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Flashcards in AML & ALL Deck (35):
1

AML- epidemiology

-3.6 per 100,000 people
-5 males to 3 females
-median age is 66yrs
-5 yr survival is 23.8yrs

2

ALL - epidemiology

-1.6 per 100,000
-median age is 14 yrs
-5 year survival is 65% and even higher fo r children

3

which is more common -AML or ALL?

AML

4

Which age group is more affected by AML? ALL?

-AML is adults
-ALL is mostly children but there are children

5

Most common genetic abnormality increase risk for acute leukemia?

Other common condition that increases risk?

-Down syndrome

-Kleinfelters

6

Which benign conditions inc risk for acute leukemia?

-paroxysmal nocturnal hemoglobinuria (PNH)
-aplastic anemia

7

Which malignant conditions inc risk for acute leukemia?

-myelodysplastic syndrome (MSD)
-myeloproliferative syndrome (P. vera)
-marrow failure syndromes: fanconi, schwachman-diamond...etc

8

CML - epidemiology:

-4 per 100,000
-2males to 1 female
-median age of 65yrs
-5 year survival is 60%

9

CLL - epidemiology:

-4.2 per 100,000
-most common leukemia in adults
-5 year survival is 78.8%

10

Acute leukemia - patient presentation/symptoms

-general fatigue
-pallor
-weakness
*-bone pain that is infrequent - sternal or long bones
*-fever/infection - neutropenia
*-skin: pallor, petechiae, GUMS enlarged, ecchymoses, infiltration of the skin (AMML)
-Sweet's syndrome: red/violaceous tender nodules & plaques: acute febrile, neutrophilic dermatosis
*-Eye: retinal hemorrhage or white plaques
*-CNS: headache, cranial nerve palsy, visual changes, more common with monocytic component
*-oropharynx: wet purpura, gum infiltration
*-organomegaly: not too common
*-joints: symmetrical or migratory polyarthritis or arthralgia
*-myeloid sarcoma: AML with extra medullary disease

11

Which FAB classification is treated very differently from the others? How is it different?

-M3 - APL or acute progranulocytic (APL)

-ATRA (maturation agent) and 7+3 induction

12

FAB classification system of AML
-M0-M7... DONT WORRY ABOUT THIS.

-M0- minimally differentiated
-M1- AML without maturation
-M2- AML with granulocyte maturation
-M3- APL or acute progranulocytic
-M4- Acute myelomonocytic
-M5- acute myelomonocytic with eosinophils
-M6- acute erythroleukemia (a &b)
-M7- acute megakaryoblastic leukemia

13

Auer rods... which disease? what are they?

-AML!
-Fused lysosomes and neutrophilic granules with enzymes and crystalline inclusions

14

-Sternal bone marrow sample info:
-normal spot for BM biopsy:

-contraindicated: that bone is only 1cm thick and 16 gauge needle into heart not a good idea
-PSIS

15

AML treatment idea:

-need to wipe the BM out except with APL
-give anthrcycline and cytarabine (c-ara)

16

AML induction support - important item:

-antibiotics!
-no sick visitors
-wash hands

17

tumor lysis syndrome:
definition:
what happens as a result:
treatment?

kill so many cancer cells results in so many metabolites being released into blood

-alakaline urine trashes the kidneys = dialysis

-rasburicase - for uric acid control

18

APL common translocation?
fusion of what genes?

15,17 - PML/RARalpha = inhibition of genes involved in promyelocytic differentation

19

vitamin therapy for which cancer?

APL - use all trans-retinoid acid (ATRA) - maturation agent - induces remision of disease then give 7+3

20

what does ATRA do for APL?

induces maturation

21

What do APL patients usually present with?

DIC

22

Retinoic acid syndrome/APL differentiation syndrome.
-due to?
-what happens?
-fix with what treatment?

-due to ATRA treatment

-leaky capillaries = edema, pleural effusion, lung infiltrates

-steroids help fix!

23

Molecular markers for ALL:

-MDR gene
-DNA microarray-base gene expression patterns
-NOTCH-1 mutations (50% t-cell ALL)
-glutathione S-trasferase
-thymidylate synthase

24

worse prognosis for ALL when...

-older than 35 yrs
-b cells>30k
-t cells>100k
-karyotype 9,22
-persistent minimal residual disease

25

ALL treatment: ideal tx?

-hyper-CVAD but if can get good BM transplant do it

26

CML presentation:

-easy bleeding
-fatigue
-fever
-frequent infections
-WL without effort
-anorexia
-LUQ pain - spleen infarct -refers to L shoulder
-night sweats

27

left shoulder pain.. what happened??

ruptured spleen

28

CML epidemiology

-male dominant
-4 per 100,000
-5 year survival 60%

29

CLL epidemiology:

-most common leukemia in adults
-5 year survival is 79%

30

Most common leukemia in adults?

CLL

31

smudge cells is which disease?

CLL

32

CML chromosome translocation:

9,22 translocation BCR/ABL1

33

CML risk factors:

-increase in age
-increased radiation exposure

34

3 phases of CML

-chronic
-accelerated
-blastic (pretty much AML)

35

drug tx for CML?

-tyrosine kinase inh:
1) imatinib
2) dasatinib
3) nilotinib
-biological:
1)interferon alpha
-chemo:
1)hydroxyurea