Leukemia

Question 1

What is leukemia?

Answer 1

Leukemia is caused by mutations in bone marrow stem cells, leading to abnormal cell production and impaired normal hematopoiesis.

Question 2

What are the two main classifications of leukemia?

Answer 2

Acute and Chronic.

Question 3

What are the types of acute leukemia?

Answer 3

Acute Myeloid Leukemia (AML) and Acute Lymphoblastic Leukemia (ALL).

Question 4

What are the types of chronic leukemia?

Answer 4

Chronic Myeloid Leukemia (CML) and Chronic Lymphocytic Leukemia (CLL).

Question 5

What is the median age of diagnosis for AML?

Answer 5

67 years.

Question 6

What are common causes of AML?

Answer 6

Genetic predisposition, radiation, chemical exposures, and certain drugs like alkylating agents.

Question 7

What is the hallmark of AML diagnosis?

Answer 7

Presence of >20% myeloblasts in the bone marrow.

Question 8

What is the first-line treatment for AML?

Answer 8

Induction therapy with cytarabine and an anthracycline (e.g., daunorubicin).

Question 9

What is the role of flow cytometry in AML?

Answer 9

To distinguish AML from ALL and identify subtypes using markers like CD34, CD13, and CD33.

Question 10

What is the Philadelphia chromosome?

Answer 10

A translocation between chromosomes 9 and 22, t(9;22), seen in CML and some cases of ALL.

Question 11

What is the primary driver of CML?

Answer 11

The BCR/ABL1 fusion gene, which results in a constitutively active tyrosine kinase.

Question 12

What is the median age of diagnosis for CML?

Answer 12

55-65 years.

Question 13

What are the typical blood findings in CML?

Answer 13

Leukocytosis with neutrophils, bands, myelocytes, metamyelocytes, and increased basophils/eosinophils.

Question 14

What is the treatment for CML?

Answer 14

Tyrosine kinase inhibitors (TKIs) like imatinib, dasatinib, or nilotinib.

Question 15

What is the most common leukemia in children?

Answer 15

Acute Lymphoblastic Leukemia (ALL).

Question 16

What is the peak age for ALL in children?

Answer 16

3-4 years.

Question 17

What is the Philadelphia chromosome-positive ALL?

Answer 17

A subtype of ALL with the BCR/ABL translocation, more common in elderly patients.

Question 18

What is the diagnostic hallmark of ALL?

Answer 18

> 90% leukemic blast cells in the bone marrow.

Question 19

What is the first-line treatment for ALL?

Answer 19

Induction therapy with chemotherapy, followed by consolidation and maintenance therapy.

Question 20

What is the role of lumbar puncture in ALL?

Answer 20

To diagnose CNS involvement and administer intrathecal methotrexate.

Question 21

What is Chronic Lymphocytic Leukemia (CLL)?

Answer 21

A monoclonal proliferation of mature B lymphocytes with an absolute lymphocyte count ≥5 × 10^9/L.

Question 22

What is the median age of diagnosis for CLL?

Answer 22

71 years.

Question 23

What are common cytogenetic abnormalities in CLL?

Answer 23

del(13q14.3), trisomy 12, del(11q22.3), and del(17p13.1).

Question 24

What is the Binet staging system for CLL?

Answer 24

A staging system based on the number of lymphoid areas involved and blood counts.

Question 25

What are the complications of CLL?

Answer 25

Infections, secondary cancers, autoimmune complications, and Richter's transformation.

Question 26

What is Richter's transformation?

Answer 26

The transformation of CLL into an aggressive lymphoma, most commonly DLBCL.

Question 27

What are the treatment options for CLL?

Answer 27

BTK inhibitors (ibrutinib), BCL2 inhibitors (venetoclax), and chemoimmunotherapy (FCR, BR).

Question 28

What is the role of FISH in CLL diagnosis?

Answer 28

To detect cytogenetic abnormalities like del(13q), trisomy 12, and del(17p).

Question 29

What is the most common symptom of CML?

Answer 29

Fatigue, weight loss, and splenomegaly.

Question 30

What is the typical WBC count in CML?

Answer 30

Elevated, often >100,000/μL.

Question 31

What is the role of PCR in CML diagnosis?

Answer 31

To detect the BCR/ABL1 fusion gene.

Question 32

What is the treatment goal in CML?

Answer 32

To achieve a deep molecular response and prevent progression to blast crisis.

Question 33

What is the most common symptom of AML?

Answer 33

Fatigue, fever, and bleeding due to cytopenias.

Question 34

What is the role of cytogenetic analysis in AML?

Answer 34

To identify chromosomal abnormalities that guide prognosis and treatment.

Question 35

What is the European LeukemiaNet risk stratification for AML?

Answer 35

A system that categorizes AML into favorable, intermediate, and adverse risk based on genetics.

Question 36

What is the treatment for Acute Promyelocytic Leukemia (APL)?

Answer 36

ATRA (all-trans retinoic acid) and ATO (arsenic trioxide).

Question 37

What is the most common genetic mutation in AML?

Answer 37

Mutations in genes like FLT3, NPM1, and CEBPA.

Question 38

What is the role of bone marrow biopsy in leukemia diagnosis?

Answer 38

To assess cellularity, blast percentage, and perform cytogenetic/molecular studies.

Question 39

What is the most common cause of death in AML patients?

Answer 39

Infection due to neutropenia.

Question 40

What is the role of supportive care in AML?

Answer 40

Platelet/RBC transfusions, antibacterial/antifungal prophylaxis, and antiviral treatment.

Question 41

What is the typical presentation of ALL?

Answer 41

Fatigue, fever, bone pain, and organomegaly.

Question 42

What is the role of immunophenotyping in ALL?

Answer 42

To differentiate between B-cell and T-cell lineage ALL.

Question 43

What is the prognosis for Ph+ ALL?

Answer 43

Poor, especially in elderly patients.

Question 44

What is the role of maintenance therapy in ALL?

Answer 44

To prevent relapse after induction and consolidation therapy.

Question 45

What is the most common cytogenetic abnormality in ALL?

Answer 45

t(9;22) or Philadelphia chromosome.

Question 46

What is the role of molecular studies in ALL?

Answer 46

To detect genetic abnormalities like MLL rearrangements and BCR/ABL fusion.

Question 47

What is the typical presentation of CLL?

Answer 47

Often asymptomatic, diagnosed incidentally on routine blood work.

Question 48

What is the role of CD5 in CLL diagnosis?

Answer 48

A T-cell marker expressed on malignant B cells in CLL.

Question 49

What is the B-cell receptor signaling pathway in CLL?

Answer 49

A key pathway involved in the pathogenesis of CLL, often mutated in IGHV.

Question 50

What is the role of TP53 mutations in CLL?

Answer 50

Associated with poor prognosis and resistance to chemotherapy.

Question 51

What is the treatment for high-risk CLL?

Answer 51

Targeted therapies like BTK inhibitors (ibrutinib) and BCL2 inhibitors (venetoclax).