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Questions and Answers
Which of the following is NOT a clinical application of cytogenetics?
Which of the following is NOT a clinical application of cytogenetics?
What is the primary significance of chromosomal analysis in cancer cytogenetics?
What is the primary significance of chromosomal analysis in cancer cytogenetics?
What is the role of oncogenes in relation to chromosomal rearrangements in cancer?
What is the role of oncogenes in relation to chromosomal rearrangements in cancer?
What is the main rationale for analyzing chromosomes in patients with hematological malignancies?
What is the main rationale for analyzing chromosomes in patients with hematological malignancies?
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Which of these is a key reason that cytogenetics is a vital component of genetic analysis?
Which of these is a key reason that cytogenetics is a vital component of genetic analysis?
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What is the primary reason for the difficulty in diagnosing Refractory Anemia by morphology alone?
What is the primary reason for the difficulty in diagnosing Refractory Anemia by morphology alone?
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Which of the following is NOT considered an environmental factor contributing to the development of hematological malignancies?
Which of the following is NOT considered an environmental factor contributing to the development of hematological malignancies?
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What is the significance of recurrent chromosomal aberrations in hematological malignancies?
What is the significance of recurrent chromosomal aberrations in hematological malignancies?
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What distinguishes acute leukemia from chronic leukemia?
What distinguishes acute leukemia from chronic leukemia?
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Which of the following viruses has been linked to the development of Burkitt's lymphoma?
Which of the following viruses has been linked to the development of Burkitt's lymphoma?
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In the context of hematological malignancies, what does the term "pancytopenia" refer to?
In the context of hematological malignancies, what does the term "pancytopenia" refer to?
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What is the relationship between the hematopoietic system and hematological malignancies?
What is the relationship between the hematopoietic system and hematological malignancies?
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Which of the following statements is TRUE about the incidence of hematological malignancies?
Which of the following statements is TRUE about the incidence of hematological malignancies?
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What is the name of the chromosomal abnormality which is present in 90% to 100% of chronic myeloid leukemia cases?
What is the name of the chromosomal abnormality which is present in 90% to 100% of chronic myeloid leukemia cases?
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What is the median survival time for patients with chronic myeloid leukemia with a 13q deletion?
What is the median survival time for patients with chronic myeloid leukemia with a 13q deletion?
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What is the name of the type of cancer that is characterized by an unrestrained expansion of pluripotent hematopoietic stem cells?
What is the name of the type of cancer that is characterized by an unrestrained expansion of pluripotent hematopoietic stem cells?
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Which of the following is NOT a frontline therapy for chronic myeloid leukemia?
Which of the following is NOT a frontline therapy for chronic myeloid leukemia?
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What is the genetic translocation that characterizes chronic myeloid leukemia?
What is the genetic translocation that characterizes chronic myeloid leukemia?
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Which of the following chromosomal abnormalities are associated with a good prognosis in pediatric Acute Lymphoblastic Leukemia (ALL)?
Which of the following chromosomal abnormalities are associated with a good prognosis in pediatric Acute Lymphoblastic Leukemia (ALL)?
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What is the most frequent adult leukemia, affecting middle-aged to elderly patients, but not children?
What is the most frequent adult leukemia, affecting middle-aged to elderly patients, but not children?
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Which of the following is NOT a characteristic symptom of Multiple Myeloma (MM)?
Which of the following is NOT a characteristic symptom of Multiple Myeloma (MM)?
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What is the typical chromosome number range associated with good risk cytogenetics in Multiple Myeloma (MM)?
What is the typical chromosome number range associated with good risk cytogenetics in Multiple Myeloma (MM)?
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Which of the following chromosomal aberrations is associated with a poor prognosis in Multiple Myeloma (MM)?
Which of the following chromosomal aberrations is associated with a poor prognosis in Multiple Myeloma (MM)?
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What is the significance of genomic aberrations in Chronic Lymphocytic Leukemia (CLL)?
What is the significance of genomic aberrations in Chronic Lymphocytic Leukemia (CLL)?
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What is the estimated percentage of pediatric Acute Lymphoblastic Leukemia (ALL) cases associated with high hyperdiploidy (>50 chromosomes)?
What is the estimated percentage of pediatric Acute Lymphoblastic Leukemia (ALL) cases associated with high hyperdiploidy (>50 chromosomes)?
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Which of the following is NOT considered one of the ‘odd numbered’ chromosomes associated with good risk cytogenetics in Multiple Myeloma (MM)?
Which of the following is NOT considered one of the ‘odd numbered’ chromosomes associated with good risk cytogenetics in Multiple Myeloma (MM)?
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Which of the following is a characteristic of AML?
Which of the following is a characteristic of AML?
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What is the significance of the karyotype 46,XY,-7 in a patient with MDS?
What is the significance of the karyotype 46,XY,-7 in a patient with MDS?
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Which of these options are considered favorable cytogenetic groups within the WHO classification of AML?
Which of these options are considered favorable cytogenetic groups within the WHO classification of AML?
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Which of the following statements is TRUE about MDS?
Which of the following statements is TRUE about MDS?
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Which of the following is NOT a subtype of MDS?
Which of the following is NOT a subtype of MDS?
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What is the significance of the presence of del(5q) in a patient with MDS?
What is the significance of the presence of del(5q) in a patient with MDS?
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What is the role of cytogenetic analysis in MDS?
What is the role of cytogenetic analysis in MDS?
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Which of the following statements accurately describes the relationship between cytogenetic abnormalities and prognosis in MDS?
Which of the following statements accurately describes the relationship between cytogenetic abnormalities and prognosis in MDS?
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Flashcards
Cytogenetics
Cytogenetics
The study of chromosome structure and function, especially in relation to cancer.
Chromosomal abnormalities
Chromosomal abnormalities
Changes in the normal structure or number of chromosomes often found in cancer cells.
Oncogenes
Oncogenes
Genes that, when mutated or expressed aberrantly, can lead to cancer development.
Hematological malignancies
Hematological malignancies
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Clonal chromosomal abnormalities
Clonal chromosomal abnormalities
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Hematological Malignancy
Hematological Malignancy
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Leukemia
Leukemia
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Lymphoma
Lymphoma
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Etiology of Hematological Malignancies
Etiology of Hematological Malignancies
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Environmental Causes
Environmental Causes
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Incidence in Hematological Malignancies
Incidence in Hematological Malignancies
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Recurrent Chromosomal Aberrations
Recurrent Chromosomal Aberrations
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Myelodysplastic Syndromes (MDS)
Myelodysplastic Syndromes (MDS)
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Karyotype
Karyotype
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MDS
MDS
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Monosomy 7
Monosomy 7
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AML
AML
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Cytogenetic abnormalities
Cytogenetic abnormalities
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Risk stratification in MDS
Risk stratification in MDS
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Refractory anemia
Refractory anemia
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5q- syndrome
5q- syndrome
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Median Survival Times
Median Survival Times
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Acute Lymphoblastic Leukemia (ALL)
Acute Lymphoblastic Leukemia (ALL)
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Chronic Myeloid Leukemia (CML)
Chronic Myeloid Leukemia (CML)
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Philadelphia Chromosome
Philadelphia Chromosome
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High Hyperdiploidy
High Hyperdiploidy
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Keystone Chromosomes in ALL
Keystone Chromosomes in ALL
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Tyrosine Kinase Inhibitors (TKIs)
Tyrosine Kinase Inhibitors (TKIs)
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Hypodiploidy in ALL
Hypodiploidy in ALL
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Progression of CML
Progression of CML
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Multiple Myeloma (MM)
Multiple Myeloma (MM)
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Good Risk Cytogenetics in MM
Good Risk Cytogenetics in MM
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Poor Prognostic Features in MM
Poor Prognostic Features in MM
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Chronic Lymphocytic Leukemia (CLL)
Chronic Lymphocytic Leukemia (CLL)
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Study Notes
Lecture 12: Cancer Cytogenetics
- Cancer cytogenetics involves analyzing chromosomes to understand cancer development and treatment.
- Chromosome analysis is a key approach in genetic testing for constitutional and somatic genetic disorders, including cancer.
- Cytogenetics is crucial to identify chromosomal changes in specific cancers and link breakpoints to oncogenes.
- Repeated cytogenetic changes are often found in similar tumor types.
- Cytogenetics is important for diagnosis and prognosis of cancer.
Clinical Cytogenetics
- Factors like early growth and development issues, spontaneous abortion, and fertility problems are associated with cytogenetic studies.
- Family history and pregnancy in women over 35 are relevant for clinical cytogenetics.
- These factors can contribute to cancer risk assessment.
Cytogenetics in Hematological Malignancies
- Chromosome analysis is vital for diagnosing hematopoietic neoplasms.
- Most patients with hematological malignancies have clonal chromosomal abnormalities.
- The pattern of chromosomal aberrations helps predict treatment response, clinical outcome, and risk.
- Genes at breakpoints in recurrent abnormalities are involved in tumorigenesis and can be treatment targets.
Hematological Malignancy
- Hematological malignancies include leukemia and lymphoma.
- Leukemia is a blood cell/bone marrow malignancy.
- Lymphoma is a lymphatic system (lymph nodes) malignancy.
- Cancer cells lose their differentiation capacity, leading to increased cell growth and proliferation.
- Immature cell growth can result in failure of the hematopoietic system and spread to other organs.
Etiology
- Unknown mutation/tumor suppressor gene alteration, and host factors like congenital chromosomal abnormalities (e.g., Down syndrome and acute leukemia) are causes of cancer.
- Chromosomal abnormalities/gene rearrangements, hereditary immunodeficiencies (e.g., ataxia telangiectasia and sex-linked agammaglobulinemia), and environmental factors (e.g., radiation exposure and certain chemicals/drugs/viruses).
Incidence
- Cancer is more frequent in adults than children (10:1 ratio).
- Incidence is higher in males than females (1-2:1 ratio).
- Specific diseases like AML, CML, CLL, ALL, MM, NHL, and HD have varying incidences, median ages at diagnosis, and 5-year survival rates.
- Statistics for 2016 and 2009-2013 show disease-specific data.
- Recent advances in treatment may affect incidence and survival trends.
Classification of Hematological Malignancies
- Classification of hematologic malignancies depends on the cell type (e.g., myeloid/lymphoid), origin of cells (different types of leukemia), onset and progression (e.g., acute/chronic), and speed of cancer cell growth.
Recurrent chromosomal aberrations in hematological malignancies
- Specific chromosomal abnormalities are associated with different types of cancers.
- Aberrations are frequently observed in CML (t(9;22)), AML (various translocations), ALL (various translocations), and lymphomas (various translocations).
- Some abnormalities are subtype-specific, useful for diagnosis & classification.
Useful applications of Cytogenetics
- Cytogentic analysis is a useful tools for diagnosis, prognosis, risk stratification of treatment, and treatment response monitoring in cancer patients.
Diagnosis
- Bone marrow smears from patients with pancytopenia (low blood cell counts) and multilineage dysplasia (problems with multiple blood cell types) are used for diagnosis of Myelodysplastic Syndromes (MDS).
- Some MDS cases, especially refractory anemia, are difficult to diagnose using morphological criteria alone.
- Karyotyping can identify acquired chromosomal abnormalities (e.g., monosomy 7) which affects treatment outcome.
Risk Stratification
- Assessing risk based on cytogenetic analysis is crucial in cancer management.
- The WHO classification system categorizes acute myeloid leukemia (AML) into different groups based on specific genetic abnormalities' presence or absence.
Impact of cytogenetics in AML
- The World Health Organization (WHO) 2016 system classifies acute myeloid leukemia (AML) based on cytogenetic abnormalities which help in risk stratification and prognosis.
- Various AML subtypes exist, each associated with different genetic abnormalities.
- Specific recurrent chromosome aberrations in AML are used for diagnosis and classifying into distinct subgroups.
- Favorable vs unfavorable prognostic risk groups are associated with different survival outcomes.
Cytogenetic risk group in AML
- Genetic abnormalities (like translocations) are crucial for classifying acute myeloid leukemia (AML) into favorable vs intermediate vs adverse risk groups based on cytogenetic attributes, determining prognosis, and treatment strategies.
- Specific translocations and mutations are linked to particular risk groups or types of AML.
Impact of cytogenetics in ALL
- The WHO 2016 system classifies acute lymphoblastic leukemia (ALL) based on cytogenetic alterations to determine prognosis, diagnose, and develop risk-adapted treatment plans.
- Genetic abnormalities affect the categorization of ALL into subtypes.
Hyperdiploidy and Near-haploid ALL
- High hyperdiploidy (>50 chromosomes) and near-haploid ALL (chromosome counts significantly below 46) are seen in childhood cases.
- High hyperdiploidy is associated with a good outcome, while near-haploid cases with 44 or 45 chromosomes have intermediate outcomes, and below 43 is very poor.
- Specific chromosomal abnormalities or their combinations within the cases affect the prognosis for either outcome.
Multiple myeloma (MM)
- Multiple myeloma is a plasma cell cancer (immuno-secretory plasma cells proliferate unchecked).
- MM is more common among middle-aged or elderly patients, particularly African Americans.
- At initial diagnosis 15-30% of patients are asymptomatic.
- Symptoms include fatigue, bone pain, abnormal protein in blood or urine, decreased normal immunoglobulin, anemia, and hyperuricemia, bone marrow plasmacytosis, etc
Impact of genomic aberrations in multiple myeloma
- Cytogenetics are strongly associated with risk factors in multiple myeloma.
- Hyperdiploidy with a broad chromosome range (48-74) implies a good risk group.
- Specific extra chromosomes (3, 5, 7, 9, 11, 15, 19, 21) are included within a good risk group based on analysis.
Impact of genomic aberrations on OS in multiple myeloma
- Genomic aberrations like del(17p), del(13q), and t(4;14) correlate with worse outcomes/overall survival (OS) in multiple myeloma.
Chronic lymphocytic leukemia (CLL)
- Chronic lymphocytic leukemia (CLL) is an adult B-cell malignancy.
- It’s prevalent in middle-age and elderly individuals.
- CLL accounts for approximately 30% of adult leukemias.
- Genomic aberrations are significant factors associated with CLL progression and overall survival.
Follow-up of clinical course
- Regular monitoring of clinical progression after diagnosis and treatment is important in cancer care.
- Monitoring helps in detecting early treatment's efficacy.
Chronic myeloid leukemia (CML)
- Chronic myeloid leukemia (CML) is a myeloproliferative neoplasm, characterized by the uncontrolled expansion of pluripotent hematopoietic stem cells.
- CML is marked by a balanced genetic translocation t(9;22)(q34;q11.2).
- The translocation results in the creation of a derivative chromosome 9 and chromosome 22 known as the Philadelphia chromosome.
Chronic myeloid leukemia (CML) – Frontline Therapy
- Frontline therapy for CML often includes tyrosine kinase inhibitors (TKIs) such as imatinib, nilotinib, dasatinib, and ponatinib.
- Progression from the chronic phase to accelerated/blast crisis phase in CML can be associated with secondary chromosomal aberrations.
t(9;22)/BCR-ABL1
- t(9;22)(q34;q11.2) is a common translocation involving chromosomes 9 and 22, forming the Philadelphia chromosome.
- t(9;22)/BCR-ABL1 is most commonly detected in chronic myeloid leukemia (CML), but also in acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML).
- The translocation creates a fusion gene BCR-ABL1, leading to persistently activated tyrosine kinase, a poor prognosis, especially in children.
Karyotype: 46,XX,t(9;22)(q34;q11.2)
- The karyotype notation illustrates the specific chromosomal abnormality in an individual. The notation shows the total number of chromosomes, sex chromosomes, and the t(9;22) translocation with precise locations on the 9 and 22 chromosomes.
- The t(9;22) translocation results in the Philadelphia chromosome being visible in a karyotype.
BCR-ABL1 DC DF probe
- The BCR-ABL1 FISH (Fluorescence in Situ Hybridization) probe detects the fusion gene BCR-ABL1.
- Normal cells show absence of the fusion gene (BCR/ABL1 negative), whereas abnormal cells have its presence (BCR/ABL1 positive).
Summary of Cancer Cytogenetics
- Cytogenetic analysis is a crucial tool in cancer care, defining specific genetic subtypes.
- Cytogenetic insights significantly contribute to diagnosis, staging, prognosis, treatment options, including treatment response evaluation.
- Immunophenotypic, clinical and morphological data in conjunction with cytogenetic aberrations are often involved in leukemias and lymphomas to categorize them.
- This is imperative to tailor treatments with maximum efficacy for positive outcomes. Additional markers or clinical features are often used for further assessment and categorization based patient-specific circumstances.
Indication of cytogenetic studies in hematological malignancies
- Cytogenetic studies are indicated in various hematological malignancies based on clinical presentation or need to evaluate cytogenetic aberrations for diagnostics, staging, prognostic insights (especially in specific subtypes), treatment selection and monitoring treatment response.
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Description
This quiz delves into the clinical applications of cytogenetics specifically in the context of hematological malignancies. Participants will explore the significance of chromosomal analysis, the role of oncogenes, and the challenges in diagnosing conditions like Refractory Anemia. Test your understanding of the complex relationship between genetics and cancer.