Leukemias

Question 1

Leukemia

Answer 1

Cancer of the WBC's
Acute or chronic cell growth
Affects ability to produce normal cells
BM makes large amounts of immature cells
"crowd out" anemia, bleeding, infxn

Question 2

Which blood-forming tissues does leukemia affect?

Answer 2

Bone Marrow
Lymph
Spleen

Question 3

Myelogenous Leukemia

Answer 3

Characterized by proliferation of myeloid tissue (as of bone marrow and spleen)
Abnormal increase in the number of granulocytes, myelocytes and myeloblasts in circulating blood

Question 4

Lymphocytic leukemias

Answer 4

Characterized by immature lymphocytes and their progenitors that originate in the BM, but infiltrate the spleen, lymph, CNS and other tissues.

Question 5

AML

Answer 5

Primarily affects older people
Acute Myeloid Leukemia
Suppresses normal blood cell production

Question 6

ALM risk factors

Answer 6

Age (over 60)
Benzene exposure
Radiation
Tobacco (20% linkage)
Genetic disorders (Down syndrome)
Past chemo/meds/cancers

Question 7

AML stats

Answer 7

12,000 new cases each year
50% mortality
65 yo 5 yr survival = 4%
20 - 30% experience remission and cure

Question 8

AML Symptoms

Answer 8

Fatigue, SOB, Fever, Weight loss
Easy bruising, bleeding, recurrent infxns
Symptoms usually present for 3 or more months before dx is made.

Question 9

AML signs

Answer 9

FUO > 3 wks
Multiple bruises
GI, gingival bleed
Splenomegaly
Sternal tenderness

Question 10

AML lab findings

Answer 10

Anemia (normochromic, normocytic)
Leukocytosis (around 150,000)
Thrombocytopenia <100,000

Question 11

AML morphology

Answer 11

> 20% myeloblasts in blood/marrow
Auer rods (cytoplasmic granules)
Hypercellular bone marrow

Question 12

AML tx

Answer 12

Chemotherapy (induction, intensification, maintainence)
Bone marrow transplant
Transfusions (for platelets <8)
Empirical Abx for fever
Allopurinol for increased uric acid levels

Question 13

ALL

Answer 13

Acute Lymphoid Leukemia
Clonal proliferation and accumulation of blast cells in blood, marrow and other organs.
Originates in B or T cell progenitor
20% of acute leukemias

Question 14

ALL stats

Answer 14

3,000 new cases per year in children
Mostly affects children (peak 4 yrs)
May be B, T cell or null (neither)

Question 15

ALL Symptoms

Answer 15

Fever, fatigue, SOB, weight loss/fatigue
Bleeding, bruising, petechiae
Bone Pain

Question 16

ALL signs

Answer 16

Fever
Splenomegaly, hepatomegaly
Lymphadenopathy
Multiple bruises, petichiae
Unexplained infxns
CN palsies, HA, N/V, papilledema

Question 17

ALL lab findings

Answer 17

Anemia (normochromic, normocytic)
WBC < 5000, or > 25,000
Thrombocytopenia
Blast cells

Question 18

in ALL, is B or T cell lineage more common?

Answer 18

B cell lineage (85%)

Question 19

ALL morphology

Answer 19

L1: Small round blasts, clumped chromatin
L2: Pleomorphic larger blasts, clefted nuclei, fine chromatin
L3: Large blasts, nucleoli, vacuolated cytoplasm

Question 20

Chromosome philadelphia

Answer 20

If positive, indicated VERY high-risk ALL

Question 21

High-risk ALL

Answer 21

Over 35 yrs old
>30 G/L in B-ALL
>100 G/L in T-ALL
NO remission after 4 weeks of induction therapy

Question 22

ALL Tx

Answer 22

Antineoplastic treatment
CNS preventative tx
supportive care
Tx of complications
Chemotherapy (methotrexate)
Stem cell transplant

Question 23

ALL prognosis

Answer 23

Children: complete remission (CR) 95 - 99%
Children: leukemia-free survival (LFS) 80%
Adults: CR 80 - 85%
Adults LFS: 30 - 40%

Question 24

CML

Answer 24

Chronic Myeloid Leukemia
Proliferative disorder of hematopoetic stem cells
Has Ph (Philadelphia) chromosome and Bcr-Abl tyrosine kinase

Question 25

Bcr-Abl Tyrosine Kinase

Answer 25

A single molecular abnormality that causes transformation of a hematopoetic progenitor into a malignant clone.

Question 26

3 phases of CML

Answer 26

Chronic phase Accelerated phase Blast crisis

Question 27

CML stats

Answer 27

1-2 cases per 100,000 ppl More common in women Median age is 50 yrs

Question 28

Philadelphia chromosome present in _____ of cases.

Answer 28

95%

Question 29

CML S/S

Answer 29

``` 40% asymptomatic Splenomegaly (increased abd girth) Anemic features Abnormal platelet fxn Gout, visual disturbances Chronic infxn - fever ```

Question 30

CML lab findings

Answer 30

Anemia (normochromic, normocytic) Leukocytosis (20,000) Basophilia Thrombocytopenia

Question 31

CML morphology

Answer 31

``` Hypercellular (reduced fat spaces) Myeloid erythroid ratio 10:1 to 30:1. Myelocyte predominant cell, blasts <10% Megakaryocytes increased and dysplastic Increased reticulin fibrosis ```

Question 32

CML chronic phase

Answer 32

85% lasts 3-5 years Treatment w/ alpha interferon

Question 33

CML accelerated phase

Answer 33

``` difficult to control lasts 6 - 9 months Symptoms related to hypermetabolism Blasts > 15% in blood Thrombocytopenia Basophils >20% ```

Question 34

CML blastic phase

Answer 34

Resembles acute leukemia Diagnosis requires >30% blasts in marrow Survival is around 3 months

Question 35

CML tx

Answer 35

``` Prolong chronic phase Alpha interferon, chemo Hydration Eradicate malignant clone Allogenic transplantation ```

Question 36

CML prognosis

Answer 36

Median survival: 3.5 yrs Interferon and Chemo: 6 yrs Transplant: 5+ yrs

Question 37

CLL

Answer 37

Chronic lymphoid leukemia 4 - 7 cases per 100,000 ppl 30% of all leukemia cases Most common lymphoid lukemia

Question 38

CLL stats

Answer 38

Median age is 70 years only 10% of pts are <50 yrs old More males than females 80% due to B lymphocytes

Question 39

CLL Symptoms

Answer 39

25% are asymptomatic at time of dx fever, night sweats, fatigue, SOB, pallor Easy bruising, bleeding, weight loss, infxns

Question 40

CLL signs

Answer 40

``` Fever spleno/hepatomegaly Lymphadenopathy Multiple bruises Easy bleeding Leukemia cutis ```

Question 41

CLL lab findings

Answer 41

Lymphocytes > 20,000 microL, which is usually 75 - 98% lymphocytes HCT and platelets are normal Smudge cells, soccer balls ** B cell specific differentiation antigens

Question 42

CLL Rai classifications, survival rates

Answer 42

0: Lymphocytosis >5 G/L (>10 yrs) I: Lymphocytosis + Lymphadenopathy (>8 yrs) II: " + splenomegaly (6 yrs) III: " + anemia < 2 yrs)

Question 43

CLL Tx

Answer 43

``` Alkylating agents Nucleoside analogs Monoclonal antibodies Bone marrow transplant Tx of symptoms (abx, steroids, blood) ```

Question 44

Hairy Cell Leukemia

Answer 44

2% of all adult leukemias Usually in males >40 Chronic disease of B cell proliferation

Question 45

Hairy Cell S/S

Answer 45

``` Splenomegaly Pancytopenia Infxn Vasculitis Decreased WBC and platelets Hairy Cells ```

Question 46

Hairy Cell Tx

Answer 46

Chemo Alpha-interferon Good prognosis