Leukemia Flashcards
1
Q
What are the two main types of leukemia based on cell type?
A
Myelogenous and Lymphocytic
2
Q
What is the most common type of acute leukemia in adults?
A
Acute Myeloid Leukemia (AML)
3
Q
At what median age is Acute Myeloid Leukemia (AML) most commonly diagnosed?
A
65 years
4
Q
What is the primary cause of the symptoms in Acute Myeloid Leukemia (AML)?
A
Normal bone marrow cells being replaced by leukemia cells
5
Q
What are Auer rods pathognomonic of?
A
Myeloblasts
6
Q
What is the significance of finding blasts in the peripheral blood?
A
It is not a normal finding and warrants further workup or referral.
7
Q
What is required for the diagnosis of Acute Myeloid Leukemia (AML)?
A
Bone Marrow Biopsy
8
Q
How is leukemia classified?
A
According to cell type and whether it is acute or chronic
9
Q
What age is considered a good risk feature for Acute Myeloid Leukemia (AML)?
A
< 40 years of age
10
Q
What is a poor risk feature related to age for AML?
A
> 60 years of age
11
Q
What are the two classification systems for Acute Myeloid Leukemia (AML)?
A
International Consensus Classification (ICC) and World Health Organization 5 (WHO)
12
Q
What WBC count is considered a good risk feature for AML?
A
< 10,000
13
Q
What are the primary characteristics used to classify Acute Myeloid Leukemia (AML)?
A
Molecular and cytogenetic characteristics
14
Q
What WBC count is considered a poor risk feature for AML?
A
> 100,000
15
Q
What is the primary driver of Acute Myeloid Leukemia (AML)?
A
Acquired genetic and epigenetic changes to myeloid cells and the bone marrow microenvironment
16
Q
What platelet count is considered a poor risk feature for AML?
A
< 30,000
17
Q
What is a good risk feature related to the type of leukemia for AML?
A
De Novo
18
Q
What is the typical percentage of myeloid blasts in blood or bone marrow for AML diagnosis?
A
Greater than 10%
19
Q
What is a poor risk feature related to the type of leukemia for AML?
A
Secondary leukemia
20
Q
What are some common signs and symptoms of Acute Myeloid Leukemia (AML)?
A
Fatigue, anemia, thrombocytopenia, neutropenia, leukostasis, dyspnea, chest pain, headache, altered mentation, hepatosplenomegaly, bone pain, fever
21
Q
What is a good risk feature related to LDH levels for AML?
A
Normal LDH
22
Q
What is a poor risk feature related to drug resistance for AML?
A
Multi-drug resistance phenotype – MDR1 gene
23
Q
What are some causes of leukemia?
A
DeNovo (unknown), secondary to MDS, myeloproliferative disorders, aplastic anemia, prior chemotherapy or radiation, toxic exposure, inherited syndromes or diseases
24
Q
What is a poor risk feature related to disease status after initial therapy for AML?
A
Residual disease after initial induction therapy
25
What is the method used to diagnose AML?
Bone Marrow Biopsy
26
What are some inherited syndromes or diseases that increase the risk of leukemia?
Down Syndrome, Klinefelter, Fanconi Anemia
27
What does 'p' stand for in cytogenetics?
Short arm
28
What is the difference between acute and chronic leukemia?
Acute leukemia develops quickly and requires immediate treatment, while chronic leukemia progresses more slowly.
29
What are common signs and symptoms of Acute Lymphoblastic Leukemia (ALL)?
Fever, infection, bleeding, bone pain, headache, pancytopenia, night sweats
30
What is the primary characteristic of blasts in leukemia?
They are abnormal and immature cells.
31
What does 'q' stand for in cytogenetics?
Long arm
32
What does 'inv' stand for in cytogenetics?
Inversion
33
What physical exam findings are associated with ALL?
Hepatomegaly, splenomegaly, lymphadenopathy, testicular enlargement, neurologic abnormalities
34
What does 'del' stand for in cytogenetics?
Deletion
35
What is the primary goal of treatment for Chronic Myeloid Leukemia (CML)?
To reduce or eliminate cells with the Philadelphia chromosome.
36
What is the effect of genetic alterations in acute leukemia?
Differentiation arrest and/or excessive proliferation of abnormal immature cells, leading to decreased normal blood cell production.
37
What does 't' stand for in cytogenetics?
Translocation
38
What percentage of children with leukemia have at least one of the following: palpable liver, palpable spleen, pallor, fever, or bruising?
50%
39
What is the relationship between atomic bomb survivors and leukemia?
Increased risks of Myeloid Leukemia
40
What is expected to occur within 3 months of CML treatment?
Hematologic remission with normal CBC and bone marrow, and a normal physical exam.
41
What does BMBx show in the diagnosis of ALL?
Infiltration of lymphoblasts
42
What cytogenetic abnormality is considered favorable in AML?
t(8;21) (q22;q22)
43
What is expected to occur within 3-6 months of CML treatment?
Cytogenetic remission with no evidence of the Philadelphia chromosome.
44
How are leukemia cells in ALL classified?
According to immunophenotype via Flow Cytometry
45
What are some secondary causes of Acute Myeloid Leukemia (AML)?
Secondary to MDS, myeloproliferative disorders, aplastic anemia, prior chemotherapy or radiation, toxic exposure
46
What cytogenetic abnormality is considered unfavorable in AML?
del 7q
47
What is the desired outcome within 12 months of CML treatment?
Molecular remission with a negative BCR/ABL mutation analysis by quantitative PCR.
48
What does CD stand for in the context of ALL?
Cluster of differentiation
49
What cytogenetic abnormality is considered intermediate in AML?
Abnormalities not otherwise specified
50
What is the role of alkylating agents in leukemia?
They can cause therapy-related AML.
51
Why is CML treatment usually not emergent?
Because the majority of circulating cells are mature myeloid cells.
52
What percentage of AML patients have normal cytogenetics?
Almost half
53
What is the significance of hepatosplenomegaly in AML?
It indicates the enlargement of the liver and spleen due to leukemia.
54
Why are chromosomal abnormalities significant in childhood ALL?
They help with risk group stratification and guide therapy.
55
What can further differentiate the intermediate risk category in AML?
Molecular profiling
56
What are cytogenetic abnormalities?
Chromosomal aberrations
57
What is the overall cure rate for children with ALL?
90%
58
How long can treatment for ALL last?
2-3 years
59
What is the primary treatment urgency for Acute Myeloid Leukemia (AML)?
Immediate treatment is required due to rapid disease progression.
60
How has the annual mortality rate for CML changed with Tyrosine Kinase Inhibitors (TKIs)?
It has been reduced from 10-20% to about 2%.
61
What are molecular abnormalities?
Gene mutations
62
What are the phases of ALL treatment?
Induction, intensified consolidation, maintenance, CNS prophylaxis during induction and consolidation
63
What do TKIs inhibit in CML treatment?
BCR-ABL tyrosine kinase.
64
What mutation is associated with shorter remission duration in AML?
FLT-3
65
What is the primary abnormality in the blood of AML patients?
Large numbers of immature/abnormal myeloid cells (blasts)
66
What is the effect of AML on normal blood cell production?
Decreased normal blood cell production
67
Why is CNS prophylaxis important in ALL treatment?
Without it, relapse significantly increases at 1 year.
68
Name a 1st generation TKI used in CML treatment.
Imatinib mesylate (Gleevec).
69
What is the primary diagnostic tool for AML?
Bone Marrow Biopsy
70
What methods are used for CNS prophylaxis in ALL?
Intrathecal chemotherapy, Omaya reservoir, lumbar puncture
71
Name two 2nd generation TKIs used in CML treatment.
Dasatinib (Sprycel) and nilotinib (Tasigna).
72
What is the primary characteristic of Auer rods?
They are pathognomonic of myeloblasts.
73
What were the relapse rates for CNS involvement in ALL before routine CNS therapy?
Up to 80%
74
What is the primary focus of the ICC and WHO classification systems for AML?
Molecular and cytogenetic characteristics
75
What is the prognosis for CML patients who achieve hematologic, cytogenetic, and molecular remission?
Excellent, with 100% remaining progression-free at 8 years.
76
What mutation improves CR rate and overall survival in AML?
NPM1
77
What is the first phase of intensive chemotherapy for AML?
Induction chemotherapy
78
What is the goal of consolidation chemotherapy in AML?
To produce and maintain a Complete Remission (CR)
79
What is a high-risk treatment option for AML relapse?
Stem cell transplantation
80
What are some long-term effects of ALL treatment?
Neurodevelopmental impairment, growth retardation, cardiotoxicity, risk for second malignancies, impaired glucose and insulin metabolism, infertility
81
What factors contribute to a worse prognosis in CML patients?
Failure to achieve remission targets, loss of cytogenetic or molecular response, or development of new mutations or cytogenetic abnormalities.
82
What is a common side effect of AML chemotherapy?
Pancytopenia
83
What is the primary abnormality in the bone marrow of AML patients?
Uncontrolled proliferation of myeloid precursors
84
What are the remission rates for adult ALL?
80-90%
85
What is a major cause of treatment failure in CML?
Poor compliance with taking the medication.
86
What is Leukemia Cutis?
Local or disseminated skin infiltration by leukemia cells
87
What is the primary cause of dyspnea in AML patients?
Leukostasis
88
What percentage of adult ALL patients have the Philadelphia Chromosome?
20-30%
89
What often causes relapses during TKI treatment in CML?
Development of a new mutation in the BCR-ABL gene.
90
What is Myeloid Sarcoma also known as?
Granulocytic sarcoma
91
What is the primary cause of bone pain in AML patients?
Replacement of normal bone marrow cells by leukemia cells
92
What is recommended for all patients with Ph-positive ALL who achieve complete remission after induction?
Allogeneic Stem Cell Transplant (SCT)
93
What is the primary cause of fever in AML patients?
Infection due to neutropenia
94
What is the most common childhood cancer?
Acute Lymphoblastic Leukemia (ALL)
95
How often should CML patients taking TKIs be monitored with a quantitative PCR assay?
Approximately every 3 months.
96
What is a risk factor for ALL?
Genetic and immunodeficiency syndromes
97
What is the primary cause of altered mentation in AML patients?
Leukostasis
98
What should be considered for CML patients who do not achieve a good molecular response or who progress following therapy?
Allogeneic stem cell transplantation.
99
What is a common symptom of ALL?
Fever
100
What characterizes Chronic Myeloid Leukemia (CML)?
Slow-growing, increased proliferation of mature myeloid cells, more functional cells
101
What is the primary cause of chest pain in AML patients?
Leukostasis
102
What physical exam finding is common in children with leukemia?
Hepatomegaly
103
What can stem cell transplant offer to CML patients?
A cure.
104
What percentage of adult leukemia cases does CML account for?
15%
105
What is the median age at diagnosis for CML?
55-65 years
106
What is the primary cause of hepatosplenomegaly in AML patients?
Infiltration of leukemia cells into the liver and spleen
107
What is the most common chronic leukemia?
Chronic Lymphocytic Leukemia (CLL).
108
What has happened to the mortality rate of CML?
It has been greatly reduced.
109
What is the primary cause of thrombocytopenia in AML patients?
Replacement of normal bone marrow cells by leukemia cells
110
What is the treatment for Myeloid Sarcoma?
Similar to AML, may benefit from radiation
111
What is the hallmark of CML?
Philadelphia Chromosome
112
What is the difference between CLL and Small Cell Lymphocytic Lymphoma (SLL)?
CLL is in the blood and bone marrow, SLL is in the lymph nodes.
113
What is the distribution pattern of ALL?
Bimodal distribution around 2-5 years of age and then again around 50 years of age
114
What is the Philadelphia Chromosome?
Translocation between the long arms of chromosomes 9 and 22
115
What is the mean age at diagnosis for CLL?
72 years old.
116
What is the primary cause of anemia in AML patients?
Replacement of normal bone marrow cells by leukemia cells
117
What is the significance of cytogenetics in AML?
Important prognostically at diagnosis and at time of relapse
118
What is the male to female ratio for CLL?
2:1.
119
What genes fuse to form the BCR-ABL gene in CML?
BCR and ABL
120
What characterizes CLL?
Proliferation and accumulation of mature-appearing but non-functioning B lymphocytes in blood and/or lymphoid tissue.
121
What does the BCR-ABL gene cause cells to produce?
An abnormal enzyme: BCR-ABL tyrosine kinase
122
What is the 7 + 3 regimen in AML treatment?
Ara-C (cytarabine) for 7 days with an Anthracycline (Idarubicin or Daunorubicin) for 3 days
123
What is the primary cause of fatigue in AML patients?
Anemia
124
What is the primary cause of neutropenia in AML patients?
Replacement of normal bone marrow cells by leukemia cells
125
What is the primary cause of leukostasis in AML patients?
High number of abnormal white blood cells
126
What is the 5-year survival rate for CLL?
Over 80%.
127
What is the 1 + 5 regimen in AML treatment?
Ara-C with Mitoxantrone on day 1 and day 5
128
What is the most likely time for AML relapse after induction chemotherapy?
Within the first two years
129
What are the three phases of CML?
Chronic phase, accelerated phase, blast phase
130
What percentage of CLL/SLL patients are asymptomatic at diagnosis?
25%.
131
What percentage of CML patients are diagnosed in the chronic phase?
85%
132
What is the primary cause of dyspnea in AML patients?
Leukostasis
133
What is the method to confirm Leukemia Cutis?
Skin biopsy
134
What are the 'B' symptoms associated with CLL/SLL?
Fatigue, drenching night sweats, weight loss, frequent and/or persistent infections.
135
What is the primary cause of chest pain in AML patients?
Leukostasis
136
What characterizes the blast phase of CML?
20-30% blast in bone marrow or blood, difficult to control
137
What is the primary cause of headache in AML patients?
Leukostasis
138
What is the common site for Myeloid Sarcoma?
Skin and soft tissues
139
What is a common finding in 80% of CLL/SLL patients?
Painless lymphadenopathy.
140
What is a key diagnostic feature of CLL on a peripheral smear?
Smudge cells.
141
What are common signs and symptoms of CML?
Usually asymptomatic, fatigue, weight loss, early satiety, poor appetite, low-grade fevers, excessive sweating
142
What is the primary cause of altered mentation in AML patients?
Leukostasis
143
What is the common age group for pediatric ALL?
2-5 years of age
144
What is the primary cause of hepatosplenomegaly in AML patients?
Infiltration of leukemia cells into the liver and spleen
145
What markers are identified in CLL/SLL through peripheral blood flow cytometry?
CD5, CD19, CD20, CD23.
146
What physical exam findings are associated with CML?
Hepatomegaly, splenomegaly, petechiae, ecchymoses, pallor
147
What is the common age group for adult ALL?
Around 50 years of age
148
What is the primary cause of bone pain in AML patients?
Replacement of normal bone marrow cells by leukemia cells
149
Is a bone marrow biopsy required for CLL diagnosis?
No, it is not required.
150
What is the common site for ALL spread?
CNS (brain, spinal fluid, spinal cord)
151
What is the most common finding in a CBC with differential for CML?
Leukocytosis (>150,000)
152
What is the primary cause of fever in AML patients?
Infection due to neutropenia
153
When is a lymph node biopsy required for SLL?
If peripheral flow cytometry is negative.
154
What is a common physical exam finding in children with leukemia?
Splenomegaly
155
What other blood abnormalities are found in CML?
Thrombocytosis, anemia
156
What is a common symptom of ALL related to the blood?
Bleeding
157
What are smudge cells?
Remnants of fragile lymphocytes distorted during slide preparation.
158
What is a common symptom of ALL related to the bones?
Bone pain
159
What is the primary cause of thrombocytopenia in AML patients?
Replacement of normal bone marrow cells by leukemia cells
160
When is treatment indicated for CLL/SLL?
Advanced stage, high tumor burden, severe 'B' symptoms, repeated infections.
161
What does a bone marrow aspiration and biopsy show in CML?
Hypercellular with increased myeloid cell line
162
What is a common symptom of ALL related to the head?
Headache
163
What is the primary cause of anemia in AML patients?
Replacement of normal bone marrow cells by leukemia cells
164
What is a common symptom of ALL related to the immune system?
Infection
165
What tests detect the Philadelphia chromosome in CML?
Cytogenetics, molecular tests like PCR or FISH
166
What is the primary cause of fatigue in AML patients?
Anemia
167
What are the treatment options for CLL/SLL?
Observation, chemotherapy, immunotherapy/biologic therapy, stem cell transplant.
168
What can stem cell transplant offer to CLL/SLL patients?
A potential cure.
169
What is a common symptom of ALL related to the skin?
Night Sweats
170
What is the goal of CML treatment?
To reduce/eliminate the cells with the Philadelphia chromosome
171
What is the primary cause of neutropenia in AML patients?
Replacement of normal bone marrow cells by leukemia cells
172
What is expected within 3 months of CML treatment?
Hematologic remission: normal CBC & bone marrow, normal physical exam
173
What is a common physical exam finding in children with leukemia related to the lymphatic system?
Lymphadenopathy
174
What is the primary cause of leukostasis in AML patients?
High number of abnormal white blood cells
175
What is the primary cause of dyspnea in AML patients?
Leukostasis
176
What is a common physical exam finding in children with leukemia related to the testes?
Testicular Enlargement
177
What is expected within 3-6 months of CML treatment?
Cytogenetic remission: no evidence of Philadelphia chromosome
178
What is the primary cause of chest pain in AML patients?
Leukostasis
179
What is the desired outcome within 12 months of CML treatment?
Molecular remission: negative BCR/ABL mutation analysis by quantitative PCR
180
What is a common physical exam finding in children with leukemia related to the nervous system?
Neurologic abnormalities
181
What is the primary cause of headache in AML patients?
Leukostasis
182
What percentage of children with leukemia have at least one of the following: palpable liver, palpable spleen, pallor, fever, or bruising?
50%
183
What is the primary cause of altered mentation in AML patients?
Leukostasis
184
What is the primary cause of hepatosplenomegaly in AML patients?
Infiltration of leukemia cells into the liver and spleen
185
What is the primary cause of bone pain in AML patients?
Replacement of normal bone marrow cells by leukemia cells
186
What is the primary cause of fever in AML patients?
Infection due to neutropenia
187
What is the primary cause of thrombocytopenia in AML patients?
Replacement of normal bone marrow cells by leukemia cells
188
What is the primary cause of anemia in AML patients?
Replacement of normal bone marrow cells by leukemia cells
189
What is the primary cause of fatigue in AML patients?
Anemia
190
What is the primary cause of neutropenia in AML patients?
Replacement of normal bone marrow cells by leukemia cells
191
What is the primary cause of leukostasis in AML patients?
High number of abnormal white blood cells
192
What is the primary cause of dyspnea in AML patients?
Leukostasis
193
What is the primary cause of chest pain in AML patients?
Leukostasis
194
What is the primary cause of headache in AML patients?
Leukostasis
195
What is the primary cause of altered mentation in AML patients?
Leukostasis
196
What is the primary cause of hepatosplenomegaly in AML patients?
Infiltration of leukemia cells into the liver and spleen
197
What is the primary cause of bone pain in AML patients?
Replacement of normal bone marrow cells by leukemia cells
198
What is the primary cause of fever in AML patients?
Infection due to neutropenia
199
What is the primary cause of thrombocytopenia in AML patients?
Replacement of normal bone marrow cells by leukemia cells
200
What is the primary cause of anemia in AML patients?
Replacement of normal bone marrow cells by leukemia cells
201
What is the primary cause of fatigue in AML patients?
Anemia
202
What is the primary cause of neutropenia in AML patients?
Replacement of normal bone marrow cells by leukemia cells
203
What is the primary cause of leukostasis in AML patients?
High number of abnormal white blood cells
204
What is the primary cause of dyspnea in AML patients?
Leukostasis
205
What is the primary cause of chest pain in AML patients?
Leukostasis
206
What is the primary cause of headache in AML patients?
Leukostasis
207
What is the primary cause of altered mentation in AML patients?
Leukostasis
208
What is the primary cause of hepatosplenomegaly in AML patients?
Infiltration of leukemia cells into the liver and spleen
209
What is the primary cause of bone pain in AML patients?
Replacement of normal bone marrow cells by leukemia cells
210
What is the primary cause of fever in AML patients?
Infection due to neutropenia
211
What is the primary cause of thrombocytopenia in AML patients?
Replacement of normal bone marrow cells by leukemia cells
212
What is the primary cause of anemia in AML patients?
Replacement of normal bone marrow cells by leukemia cells
213
What is the primary cause of fatigue in AML patients?
Anemia
214
What is the primary cause of neutropenia in AML patients?
Replacement of normal bone marrow cells by leukemia cells
215
What is the primary cause of leukostasis in AML patients?
High number of abnormal white blood cells
216
What is the primary cause of dyspnea in AML patients?
Leukostasis
217
What is the primary cause of chest pain in AML patients?
Leukostasis
218
What is the primary cause of headache in AML patients?
Leukostasis
219
What is the primary cause of altered mentation in AML patients?
Leukostasis
220
What is the primary cause of hepatosplenomegaly in AML patients?
Infiltration of leukemia cells into the liver and spleen
221
What is the primary cause of bone pain in AML patients?
Replacement of normal bone marrow cells by leukemia cells
222
What is the primary cause of fever in AML patients?
Infection due to neutropenia
223
What is the primary cause of thrombocytopenia in AML patients?
Replacement of normal bone marrow cells by leukemia cells
224
What is the primary cause of anemia in AML patients?
Replacement of normal bone marrow cells by leukemia cells
225
What is the primary cause of fatigue in AML patients?
Anemia
226
What is the primary cause of neutropenia in AML patients?
Replacement of normal bone marrow cells by leukemia cells
227
What is the primary cause of leukostasis in AML patients?
High number of abnormal white blood cells
228
What is the primary cause of dyspnea in AML patients?
Leukostasis
229
What is the primary cause of chest pain in AML patients?
Leukostasis
230
What is the primary cause of headache in AML patients?
Leukostasis
231
What is the primary cause of altered mentation in AML patients?
Leukostasis
232
What is the primary cause of hepatosplenomegaly in AML patients?
Infiltration of leukemia cells into the liver and spleen
233
What is the primary cause of bone pain in AML patients?
Replacement of normal bone marrow cells by leukemia cells
234
What is the primary cause of fever in AML patients?
Infection due to neutropenia
