Acute Leukemia Cases - Nikcevich Flashcards Preview

IHO Week 4 > Acute Leukemia Cases - Nikcevich > Flashcards

Flashcards in Acute Leukemia Cases - Nikcevich Deck (17)
Loading flashcards...
1
Q
Normal values for: 
WBC diff: 
RBC: 
Hbg: male vs. female
Platelets: 
INR
A

WBC diff: 4,500 -11,000 10^9
Hbg: Male: 14-16 F: 12-14
Platelets: M: 190-290K F: 210-340K
INR: 1

2
Q

Pancytopenia

A

Bone marrow isn’t producing cells so you get:

Anemia
Neutropenia
Thrombocytopenia

3
Q

AML clinical features:

A
  • Pancytopenia
  • B symptoms: fever, night sweats, chills malaise, weight loss
  • Extramedually disease (monocytic leuks)
  • Hyperleukocytosis
4
Q

AML info

A
  • uncontrolled clonal proliferation and accumulation of neoplastic hematopoietic precursor cells of myeloid lineage
  • can’t make cells or defective maturation
  • Need 20% myeloblasts in BM
5
Q

What drives prognosis and determines treatment?

A

CYTOGENETICS!

6
Q

Good prognosis signs in AML?
cytogenetics:
karyotype?
Auer rods?

A

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

Normal karyotype with NPM1+, FLT3–
Presence of Auer rods :)

7
Q

Unfavorable risk of AML

A

**11q23
del 5 or 7
trisomy 8

8
Q

Test question on 11q23

A

sign of unfavorable risk

*usually from prior chemo exposure!

9
Q

Treatment if less than 60 y/o

A

Induction chemo with anthracycline (rubicins) plus cytosine arabinoside in 7+3 regimen

Get remission? then do consolidation chem (cytosine arabinoside x 4 cycles) or transplant

No remission? especially poor prognostic sign

10
Q

Allogeneic stem cell transplant:

A
  • stem cell transplant from donor or cord blood
  • Match HLA phenotypes
  • Basically give them a new immune system (blood type and bone marrow will have DNA of donor)
  • Graph vs host disease is possible
11
Q

Treatment if over 60 y/o

A

Same induction chemotherapy and same if you go into remission

  • probably no role for allogeneic transplant
  • maybe just supportive care
12
Q

What is diffuse adenopathy a sign of?

A

Extramedullary disease

-always do LP to see if it’s in CSF

13
Q

Low fibrinogen in AML patient?

A

DIC= disseminated intravascular coagulation

14
Q

Acute Promyelocytic Leukemia (M3)

Please don’t miss this diagnosis!

A
***t(15:17) -->better prognosis 
fusion gene: PML/RAR-alpha
Poor risk disease with t(11;17)
**AUER RODS 
*watch out for DIC 
tx: ATRA
15
Q

AML-M4

A
  • Hyperleukocytosis
  • Hyperviscosity –>fatigue, blurred vision, headache

Monocytic

16
Q

What should you think if the automated differential reports monocytosis?

A

–Maybe it miscounted blast cells for monocystosis

17
Q

FLT-3 receptor tyrosine kinase inhibitor for AML

A

Quizartinib

Effective with 47% response rate