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Flashcards in Hematologic Malignancies Deck (124)
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What are the 2 major categories of Acute Leukemia?

• AML and ALL
• Acute myeloid leukemia and acute lymphoblastic leukemia


What makes a leukemia acute?

• Generally the level of differentiation seen in the malignant cells
• Higher growth rate means more aggressive progression/ presentation


B-ALL with t(12;21(p13;q22) have a fusion protein that does what?

• ETV6-RUNX1 = the fusion protein in this flavor of B-ALL
• Present in 25% of pediatirc B-ALL patients
• Favorable prognosis


What translocation (and what affected gene) is associated with pediatric B-ALL?

• T(11q23)
• The MLL gene. When you see this think poor prognosis but common in pediatric presentations of B-ALL


Are you happy to see t(9;22)(q34;11.2) as a clinician?

• Nope. This is the worst ALL prognosis of them all


Is the philedelphia chromosome in B-ALL the same as in CML?

• Nope. It's a bit smaller because of the different breakpoint
• (q34'q11.2) is the breakpoint here and its 190kDa not the 210kDa like "normal"


Would you expect a t(9;22) finding in an AML or ALL pediatric patient?

• Not really in AML at all and not common in ALL, this is rare in peds but 25% of adult cases
• T(9;22) = philadelphia chromosome, but NOT THE SAME AS IN CML, it's a poor prognosis in ALL children


Surface Ig and CD20 are expressed by what cells?

• Mature B-cells. Thus you wouldn't expect to see them in B-ALL


If you type an ALL patient with a high percentage of CD19, CD22, CD79a…what is the ALL subtype?

• These are all immature B cell markers


What marker is specific for immature lymphoblasts (it's not a cell surface marker it's a nuclear enzyme)?

• TdT, specific marker for immature lymphoblast, helpful in diagnosing ALL


CD34 is a surface marker for what flavor of cell?

• Immature lymphoblasts (use as a marker for ALL diagnosis)
• Myeloblasts also express this so it can get a bit more confusing


What causes the Signs and symptoms of Acute leukemia?

• Loss of normal hematopoietic elements
• The lower numbers of peripheral blood cells
• So any lowered cell you can think of might have a AML/ALL like symptom


In acute leukemias, nearly every patient exhibits a particular bone marrow finding…

• Near complete cellular replacement in the bone marrow by the malignant cell (replacing the other cells)
• The overall loss in peripheral cells causes the signs and symptoms of acute leukemias


How is ALL subdivided?

• B-ALL and T-ALL
• B-cells and T-cells


What are some specific signs and symptoms of Acute Leukemias?

• Remember they have to do with peripheral blood cells being lowered because they have been replaced in the marrow by the malignant cells
○ Cytopenia (any flavor therin)
○ Weight loss
○ Easy bruising
○ Anemia (both in CBC and in clinical findings)
○ Fatigue
○ Pallor
○ Hemmorrhage and petechiae
○ Fever, recurrent infections


What problem is found in 95% of AML and 90% of ALL patients?

• Chromosomal abnormalities
• Pretty much meaning that chromosomal abnormalities are the reason for these diseases's existence


Are there risk factors associated with acute leukemias? Do patients tend to have them?

• Yes, but patients don't tend to exhibit a ton of them
• Remember, children are often affected by them


What different types of myeloid cells can exhibit AML?

• Any type of myeloid. Why? Because the cells reaching malignancy are somewhere in the progenitor stem cell or pluripotent stem cell region
• These will proliferate along any of the different differentiation trains


Surface Ig and CD20 are expressed by what cells?

• Mature B-cells. Thus you wouldn't expect to see them in B-ALL


Concerning the stage of differentiation, what are the differences between AML and ALL?

• ALL deals with lymphoblasts, so they have to be differentiated at least to the pro-B or pro-T celll stage
• AML deals with less differentiated (and by definition not the B or T cell lineage)


What do all hematological malignancies have in common?

clonal populations of malignant cells from marrow origin
*doesn't matter if mutation arose in the marrow or not


what is a leukemia?

hematapoietic cells cancer, manifests chiefly in the blood and marrow, but is NOT lymphocytic (B or T cells)


What is the difference between leukemia and lymphoma?

both are hematopoietic cell malignancies BUT lymphoma = lymphocytes (or precursors) and leukemia = anything but a lymphocyte/lymphocyte precursor.
*another discriminatory idea is "node vs. marrow"


what is CLL and SLL a classic example of?

symptom/presentation overlap
*same disease cellularly just CLL is in bone marrow and SLL in lymph nodes
*CLL = chronic lymphocytic leukemia
*SLL = small lymphocytic leukemia


If one malignancy is a higher grade than the other what does that mean?

the higher grade means more mitotic figures and more aggressive growth. It also normally means there is a lesser degree of differentiation in the cell sample recieved by path


Can hematologic malignancies be high or low grade?

Yep. in general that is the classification scheme of these malignancies. But a cancer of a hematapoietic cell is by definition malignant, it skips any benign stage


What is the difference btw. Acute and chronic leukemias?

Acute = high grade
Chronic = low grade


Regarding malignancy, what's a major difference btw. solid tissue and hematologic origin?

Soft tissue proliferation can be benign. There can be a non-malignant tumor. With hematologic cells that reach "cancer" stage, they are malignant by definition. They skip the benign stage/classification


Regarding chromosomal structure what classifies most hematological malignancies?

chromosomal abnormalities and certainly tanslocations are extremely common in these malignancies. Over 90% of AML and ALL cancers have chromosomal abnormalities (big deletions, translocations, etc.)


when you see t(9;22) what do you think?

CML. philadelphia chromosome. Good in CML BAD in ALL