Flashcards in AML & Myelodysplasia- Krafts Deck (31):
What is the difference between a leukemia and a lymphoma?
Leukemia- starts in the bone marrow (myeloid or lymphoid)
Lymphoma- starts in the lymph nodes (lymphoid only)
How are acute and chronic leukemias different morphologically?
-Acute leukemias have tons of blasts
-chronic leukemias have more mature cells
What are acute leukemias?
malignant, monoclonal proliferations of immature myeloid or lymphoid cells in the bone marrow (basically when marrow fills up with malignant blasts)
What is "bone marrow failure"? Would you expect RBC, WBC, and platelets to go up or down in the blood?
When malignant cells "fill up" the bone marrow, and don't leave room for normal RBC, WBC and platelets to grow
So their counts will go DOWN in the blood
What are some general clinical features of acute leukemias?
Sudden onset (days or weeks)
Excessive bleeding or bruising
Symptoms of extramedullary involvement
What percent of blasts are needed in the blood/bone marrow to make the diagnosis of AML?
What are two morphologic clues indicating myeloid leukemia?
Dysgranulopoiesis = disordered neutrophil production (hypogranularity or hyposegmentation= one nuclear lobe)
Auer rods= needle-like, eosinophilic inclusions in the cytoplasm
What does the MPO stain highlight?
Myeloperoxidase is stain that highlights neutrophils and their precursors
Can indicate myeloblasts
What does the NSE stain highlight?
Stain highlights monocytes and their precurosrs
What is a common myeloid marker used for immunophenotying?
CD33- virtually all myeloid cells
What are cytogenetic studies?
Looking for specific chromosomal abnormality
What does abnormality 11q23 indicate for prognosis?
What does abnormality t(8;21) indicate for prognosis?
What does abnormality t(15:17) indicate for prognosis?
What does abnormality inv(16) indicate for prognosis?
What does abnormality AML with FLT3 indicate for prognosis?
TON OF MYELOBLASTS
-malignant myeloblasts are stuck in such an early stage in development you can't tell if myeloid or lymphoid
-No auer rods, no MPO stain
**need to do immunophenotying to determine
increased myeloblasts with some differentiation
See some auer rods, and +MPO stain
Myeloblasts + maturing neutrophils
See Auer rods, +MPO stain, and maturation
usually with t(15;17) translocation
Faggot cells- many auer rods!!
Seen in M3
Abnormal retinoic acid receptors that interferes with maturation of the cells.
Treatement = ATRA (targets messed up receptor) = good prognosis
Myeloblasts + moncytic cells
Some have inv(16) = better prognosis
AML M5A and M5B
What does monocytic involvement have an increased incidence of? (M4 and M5)
Common sites are: skin, CNS, gums and testes
Erythroblasts + myeloblasts
Erythorid precursors may be giant, with blobbed nuclei or multinucleation
No specific cytochemical stains, have to do flow cytometery
What is the most common genetic abnormality in AML?
FLT3 mutation (seen in 1/3 of cases)
most cases have monocytic component
Mutation indicates increases relapse rate and shortened survival
AML with multi-lineage dysplasia?
At least 20% blasts
Dysplasia in at least two myeloid cell lines
Overall prognosis is poor
Common patient presentation with multi-lineage dysplasia?
What two classes of chemotherapy usually cause AML or myleodysplastic syndrome?
Topo II inhibitors