Hematology pt 1 Flashcards
(130 cards)
leukemia etiology
- unknown
- culmination of multiple processes resulting in genetic damage
things that can cause leukemia
- radiation
- carcinogens (benzene)
- chemotherapy
leukemia symptoms result from:
- bone marrow failure
- tissue infiltration
- circulating leukemia
labs that indicate bone marrow failure when low
WBC (leukopenia)
RBC (anemia)
platelets (thrombocytopenia)
technique to diagnose and stage leukemia
bone marrow aspiration and biopsy
AML
acute myelogenous leukemia
population AML is most common in
elderly
regular intense induction therapy for AML
7 + 3
- 3 days of an anthracycline
- 7 days of cytarabine
low intensity induction therapy for AML
azacitadine or decitabine
consolidation therapy for AML
- HiDAC (high dose cytarabine) for all cytogenetics
- AlloHSCT can be used for intermediate or high risk cytogenetics
salvage chemo for AML
- CLAG/CLAG-M (cladribine, cytarabine, GCSF +/- mitoxantrone)
- FLAG/FLAG-IDA (fludarabine + cytarabine + GCSF +/- idarubicin)
- MEC (mitoxantrone + etoposide + cytarabine)
APL
acute promyleocytic leukemia
APL etiology
fusion of chromosome 15 and 17 to form PML-RAR-alpha
effects of PML-RAR alpha in APL
- binds to DNA and blocks transcription
- prevents differentiation
- fusion to retinoic acid receptor (RAR)
APL induction treatment
-ATRA (all-trans retinoic acid) aka tretinoin given emergently -ATRA + ATO (arsenic trioxide) *curative*
APL has high risk of what complication and how does it work
hemorrhage
annexin II produced in APL cells bind plasminogen and tPA to increase plasmin activity
APL differentiation syndrome (retinoic acid syndrome) symptoms
- fever
- respiratory distress
- interstitial pulmonary infiltrates
- pleural or pericardial effusions
- weight gain
- hypotention
how does APL differentiation syndrome lead to death
pleural effusion -> pulmonary infiltration -> pulmonary hemorrhage
how to treat APL differentiation syndrome
dexamethasone
OR
prophylactic prednisone
arsenic trioxide MoA
- low concentrations = differentiation inducer
- high concentrations = direct apoptosis inducer
arsenic trioxide toxicities
- QT prolongation
- hepatotoxicity
ALL
acute lymphoblastic leukemia
where does ALL stem from
disorder of lymphoid progenitor cells
ALL is most common in which patients
children