Leukemia

Question 1

What are common symptoms of acute leukemia?

Answer 1

Signs of Pancytopenia: Fatigue, infection, bleeding
-even though WBC are normal or increased

Infections despite increased WBC: leukemic cells (Blasts) do not function normally

Question 2

What are leukemic cells called?

Answer 2

Blasts

Question 3

What is the best initial test for acute leukemia?

Answer 3

Blood smear showing blasts

Question 4

What is the most accurate test for acute leukemia?

Answer 4

Flow cytometry to distinguish subtypes

Question 5

How do you treat acute leukemia?

Answer 5

Chemotherapy to remove blasts from peripheral blood: induce remission

If prognosis is good give more chemotherapy

Question 6

How do you determine prognosis in acute leukemia?

Answer 6

Cytogenetics or assessing specific chromosomal characteristics

Question 7

What to do with good cytogenetics in acute leukemia?

Answer 7

Less chance or relapse: give more chemotherapy

Question 8

What to do with bad cytogenetics in acute leukemia?

Answer 8

More chance of relapse: immediate BMT

Question 9

What do you add to treatment for M3 (Promyelocytic Leukeima)?

Answer 9

All-trans-retinoic acid or arsenicals

Question 10

What do you add to treatment for patients with Acute Lymphocytic Leukemia (ALL)?

Answer 10

Intrathecal chemotherapy with Methotrexate: prevents relapse

Question 11

What is M3 (promyelocytic leukemia) associated with?

Answer 11

DIC

Question 12

What do Auer rods indicate?

Answer 12

Acute Myelocytic Leukemia (AML)

Question 13

What are Auer Rods?

Answer 13

Eosinophilic Inclusions associated with AML

Question 14

How to identify Leukostasis or blast crisis?

Answer 14

Hyperkalemia
High Phosphate and Uric Acid
Low Ca from binding to phosphate

Question 15

How do you manage Leukostasis or blast crisis?

Answer 15

Fluids
Allopurinol
Possibly Rasburicase

Question 16

What Myeloproliferative disorder has the highest chance of transforming into acute leukemia (Blast crisis)?

Answer 16

Chronic Myelogenous Leukemia (CML)

Question 17

What is seen on blood counts for a patient with Chronic Myelogenous Leukemia (CML)?

Answer 17

Persistently high WBC count that is all Neutrophils

Question 18

What are common symptoms associated with Chronic Myelogenous Leukemia (CML)?

Answer 18

Pruritus: after hot bath/shower from histamine release
Splenomegaly: early satiety, abd fullness, LUQ pain
Fatigue, night sweats, fever: Hypermetabolic syndrome
High WBC

Question 19

What is the best initial test for Chronic Myelogenous Leukemia (CML)?

Answer 19

High neutrophils
-small # of blasts
-increased basophils

Question 20

What is the most accurate test for Chronic Myelogenous Leukemia (CML)?

Answer 20

BCR-ABL

Question 21

What is BCR-ABL?

Answer 21

9:22 Translocation: philadelphia chromosome

Question 22

What lab value can be used to show Leukemia vs Leukemoid?

Answer 22

Leukocyte Alkaline Phosphatase (LAP)

Question 23

What is the LAP score in CML?

Answer 23

Down

Question 24

What is the LAP score in Leukemoid (reactive high WBC)?

Answer 24

UP

Question 25

What is the best initial therapy for CML?

Answer 25

TK-Inhibitors: Imatinib, Dasatinib, Nilotinib

Question 26

What is the curative therapy for CML?

Answer 26

BM transplant

Question 27

What is Chronic Lymphocytic Leukemia (CLL)?

Answer 27

Clonal proliferation of normal mature-appearing B lymphocytes that function abnormally

Question 28

What is the Richter Phenomenon?

Answer 28

Conversion of CLL into High-grade lymphoma

Question 29

What age group do most cases of Chronic Lymphocytic Leukemia (CLL) occur in?

Answer 29

>50

Question 30

What are the most common symptoms of Chronic Lymphocytic Leukemia (CLL)?

Answer 30

Fatigue Lymphadenopathy Spleen or Liver Enlargement Infection from poor lymphocyte function Hemolysis

Question 31

What is the definitive diagnosis test for Chronic Lymphocytic Leukemia (CLL)?

Answer 31

Flow Cytometry for CD types

Question 32

What are the other diagnostic tests for Chronic Lymphocytic Leukemia (CLL)?

Answer 32

WBC>20,000 with 80-90% lymphocytes Hypogammaglobulinemia Anemia and Thrombocytopenia

Question 33

What is stage 0 CLL?

Answer 33

Elevated WBC

Question 34

How do you treat stage 0 CLL?

Answer 34

no treatment

Question 35

What is stage 1 CLL?

Answer 35

Lymphadenopathy

Question 36

How do you treat stage 1 CLL?

Answer 36

No treatment

Question 37

What is stage 2 CLL?

Answer 37

Hepatosplenomegaly

Question 38

How do you treat stage 2 CLL?

Answer 38

no treatment

Question 39

What is stage 3 CLL?

Answer 39

Anemia

Question 40

How do you treat stage 3 CLL?

Answer 40

Fludarabine, Cyclophosphamide and Rituximab

Question 41

What is stage 4 CLL?

Answer 41

Thrombocytopenia

Question 42

How do you treat stage 4 CLL?

Answer 42

Fludarabine, Cyclophosphamide and Tiruximab

Question 43

What drug can be used for stage 4 CLL if Fludarabine fails?

Answer 43

Alemtuzumab: Anti-CD52

Question 44

What drug can be combined with Cyclophosphamide?

Answer 44

Ibrutinib: inhibits Bruton Tyrosine Kinase

Question 45

How do you treat autoimmune-derived thrombocytopenia in CLL?

Answer 45

Prednisone

Question 46

What prophylaxis is indicated in CLL?

Answer 46

PCP prophylaxis

Question 47

How does Hairy Cell Leukemia Present?

Answer 47

Middle aged men with Panycytopenia, Massive Splenomegaly, Monocytopenia and an inaspirable "Dry" tap despite hypercellularity of bone marrow

Question 48

What it the best initial test for Hairy Cell Leukemia?

Answer 48

Smear showing hairy cells

Question 49

What is the most accurate test for Hairy Cell Leukemia?

Answer 49

Immunotyping by flow cytometry

Question 50

What helps guide therapy in Hairy Cell Luekemia?

Answer 50

BRAF mutation

Question 51

How do you treat Hairy Cell Leukemia?

Answer 51

Cladribine or Pentostatin