Acute Leukemia Characteristics Quiz
38 Questions
0 Views

Choose a study mode

Play Quiz
Study Flashcards
Spaced Repetition
Chat to lesson

Podcast

Play an AI-generated podcast conversation about this lesson

Questions and Answers

Which subtype of B lineage ALL is characterized by HLA-DR+, TdT+, CD19+, and CD10-?

  • Pro B-ALL
  • PreB-ALL (correct)
  • Common ALL
  • B-cell ALL

    • Which category of AML includes cases with distinct numerical chromosomal abnormalities?

  • Acute myeloid leukemia with recurrent genetic abnormalities (correct)
  • Acute myeloid leukemia and myelodysplastic syndromes, therapy-related
  • Acute myeloid leukemia not otherwise categorized
  • Acute myeloid leukemia with multi-lineage dysplasia

    • What is a common clinical feature of ALL at presentation?

  • Difficulty swallowing
  • Chronic cough
  • Weight gain
  • Acute presentation with severe anemia (correct)

    • What must be present in at least 50% of cells in 2 or more myeloid lineages to classify AML as having multi-lineage dysplasia?

    <p>Dysplasia</p> Signup and view all the answers

    Which type of T lineage ALL is identified by TdT+, cytoplasmic CD3+, and CD1a/2/3+?

    <p>T-cell ALL</p> Signup and view all the answers

    Which infection is particularly common in patients with ALL?

    <p>Staphylococcus</p> Signup and view all the answers

    Which type of AML is particularly associated with prior exposure to alkylating agents or radiation?

    <p>Acute myeloid leukemia and myelodysplastic syndromes, therapy-related</p> Signup and view all the answers

    Which lymphadenopathy prevalence rate is reported in patients with ALL?

    <p>55%</p> Signup and view all the answers

    What is a characteristic of acute myeloid leukemia not otherwise categorized?

    <p>Includes acute megakaryoblastic leukemia</p> Signup and view all the answers

    How is acute promyelocytic leukemia identified within the WHO classification system?

    <p>By t(15;17) chromosomal abnormality</p> Signup and view all the answers

    What is a characteristic finding in the full blood count of a patient with acute leukemia?

    <p>Low packed cell volume</p> Signup and view all the answers

    Which cytochemical stain is NOT positive in acute myeloid leukaemia (AML)?

    <p>Lymphocyte-specific antigens</p> Signup and view all the answers

    What condition has the highest incidence of acute lymphoblastic leukaemia (ALL)?

    <p>Children under 15 years</p> Signup and view all the answers

    Which of the following is considered a potential environmental risk factor for acute lymphoblastic leukaemia (ALL)?

    <p>Chemical mutagens</p> Signup and view all the answers

    What does the presence of more than 20% myeloblasts in the bone marrow indicate?

    <p>Acute leukemia</p> Signup and view all the answers

    Which subtype of acute lymphoblastic leukaemia is most common?

    <p>L1</p> Signup and view all the answers

    Which of the following leukaemias is more common in males than females?

    <p>Acute lymphoblastic leukaemia (ALL)</p> Signup and view all the answers

    What finding in a bone marrow aspiration typically suggests acute leukaemia?

    <p>Hypercellular, with myeloblasts in excess of 20%</p> Signup and view all the answers

    What blood findings are typically associated with the diagnosis of ALL?

    <p>Normocytic normochromic anemia, thrombocytopenia, and leucocytosis</p> Signup and view all the answers

    Which treatment is generally used for CNS prophylaxis in ALL?

    <p>Cranial irradiation and/or intrathecal chemotherapy</p> Signup and view all the answers

    What is one of the primary supportive treatments in managing ALL?

    <p>Counselling and explanation of the diagnosis</p> Signup and view all the answers

    Which biochemical test result is expected to be elevated prior to chemotherapy in ALL patients?

    <p>Increased uric acid levels</p> Signup and view all the answers

    What is the primary goal during the remission induction phase of ALL treatment?

    <p>To achieve complete remission</p> Signup and view all the answers

    What is the primary characteristic required to diagnose acute leukemia?

    <p>Presence of 20% or more blasts in the blood</p> Signup and view all the answers

    Which type of leukemia predominantly affects children?

    <p>Acute Lymphoblastic Leukemia</p> Signup and view all the answers

    Which of the following best describes Acute Myeloid Leukemia (AML)?

    <p>It leads to the accumulation of myeloblasts in various tissues.</p> Signup and view all the answers

    What is a common symptom of acute leukemia due to marrow failure?

    <p>Bleeding and bruising tendencies</p> Signup and view all the answers

    Which of the following is NOT a classification of leukemia?

    <p>Chronic Eosinophilic Leukemia</p> Signup and view all the answers

    What proportion of patients with AML typically show chromosomal abnormalities?

    <p>About 80%</p> Signup and view all the answers

    In which demographic does the incidence of Acute Myeloid Leukemia (AML) notably increase?

    <p>Adults as age increases</p> Signup and view all the answers

    What is a common cause of idiopathic Acute Myeloid Leukemia?

    <p>Most cases are idiopathic</p> Signup and view all the answers

    Which statement is true regarding the prognosis of Acute Lymphoblastic Leukemia (ALL)?

    <p>Cure rates are approximately 70% in children.</p> Signup and view all the answers

    What percentage of acute leukemias in adults does Acute Myeloid Leukemia (AML) account for?

    <p>80%</p> Signup and view all the answers

    Which of the following factors is associated with a poor prognosis in acute lymphoblastic leukemia (ALL)?

    <p>Ph+ cytogenetics</p> Signup and view all the answers

    What is the primary characteristic of biphenotypic acute leukemias?

    <p>Two distinct leukemic cell populations</p> Signup and view all the answers

    What percentage of myeloblasts in a peripheral smear is required for a diagnosis of acute leukemia according to the WHO?

    <p>20%</p> Signup and view all the answers

    Which of the following statements is true regarding maintenance therapy in acute leukemia?

    <p>It is necessary for all patients not proceeding to a stem cell transplant.</p> Signup and view all the answers

    Which of the following conditions is more prominent in chronic leukemias compared to acute leukemias?

    <p>Hepato-splenomegaly</p> Signup and view all the answers

    Study Notes

    Acute Leukemias

    • Acute leukemia is a group of malignant blood disorders
    • Originates from the clonal proliferation of hematopoietic stem cells in bone marrow
    • Accumulation of immature (blast) or abnormal white blood cells in both peripheral blood and bone marrow occurs
    • Caused by somatic mutation and malignant transformation of BM pluripotent stem cells
    • Neoplastic expansion in the BM leads to abnormal leukemic cells with impaired production of red cells, neutrophils, and platelets
    • Unique morphological, cytogenetic, and immunophenotypic features are used for classification, diagnosis, and prognosis
    • In acute leukemia, a diagnosis requires 20% or more blasts (immature cells) in the blood and bone marrow

    Classification of Leukemia

    • Categorized into acute and chronic types
    • Further sub-classified based on myeloid or lymphoid origin
    • Acute myeloid leukemia (AML)
    • Chronic myeloid leukemia (CML)
    • Acute lymphoblastic leukemia (ALL)
    • Chronic lymphocytic leukemia (CLL)

    AML (Acute Myeloid Leukemia)

    • AML is a malignant clonal disorder of the myeloid cell line
    • Characterized by accumulation of myeloblasts in blood, bone marrow, or other tissues
    • Myeloblasts often show myeloid or monocytic differentiation
    • Approximately 80% of AML patients have chromosomal abnormalities
    • 20% or more blasts are present in blood and bone marrow

    AML Epidemiology

    • AML can occur at any age; incidence increases with age
    • Accounts for 80% of adult acute leukemias and 20% of childhood acute leukemias
    • Predominant form of congenital leukemia, often associated with Down syndrome (Trisomy 21)
    • Incidence slightly higher in males compared to females
    • Higher incidence in developed and industrialized countries
    • Little difference in incidence between blacks and whites at any age

    AML Causes

    • Idiopathic (most common)
    • Underlying hematologic disorders (MDS, PNH, PRV, MF)
    • Exposure to chemicals (e.g., benzene, petroleum products)
    • Certain drugs (cytotoxic drugs)
    • Ionizing radiation
    • Viral infections (HTLV-I)
    • Genetic conditions (Down syndrome, Turner syndrome, Klinefelter syndrome, Fanconi anemia)
    • Primary (de novo AML) or secondary to other conditions (MDS, PNH, MF, PRV) or exposure to chemical/drugs

    AML Clinical Features

    • Symptoms related to bone marrow suppression and organ infiltration by malignant myeloblasts
    • Symptoms due to:
      • Marrow failure
      • Tissue infiltration
      • Leukostasis (excessive WBC accumulation in circulation)
      • Constitutional symptoms (fever, headaches, night sweats, anorexia, nausea, vomiting)
      • Bleeding tendency (thrombocytopenia or DIC)
    • Usually short duration of symptoms (weeks/months if untreated)
    • Clinical findings: bone marrow infiltration, neutropenia, anemia, thrombocytopenia, medullary infiltration (marrow), extramedullary infiltration (liver, spleen, lymph nodes, central nervous system), gum hypertrophy, purpuric/petechial rashes, subcutaneous nodules,chloromas/granulocytic sarcomas

    AML Classification

    • Classified based on morphology of myeloblasts, molecular markers, and cytogenetic abnormalities
    • Key classification systems include:
      • French-American-British (FAB) classification (divides AML into 8 types; Mo-M7)
      • World Health Organization (WHO) classification (divides AML into 5 categories/groups based on recurrent genetic abnormalities, multi-lineage dysplasia, therapy-related syndromes, not otherwise categorized, and ambiguous lineage)

    ALL (Acute Lymphoblastic Leukemia)

    • Results from accumulation of lymphoblasts in both peripheral blood and bone marrow
    • Most common childhood leukemia, though it can occur in adults
    • Accounts for about 76% of all leukemias diagnosed in children below 15 years
    • More males are affected than females

    ALL Etiology

    • Etiology is unknown in most cases
    • Environmental factors (ionizing radiation, chemical mutagens)
    • Genetic predisposition (e.g., Down syndrome)
    • Exposure to childhood infections (mainly viral)

    ALL Classification

    • Classified based on morphology of lymphoblasts and immunological markers
    • Types:
      • FAB (L1, L2, L3) - morphological classification
      • Immunological classification (e.g., B-lineage: pro-B-ALL, common ALL, pre-B-ALL, B-cell ALL; T-lineage: pre-T-ALL, T-cell ALL)

    ALL Morphology (FAB)

    • L1: Small, homogeneous blasts
    • L2: Large, heterogeneous blasts
    • L3: Large, homogeneous blasts with abundant basophilic cytoplasm and vacuoles

    ALL Clinical Features

    • Acute presentation, often critically ill due to bone marrow failure
    • Symptoms of anemia, weakness, lethargy, breathlessness, palpitations
    • Infections (e.g., Staphylococcus, Pseudomonas, HSV, Candida)
    • Bleeding tendencies (purpura, menorrhagia, epistaxis)
    • Signs of leucostasis (hypoxia, retinal hemorrhage)
    • Mediastinal involvement and CNS involvement are considerations

    ALL Investigations and Diagnosis

    • Full blood count and blood film (normocytic normochromic anemia, thrombocytopenia, leukocytosis with lymphoblasts)
    • Bone marrow aspiration/biopsy (hypercellular marrow with >20% lymphoblasts)
    • Bone marrow cytogenetics (to detect chromosomal abnormalities)
    • CSF examination to look for CNS involvement
    • Biochemical tests (↑ LDH, ↑ uric acid, LFTs, renal function tests)
    • X-rays (to detect possible thymic or mediastinal lymph node enlargement)
    • Immunophenotyping of blood or bone marrow blasts

    ALL Treatment (Supportive and Specific)

    • Supportive:

      • Explain diagnosis and offer counseling
      • Central venous catheter for drug and blood product administration
      • Transfusions of RBC and platelets
      • Prophylactic and aggressive treatment of infections (antibiotics, antivirals, antifungals)
      • Allopurinol to prevent hyperuricemia and tumor lysis syndrome
      • Antiemetic drugs to prevent vomiting

    • Specific:

      • Induction therapy to achieve complete remission (vincristine, prednisolone, daunorubicin, L-asparaginase)
      • CNS prophylaxis (generally includes cranial irradiation and/or intrathecal chemotherapy)
      • Consolidation therapy to reduce tumor burden and prevent relapse.
      • Maintenance therapy (necessary for those not undergoing stem cell transplant)
      • Allogeneic stem cell transplantation (SCT) in some cases

    Prognostic Factors (AML and ALL)

    • AML:

      • Cytogenetics (favorable = t(8;21), t(15;17), inv 16; unfavorable = deletions of chromosomes 5 or 7, FLT3 mutation)
      • Age at diagnosis (>60 years is unfavorable)
      • Onset of disease (primary or secondary)
      • Bone Marrow response to induction chemotherapy (CR or <5% blasts after first course vs. >20% blasts)

    • ALL:

      • TWBC (Total White Blood Cell Count) at diagnosis (low is good)
      • Sex (female better prognosis)
      • Age (childhood better prognosis)
      • Immunophenotype (certain types of ALL have better prognoses)
      • Cytogenetics (normal or hyperdiploidy is better than Ph+ or hypoploidy)
      • CNS disease (absence preferable)

    Biphenotypic Acute Leukemias

    • A minority of cases with two distinct leukemia cell populations
    • Often expressing both B-lymphoid and myeloid markers
    • Variable response rates; treatment protocol selection can be problematic

    Tumor Lysis Syndrome (TLS)

    • Rapid tumor cell lysis causes release of intracellular substances (potassium, phosphate, nucleic acids) overwhelming the kidneys
    • Can occur at presentation with chemotherapies or high-grade lymphomas
    • Risk of renal failure, electrolyte imbalances, and hyperphosphatemia
    • Usually treated with hydration, allopurinol, and supportive care

    Additional Notes

    • Presented data is from a series of presentations
    • Specifics like patient demographics and detailed clinical findings depend on the specific case studies, and the summary assumes general context from the presentations.

    Studying That Suits You

    Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

    Quiz Team

    Related Documents

    Acute Leukaemias PDF

    Description

    Test your knowledge on acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML) with this quiz. Explore topics such as cell markers, clinical features, and classifications of different leukemia subtypes. Answer questions about presentations and findings associated with these hematological malignancies.

    More Like This

    Use Quizgecko on...
    Browser
    Open
    Browser
    Browser