Leukemias

Question 1

Leukemia most commonly seen <15 years?

Answer 1

ALL (acute lymphoblastic leukemia)

Question 2

Typical age range of pts with CLL/SLL?

Answer 2

> 60 years of age

Question 3

Typical age of pts with AML?

Answer 3

~60 yrs

Question 4

Age range of pts with CML?

Answer 4

30-60 yrs

Question 5

Smudge cells are commonly seen in neoplastic proliferation of:
mature granulocytes, lymphoblasts, mature lymphocytes, myeloblasts?

Answer 5

mature lymphocytes (which are found in CLL)

Question 6

Name the leukemia(s) associated with t(9; 22).

Answer 6

The Philadelphia chromosome is most associated with CML.

It is also possible for this to be found in ALL pts. (“Ph+ ALL”)

Question 7

Auer rods are aggregates containing what granulocytic enzyme?

Answer 7

Myeloperoxidase

Question 8

What is the function of Myeloperoxidase?

Answer 8

H2O2–>HOCl ; the creation of hypochlorite which acts as a bactericidal agent in neutrophilic innate immunity (oxygen dependent killing)

Question 9

ID the translocations seen in ALL

Answer 9

t(12;21) most commonly

t(9;22)

Question 10

Describe the mutation in a subset of AML patients that can be cured without chemotherapy/radiation.

Answer 10

-Known as the M3 form, aka “acute promyelocytic leukemia.” This is a t(15; 17) which results in a defect in the Retinoic Acid Receptor.

Therefore, myeloblasts can’t divide (stuck as blast)

Therefore, treatment involves ATRA (all trans retinoic acid)

Question 11

Hyperproliferation of monoblasts will show what characteristic symptom?

Answer 11

grossly swollen gums (MPO negative cells)

Question 12

Where must chemotherapy be specifically injected for ALL patients?

Answer 12

CNS and testes. Regular chemotherapy does not cross the BBB or the BTB

Question 13

What CD marker(s) is/are commonly seen on CLL neoplastic cells?

Answer 13

CD20 
and CD5 (which is normally a T cell marker!)

Question 14

What is the key diagnostic cell marker for ALL and what is its normal function?

Answer 14

TdT (terminal deoxynucleotidyl transferase)

Only expressed in lymphocytes (B and T cells).

It is an enzyme that randomly spits nuclotides onto the rearranging genes of the B or T cell (this helps add some variety)

The Variable region (of both the heavy and light chains of the B/T cell receptor) is what does the rearrangement and what binds to Antigen!

Question 15

What autoimmune-mediated anemia has a high association with a leukemia?

Answer 15

Warm agglutinin autoimmune hemolytic anemia

IgG mediated
Seen in SLE, CLL, and drug rxns (alpha methyldopa, penicillin)

Question 16

What does CML best respond to?

Answer 16

Imatinib (inhibitor of the bcr-abl tyrosine kinase)

Question 17

What is the difference between SLL and CLL?

Answer 17

CLL: chronic lymphocytic leukemia; disseminated throughout blood
SLL:small lymphocytic lymphoma; when CLL gets trapped inside lymph node and becomes a mass