly, decreased food intake due to enlargement of spleen. Accelerated: bleeding, brusing blast: bone pain and fever, this phase can progress to a blast crisis...acute myeloid leukemia.

Question 29

What is a blast crisis

Answer 29

a blast crisis:: increasing anemia, thrombocytopenia, basophilia, rapidly enlarging spleen.

Question 30

What the labs show with CML?

Answer 30

``` cvc with diff : increased wbc elevated granulocytes PLT counts vary Philadelphia chromosome = BAD, and seen in 95% bar/abl gene is detected by PCR ```

Question 31

What is the treatment for CML

Answer 31

1. TK1 bc of philadelphia chromosome 2. chemo and TK1 3. transplant.