Nikcevich- Acute Leukemia Cases Flashcards Preview

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Flashcards in Nikcevich- Acute Leukemia Cases Deck (33):
1

What is the definition of AML?

Uncontrolled clonal proliferation and accumulation of neoplastic hematopoietic precursor cells of myeloid lineage

2

What happens in AML that results in the sxs experienced?

Inhibition of normal hematopoiesis
Defective maturation
Dissemination into blood and other tissues

3

What are clinical features of AML?

Pancytopenia
B symptoms
Extramedullary disease
Hyperleukocytosis
Coagulation abnormalities

4

What is pancytopenia?

Anemia
neutropenia
Thrombocytopenia

5

What are B symptoms?

Fever, night sweats, chills, malaise, weight loss

6

What is hyperleukocytosis? What AMLS is it seen with?

>100,000 blast count/ml
APML, monocytic AML
inv(16), 11q23)

7

DIC is seen w/ what AML?

M3

8

What are favorable prognostic features associated w/ AML?

<55
absence of infection
low WBC
presence of auer rods

9

What are "good risk" cytogenetics?

t (8;21)
t (16;16)
t (15,17)

10

What are unfavorable diagnostic features?

>60
presence of infection
poor performance status
extreme leukocytosis
extramedullary disease

11

What is the single most important prognostic factor?

Cytogenetics

12

What are intermediate risk genotypes?

NPM1
FLT3

13

What are unfavorable risk genotypes?

del 5
del 7
trisomy 8
11q23

14

How do you treat AML?

7 and 3 regimen
Anthracycline plus cytosine arabinoside

15

What happens if remission is obtained w/ AML?

Then consolidation chemo or transplantation

16

What is consolidation chemotherapy? and who is it given to

High dose cytosine arabinoside x 4 cycles

Pts w/ good risk/normal cytogenetics

17

Why would you have a pt sign their name before receiving chemo tx w/ cytosine arabinoside?

To check for cerebellar toxicity

18

When is allogneic stem cell transplantation used?

Poor risk cytogenetics
Intm risk cytogenetics w/ matched sibling donor
Extramedullary disease
1st or 2nd relapse
Donor sources include siblings, children, parents, MUD, umbilical cord blood

19

What is the common presentation of leukemia?

Fevers, malaise, fatigue

20

What labs are indicative of M3?

HIGH WBC
HIGH INR
LOW Hg
LOW platelets
LOW fibrinogen--being consumed

21

What translocation is associated w/ M3 and what does it result in?

t(15,17)

fusion gene PML/RAR alpha

22

How do you treat M3?

Induction therapy w/ ATRA plus anthracycline based chemo

2 years maintenance chemo w/ ATRA, 6 MP and MTX

23

How do you treat someone who has a relapse w/ M3?

arsenic trioxide

24

What is the AML that you don't want to miss?

M3

Pts can bleed out and die if you miss it

25

What is a common histological finding of M3?

Stacked auer rods

26

What is a common presentation associated w/ DIC?

Coagulopathy
depressed fibrinogen
thrombocytopenia
fatal hemorrhage

27

If pt has M3 and DI than it's impt to start ATRA....

in < 6 hrs

28

Hyperleukocytosis is a common finding in what AML?

AML-M4

29

What is hyperleukocytosis and what are the clinical features associated with it?

VERY elevated WBC

Hyperviscosity-->HA and blurred vision

Sludging in vasculature w/ ischemia and/or infarct

30

In a pt w/ hyperleukocytosis, what do you do to reduce WBC to < 100K?

Leukophoresis

31

Normal WBC
LOW Hb
Little low platelets is associated w/ what AML?

M4

32

What is Quizartinib?

drug effective in relapsed
AML
May be effective bridge to transplant strategy

33

What are side effects of Quizartinib?

Prolonged QT
puts them at risk for ventricular ectopy