Leukemias

Question 1

myelodysplastic syndrome

Answer 1

chronic cytopenia (anemia, neutropenia, thrombocytopenia)
abnormal cell maturation
hematologic condition
pre-leukemia
may do bone marrow biopsy
risk for anemia, infection, bleeding/bruising, AML

Question 2

leukemia

Answer 2

hematologic malignancy
cancer of bone marrow
affect the blood and lymph tissue
symptoms include fatigue, infections, bleeding, bruising
treated via chemo and bone marrow transplant
leukemic cells crowd bone marrow
decreased function and production of normal cells in bone marrow
leukemic infiltrates (pain, swelling in joints, organomegaly)

Question 3

acute leukemia

Answer 3

abnormal proliferation of immature blood cells for 1-5 months
cells nonfunctional
affects lymphoblasts and myeloblasts

Question 4

chronic leukemia

Answer 4

abnormal proliferation of immature blood cells for 2-5 yrs
decreased function of cells
affects mature lymphocytes and immature myeloid cells

Question 5

risk factors for leukemia

Answer 5

down syndrome
radiation
benzene
viruses
drugs (alkylating agents)-> 1/4 happen after chemo

Question 6

acute leukemia symps

Answer 6

fatigue
abdominal fullness
infection
bleeding
pancytopenia
lymphadenopathy
hepatosplenomegaly
CNS involvement
leukostasis

Question 7

leukostasis

Answer 7

systemic hyperleukocytosis
medical emergency
seen in AML
elevated blast count w/ symps respiratory and/or neurological distress
treated via leukapheresis and cytoreduction

Question 8

acute leukemia diagnosis

Answer 8

bone marrow biopsy
peripheral blood smear
cytogenetics (crucial for prognosis and treatment)

Question 9

acute leukemia imaging and procedures

Answer 9

chest xray
MUGA scan
lumbar puncture
venous access placement
leukpheresis

Question 10

types of acute leukemia

Answer 10

AML
APL
ALL

Question 11

complications of acute leukemia

Answer 11

transfusions (graft vs host and alloimmunization)
infection (neutropenic fever)
tumor lysis syndrome (rapid tumor breakdown after chemo)

Question 12

treatment of acute leukemia

Answer 12

chemo
stem cell implant
supportive care
highest risk of relapse (first 3 yrs)-> so followup!

Question 13

AML

Answer 13

median age 67 yrs old
exposure to ionizing radiation and benzene
chemo
meds
progresses quickly

Question 14

symptoms of AML

Answer 14

fever and infection
bleeding, mucosal, cutaneous (petechiae and bruising)
fatigue and dyspnea (anemia)

Question 15

AML labs

Answer 15

normocytic
normochromic
thrombocytopenia
>20% myeloblasts
auer rod diagnostics
confirmation of diagnosis via myeloid specific surface markers
remission= return of normal peripheral count and <5% blasts in bone marrow

Question 16

treatments of AML

Answer 16

remission induction chemo
intensive
post-remission therapy
stem cell transplant

Question 17

ALL

Answer 17

most common type of leukemia in children (ages 2-5)
affect precursor B-cells
pre B can develop into burkitt’s lymphoma
starry skey appearance of tumor of cytogenic analysis
affect precursor T cell in adolescents

Question 18

ALL assessment

Answer 18

pallor
fever
bone pain
splenomegaly
ecchymosis
lymphadenopathy

Question 19

ALL labs

Answer 19

leukopenia
thrombocytopenia
anemia
lymphoblasts (>20%)
bone marrow biopsy (>20% blasts)
cell analysis shows B and T cell linage, NK lineage

Question 20

ALL treatment

Answer 20

LP prior to treatment
chemo (3 phases)-> induction therapy, CNS prophylaxis, post-remission therapy (high dose)
bone marrow transplant

Question 21

ALL prognosis

Answer 21

children and adults less than 39 years of age= 90% remission and cure-rate 60-80%
older adults= remission rate 80% and cure rate 20-40%

Question 22

ALL good prognosis

Answer 22

<30 yrs
WBC= <50k

Question 23

ALL poor prognostic factors

Answer 23

elevated blasts
delayed remission
blasts in CSF

Question 24

chronic leukemia

Answer 24

long median survival, but not curable
CML and CLL

Question 25

CML

Answer 25

median age 55-65 risk factors include ionizing radiation philly chromosome (translocation of chromosome 9 and 22)

Question 26

symptoms of CML

Answer 26

splenomegaly (1st symp) early satiety fever in blast crisis

Question 27

CML labs

Answer 27

WBC=>100k anemia (normocystic, normochromic) thrombocytosis

Question 28

CML assessment

Answer 28

bone marrow biopsy cytogenetic analysis

Question 29

CML treatment

Answer 29

TKIs HCTs pallitative care w/ chemo

Question 30

CLL

Answer 30

most common adult (71 yrs old)leukemia orange agent highest familial risk of all hematology malignancies

Question 31

CLL symps

Answer 31

asymp splenomegaly hepatomegaly lymphadenopathy (painless)

Question 32

CLL labs

Answer 32

leukocytosis lymphocytosis anemia thrombocytopenia smudge cells

Question 33

3 disease phases of CML

Answer 33

chronic phase accelerated phase blast crisis

Question 34

chronic phase

Answer 34

< 5% blasts palpable splenomegaly

Question 35

accelerated phase

Answer 35

6-30% blasts increased number of precursors and blasts

Question 36

blast crisis

Answer 36

30-40% bone marrow is blasts leukocytic lesions= form as a result of high cell number-> thrombosis low survival rate (3 months)

Question 37

what does AML affect?

Answer 37

myeloblasts

Question 38

what does CML affect?

Answer 38

granulocytes neutrophils mature and immature myeloid cells

Question 39

what does CLL affect?

Answer 39

lymphocytes

Question 40

what does ALL affect?

Answer 40

lymphoblasts

Question 41

APL

Answer 41

subtype of AML (most common adult leukemia) treated with vit. A along w/ chemo A-rod (auer rods) plays for the NY Yankee's in the big APL