AML Flashcards
(163 cards)
1
Q
▪ otherwise known as Acute Non-Lymphocytic Leukemia (ANLL)
A
ACUTE MYELOCYTIC LEUKEMIA (AML)
2
Q
▪ progressive, malignant disease affecting stem (precursor) cells
A
ACUTE MYELOCYTIC LEUKEMIA (AML)
3
Q
▪ a stem cell disorder with predominance of blast cells (> 20%) in the blood or marrow
A
ACUTE MYELOCYTIC LEUKEMIA (AML)
4
Q
• blast cells: immature due to
A
1) genetic mutation or 2) induced by radiation, virus, chemical exposure
5
Q
partially differentiated or undifferentiated cells
A
• blast cells
6
Q
▪ may resemble [?] at presentation due to ↑WBC counts (w/ fever and weakness) → [?] → [?]
A
acute infection
pancytopenia
death
7
Q
(leads to abnormal bleeding; lack of resistance to infection; abnormal proliferates = normal decreases)
A
pancytopenia
8
Q
▪ affects all ages, but increases with older age (> 60 years = disease of adulthood); newborns (pre-mature leukemic development)
A
ACUTE MYELOCYTIC LEUKEMIA (AML)
9
Q
▪ also the most common form of acute leukemia during the first few months of life
A
ACUTE MYELOCYTIC LEUKEMIA (AML)
10
Q
tested for the identification of AML stage or classification using stains and CD markers
A
• Myeloperoxidase (MPO)
• CD13
• CD33
• CD117
• CD14
• CD64
11
Q
• first stage; large
A
primitive myeloblasts
12
Q
• usually stained with MPO
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primitive myeloblasts
13
Q
• detected with CD13, CD33, and CD117 (more specific than staining/no staining capability; identification via CD markers/immunology)
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primitive myeloblasts
14
Q
• usually stained with MPO, Sudan Black B (SBB), Chloroacetate Esterase (CAE)
A
more mature blasts (2-3 stages)
15
Q
AML ETIOLOGY
A
- RADIATION
- GENETICS
- CHEMICALS
16
Q
▪ linked to an increase incidence of leukemia (aggravates leukemic conditions)
A
- RADIATION
17
Q
Chromosomal defects
A
• aneuploidy
• breakage and rearrangement
18
Q
- unstable chromosomes bound to be modified or rearranged
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• breakage and rearrangement
19
Q
- (e.g., Fanconi Syndrome, Bloom Syndrome, Ph1 chromosome)
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• breakage and rearrangement
20
Q
- extra or missing chromosome
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• aneuploidy
21
Q
- (e.g., Trisomy 21 or Down Syndrome)
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• aneuploidy
22
Q
- CHEMICALS
A
a. Leukomogen
b. Benzene
23
Q
suppress the bone marrow and eventually causes aplasia
A
Leukomogen
24
Q
(inhibition of production of blood cells in the bm = [?]; disease in which the red bone marrow disappears and consequently ceases to produce red blood cells, white blood cells and platelets)
A
balstic aplasia
25
Leukomogen proposed (still controversial; not evidential but linked to leukemia):
- chloramphenicol
- phenylbutazone
- arsenic-containing compounds
- sulfonamides
- insecticides
26
: only proven chemical known to cause cancer
Benzene
27
▪ not conclusive/proven to humans but linked like the chemical etiology
4. VIRUSES
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: • most common class of tumor associated with animal leukemia and lymphoma
▪ Type C RNA viruses
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: • carry genes responsible for the induction of cancer
▪ Retroviruses (e.g., HIV)
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• activates our proto-oncogene to oncogene which causes or induces cancer cells
▪ Retroviruses (e.g., HIV)
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AML with minimal differentiation/ Undifferentiated leukemia
M0
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(similar to Undifferentiated MDS; general features: myelocytic and monocytic origin)
M0
33
AML without maturation
M1
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▪ myelocytic origin
M1
M2
M3
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▪ > 30% myeloblast in BM
M1
36
▪ + Auer rods (fused primary granules; spindle-shaped, redpurple)
M1
M2
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AML with maturation
M2
38
Myeloblast + Mature cells
M2
39
▪ myelocytic origin
M2
40
▪ > 30% myeloblast with > 10% granulocytic component
M2
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▪ + Auer rods
M1
M2
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→ t(8q;21)
M2
43
Acute Promyelocytic Leukemia /Hypergranular Promyelocytic Leukemia
M3
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→ t(15;17)
M3
45
Lesser blast (2nd stage)
M3
46
▪ myelocytic origin
M3
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▪ with heavy granulation
M3
48
▪ many Auer rods in bundles called "faggot cells"
M3
49
▪ nuclear shape: bilobed or reniform (kidney-shaped)
M3
50
▪ associated with DIC
M3
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M3 Coagulation tests/blood findings:
• prolonged PT, APTT, TCT
• ↓fibrinogen, platelet, AT-III
• ↑FSP, fibrin monomers
• (+) D-dimer
52
Acute Myelomonocytic Leukemia
M4
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→ inv(16) subclass M4e
M4
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▪ > 20% of PB WBCs are monocytes or monocytic precursors (promonocytes)
M4
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▪ > 30% blasts
M4
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▪ > 20% granulocytes
M4
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▪ associated with CNS involvement or tissue infiltration (capable of infiltrating tissue barriers on the brain)
M4
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▪ increased lysozyme
M4
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Acute Monocytic Leukemia
M5
60
Schilling's Leukemia
M5
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→ t(9;11)
M5
62
▪ > 80% of BM elements are of monocytic series
M5
63
▪ increased lysozyme
M5
64
▪ associated with CNS involvement
M5
65
• poorly differentiated monocytic leukemia (nonspecific cell location; due to the presence of promonocyte and mature monocyte in both PB and BM)
M5a
66
• predominant cell: promonocyte (immature) in BM and PB
M5a
67
• M5a distinguishing morphologic features:
- lacy chromatin in the nucleus (normal)
- cerebriform shape nucleus (brain-like structure)
68
well differentiated (more mature seen in PB)
M5b
69
• more of promonocytes (BM) and monocytes (PB)
M5b
70
Naegeli monocytic Leukemia
M4
71
Erythroleukemia
M6
72
Erythremic Myelosis
M6
73
DiGuglielmo Disease (common name)
M6
74
Pure Erythroid Leukemia
M6
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▪ with neoplastic myeloblasts and erythroblasts
M6
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▪ > 50% are erythroid cells in all stages of maturation in PB
M6
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▪ > 30% blasts in PB (acute)
M6
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▪ dyserythropoiesis (presence of erythroblasts, nuclear fragments, N:C asynchrony or megaloblastic changes, and normoblastosis)
M6
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• normoblastosis: increased nucleated RBCs in peripheral blood (erythroblast)
M6
80
▪ Stains (+): Periodic Acid Schiff (PAS)
M6
81
Acute Megakaryocytic Leukemia
M7
82
→ ch21 abnormality
M7
83
▪ predominantly megakaryoblasts (≥30%)
M7
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▪ > 30% myeloblasts
M1
M2
M7
85
▪ myelosclerosis
M7
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• sclerosis of the bone marrow
M7
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• obliteration of the marrow cavity by small spicules of bone
M7
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• irregularly thickened bony trabeculae
M7
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• proliferation of fibroblastic cells (build-up of fibrous CT) in the bone marrow (affecting blood production) associated with splenomegaly and enlargement of liver
M7
90
▪ Stains (-): SBB and Peroxidase
M7
91
M1, M2, M3 STAINS
▪ SBB
▪ Peroxidase (MPO)
▪ a-Naphthol chloroacetate esterase (ANCAE)
92
M4 STAINS
▪ SBB*
▪ PAS
▪ Peroxidase
▪ a-Naphthol chloroacetate esterase (ANCAE)
▪ a-Naphthyl butyrate (ANB) and acetate esterase
93
M5 STAINS
▪ PAS
▪ a-Naphthyl acetate esterase
▪ a-Naphthyl butyrate esterase (ANB)
▪ ANCAE
94
M6 STAINS
▪ PAS
▪ a-Naphthyl acetate esterase
▪ a-Naphthyl butyrate esterase
▪ a-Naphthol chloroacetate esterase (ANCAE)
95
M7 STAINS
▪ Acid phosphatase
▪ PAS
▪ a-Naphthol chloroacetate esterase (ANCAE)
96
WHO Classification - Main Categories of AML
1. AML with recurrent cytogenetic abnormalities
2. AML with multilineage dysplasia
3. AML, Therapy related
4. AML, Not otherwise specified (subclassified by morphology and immunophenotype).
97
AML with t(8;21) FAB:
M2
98
AML with inv(16) FAB:
M4e
99
APL with t(15;17) FAB:
M3
100
AML with t(9;11) FAB:
M5a
101
AML with t(1;22;21) FAB:
M7
102
▪ ≥20% blasts
AML with t(8;21)
103
▪ ≥10% maturing granulocytes
AML with t(8;21)
104
▪ Auer rods
AML with t(8;21)
APL with t(15;17)
105
▪ dysplasia
AML with t(8;21)
106
▪ abnormal granules
AML with t(8;21)
107
▪ Blasts with both monocytic and neutrophilic differentiation
AML with inv(16)
108
▪ increased eosinophils/immature eosinophils
AML with inv(16)
109
▪ Promyelocytes with azurophilic granules
APL with t(15;17)
110
▪ Monoblasts and promonocytes predominate
AML with t(9;11)
111
▪ Multilineage dysplasia
AML, therapy related
112
▪ RS
AML, therapy related
113
▪ increased basophils
AML, therapy related
114
▪ Any morphology may be seen but myelomonocytic is most common
AML with t(6;9)
115
▪ Any morphology may be seen except APL
AML with inv(3) or t(3;3)
116
▪ Megakaryoblastic morphology with small and large megakaryocytes
AML with t(1;22;21) FAB: M7
117
▪ Any
AML with FLT3 mutation/duplication
118
▪ Myelomonocytic and monocytic features
AML with NPM1 mutation
119
▪ Variable, generally similar to less differentiated AMLs in FAB scheme (M1, 2)
AML with CEBPA mutation
120
AML
Acute myeloid leukemia
121
APL
acute promyelocytic leukemia
122
ATRA
all-trans retinoic acid
123
PML
promyelocytic leukemia
124
RARα
retinoid acid receptor gene-α
125
CD13, CD33, CD117, CD19, CD34
AML with t(8;21)
126
CD13, CD33, CD14, CD4, CD64
AML with inv(16)
127
CD13, CD33, CD2, ± CD117
APL with t(15;17)
128
CD33, CD65, CD4, HLADR
AML with t(9;11)
129
CD13, CD33, CD34, ± CD56, CD57
AML, therapy related
130
CD13, CD33, CD38, HLADR, CD117
AML with t(6;9)
131
CD13, CD33, HLADR, CD34, CD38
AML with inv(3) or t(3;3)
132
CD41, CD61, ± CD13, CD33
AML with t(1;22;21)
133
CD13, CD33, CD34 is negative
AML with NPM1 mutation
134
CD13, CD33, CD65, CD11b, CD15
AML with CEBPA mutation
135
t(8;21)(q22;q22)
AML with t(8;21)
136
AML1/ETO
AML with t(8;21)
137
More favorable
AML with t(8;21)
AML with inv(16)
AML with CEBPA mutation
138
inv(16)(p13;q22)
AML with inv(16)
139
t(16;16)(p13;q22)
AML with inv(16)
140
More favorable if responsive to ATRA
APL with t(15;17)
141
Inc px survival upon treatment
ATRA
142
t(15;17)(q22;q12)
APL with t(15;17)
143
PML/RARα
APL with t(15;17)
144
Variants all involve 17q12
APL with t(15;17)
145
t(9;11)(p22;q23)
AML with t(9;11)
146
MLLT3-MLL
AML with t(9;11)
147
Intermediate
AML with t(9;11)
148
11q23 abnormality seen with topoisomerase II inhibitor–associated AML
AML, therapy related
149
Less favorable
AML, therapy related
AML with t(6;9)
AML with inv(3) or t(3;3)
AML with t(1;22;21)
AML with FLT3 mutation/duplication
150
Median survival: < 3 years
AML, therapy related
151
More favorable in absence of FLT3
AML with NPM1 mutation
152
NPM1 mutation
AML with NPM1 mutation
153
cytoplasmic expression
AML with NPM1 mutation
154
DEK-NUP214
AML with t(6;9)
155
t(6;9) (p23;q35)
AML with t(6;9)
156
Inv(3)(q21;q26.2)
AML with inv(3) or t(3;3)
157
t(3;3)(q21;q26.2)
AML with inv(3) or t(3;3)
158
RPN1- EV11
AML with inv(3) or t(3;3)
159
t(1;22)(p13;q13)
AML with t(1;22;21)
160
RBM15-MKL1
AML with t(1;22;21)
161
t(6;9)(p23;q34)
AML with FLT3 mutation/duplication
162
t(15;17)(q22;q12) or normal
AML with FLT3 mutation/duplication
163
CEBPA mutation
AML with CEBPA mutation
