AL 2

Question 1

fatigue & short breath

Answer 1

low amt Hb, not enough O2

Question 2

arm bruising, purple spots on legs

Answer 2

low platelet count

Question 3

AL & wbc

Answer 3

low neutrophils, lymphocytes, >20% blasts

Question 4

what are blasts?

Answer 4

immature wbc

Question 5

AL diagnosis!

Answer 5

clin presentation, morphology, immunophenotype, cytogenetics, molecular studies

Question 6

clin info in AL

Answer 6

~lacking but critical. history of prior BM disorder (MDS). prior cytotoxic therapy. down syndrome

Question 7

MDS

Answer 7

myelodysplastic syndrom

Question 8

1st indication of AL

Answer 8

morphology, guides approp ancillary tests & indicates

Question 9

blast count for morphology

Answer 9

> 20% blasts in PB or BM

Question 10

morphology can indicate subtype, genetic changes. example?

Answer 10

auer rods only in ML

Question 11

needles

Answer 11

illinois BM aspirate needle & jamshidi BM biopsy needle

Question 12

BM biopsy MI

Answer 12

morphology, immunohistochem

Question 13

BM aspirate MFCCFM

Answer 13

morph features, flow cytometric, cytgenetic FISH, molecular analysis

Question 14

what is performed in all suspected AL cases

Answer 14

flow cytometry

Question 15

immunophenotype is needed for

Answer 15

diagnosis, classification.

Question 16

phenotypes can be

Answer 16

AML, ALL, or mixed

Question 17

immunophenotyping may ID aberrant antigen exp corresponding to what

Answer 17

specific genetic changes

Question 18

hard to morphologically tell AML from ALL using what?

Answer 18

morphology (rely on immunophenotype)

Question 19

flow cytometry involves

Answer 19

laser, electronics, fluidic & optic system… flor labelled cell parts, light scattered when hit cell

Question 20

CD45 is example of

Answer 20

leukocyte antigen. expressed on all hematopoietic cells

Question 21

cells express myeloperoxidase MPO only in

Answer 21

ML. see brown stain (instead of blue)

Question 22

all new cases should include

Answer 22

karyotyping (key for classification)

Question 23

molecular methods may be better than cytogenetics for some

Answer 23

abnormalities (translocations, duplication, deletion)

Question 24

FISH

Answer 24

fluorescent in situ hybridization.

Question 25

confirm translocation w FISH

Answer 25

add probes, red binds gene on xsome 17, green for 15. in normal cell, 2R & 2G. in leukemia, see yellow (fusion signal)

Question 26

molecular studies in AL

Answer 26

PCR based assays & NGS

Question 27

PCR

Answer 27

detect new fusion proteins in AML w recurrent translocations

Question 28

what mutations are tested w PCR in all new AML cases

Answer 28

FLT3 & NPM1

Question 29

NGS

Answer 29

perform routinely in clinic for all new AL cases

Question 30

acute promyelocytic leukemia

Answer 30

w PML-RARA

Question 31

mutation w too many b-lymphocytes

Answer 31

CLL chronic lymphocytic leukemia

Question 32

myeloproliferative neoplasms w too many

Answer 32

neutrophils - CML myelogenous platelets - ET essential thrombocythemia rbc - polycythemia vera

Question 33

too many blasts

Answer 33

ALL or AML

Question 34

AML, ALL common in what age

Answer 34

AML - elderly | ALL - kids

Question 35

underlying disorder

Answer 35

marrow infiltration w blasts

Question 36

BM fail

Answer 36

neutropenia, anemia, thrombocytopenia

Question 37

lab features

Answer 37

BM fail, circulating blasts, intravascular coagulation

Question 38

circulating blasts

Answer 38

wbc ~ incr but not always

Question 39

intravasc coag

Answer 39

coagulopathy, hemolysis w rbc frags, thrombocytopenia (low platelet)

Question 40

BM fail leads to

Answer 40

infection, fatigue, bleeding

Question 41

circulating blasts leads to

Answer 41

leukostasis (pulm, CNS) & tissue infiltration (lymphadenopathy, splenomegaly, CNS, skin)

Question 42

intravasc coag leads to

Answer 42

bleeding

Question 43

lab & clin presentations ~acute/subacute

Answer 43

days to wks

Question 44

AL classification

Answer 44

FAB - morphology, cytochem only, limited immunophenotyping 2017 WHO - morph, immunophenotype, cytogenetics, molecular, prior disease & therapy history

Question 45

AL treatment depends on

Answer 45

type (ALL/AML), age of patient (ped vs adult vs old), curative vs palliative intent

Question 46

combination chemotherapy (2)

Answer 46

induction - for full remission. consolidation - prevent relapse

Question 47

supportive care TANPS

Answer 47

transfusions, antibiotics, nutrition, psychosocial support

Question 48

standard 3 + 7 AML treatment (chemo)

Answer 48

daunorubicin + cytarabine. no particular targets, just kill dividing cells

Question 49

daunorubicin interact w dna how

Answer 49

intercalation, inhibition of macromolecular biosynth. also inhib topoisomerase 2 (relax dna supercoils for transcrip)

Question 50

admin daunorubicin & cytarabine. how?

Answer 50

both IV. daunorubicin - 3 days, cytarabine 7 days

Question 51

cytrarabine similar to what human compound (but still diff enough to kill)

Answer 51

cytosine deoxyribose (deoxycytidine) which is incorporated into dna

Question 52

new targeted therapies for APL

Answer 52

retinoic acid, arsenic trioxide

Question 53

BM transplant for who

Answer 53

younger patients (relapsed/high risk AL)

Question 54

BM transplant HSC from who

Answer 54

matched: sibling or unrelated donor

Question 55

BM transplant is toxic therapy

Answer 55

yes, many side effects as new immune system attacks own organs (take immunosuppresants) but potential for cure

Question 56

graft vs leukemia effect

Answer 56

transplant new cells, kill out residual leukemia :) thx to immune response to tumor

Question 57

prognosis wrt age

Answer 57

survival % higher in young ppl (ALL better than AML), ~none for 75+

Question 58

treatment is long

Answer 58

at least 1 month, but some improvement in outcomes (targeted approaches)