AML and MDS - Krafts Flashcards Preview

IHO Week 3 > AML and MDS - Krafts > Flashcards

Flashcards in AML and MDS - Krafts Deck (45):
1

What is AML?

Acute Myeloid Leukemia

2

What is MDS?

Myelodysplastic Syndrome

3

Acute Leukemia characteristics

Sudden onset
Adults or Children
Rapidly fatal without treatment
Immature cells (blasts)

4

Chronic Leukemia characteristics

Slow onset
ONLY in adults (>40)
Longer course
Mature cells

5

What is ALL?

Acute Lymphoblastic Leukemia

6

What is CLL?

Chronic Lymphocytic Leukemia

7

What is CML?

Chronic Myeloid Leukemia

8

What is the definition of Acute Leukemia?

Malignant proliferation of immature myeloid or lymphoid cells in the blood or bone marrow

9

What causes Acute Leukemia?

Clonal Expansion
Maturation Failure (Arrest)
Usually idiopathic
Genetic disorders can predispose patients (Down's Syndrome)
Sometimes caused by toxins (Benzenes)

10

What is so bad about Acute Leukemia?

Crowds out normal cells
Inhibits normal cell function (making immunoglobulins)
Fill up marrow space
Infiltrate other organs

11

Describe Acute Leukemia bone marrow

Normal Marrow space filled with many malignant cells

12

Bone Marrow Failure in Acute Leukemia symptoms

Fatigue
Infections
Bleeding

13

What symptoms are associated with Acute Leukemia?

Sudden onset
Bone Marrow Failure
Bone Pain (expanding marrow of long bones)
Organ Infiltration (liver, spleen, brain)

14

What are the laboratory findings for Acute Leukemia?

Leukocytosis
Anemia
Thrombocytopenia
Blasts/immature cells in blood

15

Acute Myeloid Leukemia Characteristics

Malignant proliferation of myeloid blasts in blood and bone marrow
20% blast cutoff for diagnosis
Poor prognosis

16

How do you know when a leukemia is myeloid?

Dysgranulopoiesis
Auer Rods
Cytochemistry
Immunophenotyping
Cytogenetics

17

What is dysgranulopoiesis?

Nucleus is not segmented and cytoplasm is devoid of granulation

18

What are Auer rods?

Thin, purple rods composed of primary granules

19

Where would you find Auer rods?

Malignant, Myeloid Blast cells

20

How would you determine myeloid leukemia using cytochemistry?

Stain with non-specific esterase (turns orange)

21

AML-M0

Acute Myeloblastic Leukemia, Minimally Differentiated

HIGH number of myeloblasts
Bland blasts = no Auer rods, no granulation
Myeloperoxidase negative
Need markers on cell surface for diagnosis = via FLOW cytometry

22

AML-M1

Acute Myeloblastic Leukemia without Maturation

HIGH number of myeloblasts
No maturation (ALL Blasts)
Auer Rods
Myeloperoxidase positive

23

AML-M2

Acute Myeloblastic Leukemia with Maturation

Increased number of myeloblasts
Some maturing neutrophils
Some cases have special translocation t(8;21) = better outcome

24

AML-M3

Acute Promyelocytic Leukemia

HIGH number of promyelocytes
Faggot cells with a TON of Auer rods
DIC (Disseminated Intervascular Coagulation)
ALL cases have translocation t(15;17) = good prognosis

25

What is the t(15;17) translocation involved in?

Retinoic Acid Receptor
Treat with All-Trans Retinoic Acid

26

M0, M1, M2, M3 Acute Myeloid Leukemias

Involve Neutrophilic Series
Myeloblasts, Promyelocytes

27

AML-M4

Acute Myelomonocytic Leukemia

Increased myeloblasts (20%) and monocytic cells
Extramedullary Tumor Masses
Some cases have translocation inv(16) = better prognosis

28

AML-M5

Acute Monocytic Leukemia

Increased monocytic cells
Non-Specific Esterase Positive
Two Types: M5A and M5B
Extramedullary Tumor Masses

29

M4 and M5 Acute Myeloid Leukemias

Involve Monocytic Series
Monoblasts

30

AML-M6

Acute Erythroblastic Leukemia

Increased Erythroblasts and Myeloblasts
Dyserythropoiesis

31

M6 Acute Myeloid Leukemia

Involves Erythroid Series
Erythroblasts

32

AML-M7

Acute Megakaryoblastic Leukemia

Increased Megakaryoblasts
Bland blasts
Myeloperoxidase Negative
Need cell surface markers for diagnosis via FLOW cytometry

33

M7 Acute Myeloid Leukemia

Involves Megakaryocytic Series
Megakaryoblasts

34

AML, not otherwise classified

AML - M0 through M7

35

AML with Genetic Abnormalities

Good Prognosis:
AML-M2 with t(8;21)
AML-M4 with inv(16)
AML-M3 with t(15;17)

Poor Prognosis:
AML-Monocytosis with 11q23

36

AML with FLT-3 Mutation

Mutation of FLT-3 (a tyrosine kinase)
Present in 1/3 of cases of AML!
Monocytic cells
Poor prognosis

37

AML with Multi-Lineage Dysplasia

≥ 20% blasts + dysplasia in ≥ 2 cell lines
Elderly
Severe pancytopenia
Chromosome abnormalities
Poor prognosis

38

AML Therapy-Related

Previous chemotherapy from Alkylating Agents (Busulfan) or TOPO II inhibitors (Etoposide
Onset is 2-5 years after chemo
EXTREMELY HARD TO TREAT!

39

Treatment for AML

Chemotherapy and Bone Marrow Transplant (Curative)

40

Prognosis for AML

Not good
Better in children than adults

Better:
t(8;21)
t(15;17)
inv(16)

Worse:
FLT-3
Therapy-Related

41

Myelodysplastic Syndrome

Problem: abnormal stem cells
Dysmyelopoiesis
Maybe more blasts
May evolve into acute leukemia

42

What does dysplasia of Red Cells look like?

Megaloblastic nuclei with fragmentation

43

What does dysplasia of Neutrophils look like?

Hypogranulation and Hyposegmentation

44

What does dysplasia of Megakaryocytes look like?

Small, non-lobulated cells

45

Clinical Findings in MDS

Older patients
Asymptomatic or Bone Marrow Failure
Macrocytic Anemia