Cytogenetics in Hematological Malignancies
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Questions and Answers

Which of the following is NOT a clinical application of cytogenetics?

  • Diagnosing hematological malignancies
  • Determining the cause of spontaneous abortion
  • Predicting treatment response in cancer patients
  • Evaluating the effectiveness of a new drug for treating cancer (correct)
  • What is the primary significance of chromosomal analysis in cancer cytogenetics?

  • Identifying the specific type of tumor
  • Determining the stage of cancer progression
  • Understanding the mechanisms of tumorigenesis (correct)
  • Predicting the patient's overall prognosis
  • What is the role of oncogenes in relation to chromosomal rearrangements in cancer?

  • Oncogenes are always activated by chromosomal rearrangements
  • Oncogenes are not affected by chromosomal rearrangements in cancer
  • Chromosomal rearrangements can either activate or inactivate oncogenes (correct)
  • Oncogenes are always inactivated by chromosomal rearrangements
  • What is the main rationale for analyzing chromosomes in patients with hematological malignancies?

    <p>All of the above (D)</p> Signup and view all the answers

    Which of these is a key reason that cytogenetics is a vital component of genetic analysis?

    <p>It can detect both constitutional and somatic genetic disorders (C)</p> Signup and view all the answers

    What is the primary reason for the difficulty in diagnosing Refractory Anemia by morphology alone?

    <p>The absence of specific morphological features characteristic of the condition. (C)</p> Signup and view all the answers

    Which of the following is NOT considered an environmental factor contributing to the development of hematological malignancies?

    <p>Congenital chromosomal abnormalities (B)</p> Signup and view all the answers

    What is the significance of recurrent chromosomal aberrations in hematological malignancies?

    <p>They are valuable for diagnosis, classification, and treatment planning. (C)</p> Signup and view all the answers

    What distinguishes acute leukemia from chronic leukemia?

    <p>The speed at which cancerous cells proliferate. (D)</p> Signup and view all the answers

    Which of the following viruses has been linked to the development of Burkitt's lymphoma?

    <p>Epstein-Barr virus (EBV) (A)</p> Signup and view all the answers

    In the context of hematological malignancies, what does the term "pancytopenia" refer to?

    <p>A decrease in the number of all types of blood cells. (A)</p> Signup and view all the answers

    What is the relationship between the hematopoietic system and hematological malignancies?

    <p>Hematological malignancies disrupt the normal function of the hematopoietic system. (D)</p> Signup and view all the answers

    Which of the following statements is TRUE about the incidence of hematological malignancies?

    <p>They are more common in adults than in children. (C)</p> Signup and view all the answers

    What is the name of the chromosomal abnormality which is present in 90% to 100% of chronic myeloid leukemia cases?

    <p>Philadelphia chromosome (A)</p> Signup and view all the answers

    What is the median survival time for patients with chronic myeloid leukemia with a 13q deletion?

    <p>133 months (A)</p> Signup and view all the answers

    What is the name of the type of cancer that is characterized by an unrestrained expansion of pluripotent hematopoietic stem cells?

    <p>Chronic Myeloid Leukemia (CML) (C)</p> Signup and view all the answers

    Which of the following is NOT a frontline therapy for chronic myeloid leukemia?

    <p>Methotrexate (C)</p> Signup and view all the answers

    What is the genetic translocation that characterizes chronic myeloid leukemia?

    <p>t(9;22)(q34;q11.2) (C)</p> Signup and view all the answers

    Which of the following chromosomal abnormalities are associated with a good prognosis in pediatric Acute Lymphoblastic Leukemia (ALL)?

    <p>+4, +10, +17 (D)</p> Signup and view all the answers

    What is the most frequent adult leukemia, affecting middle-aged to elderly patients, but not children?

    <p>Chronic Lymphocytic Leukemia (CLL) (D)</p> Signup and view all the answers

    Which of the following is NOT a characteristic symptom of Multiple Myeloma (MM)?

    <p>Increased normal immunoglobulin (B)</p> Signup and view all the answers

    What is the typical chromosome number range associated with good risk cytogenetics in Multiple Myeloma (MM)?

    <p>48-74 (D)</p> Signup and view all the answers

    Which of the following chromosomal aberrations is associated with a poor prognosis in Multiple Myeloma (MM)?

    <p>del(13q) (C)</p> Signup and view all the answers

    What is the significance of genomic aberrations in Chronic Lymphocytic Leukemia (CLL)?

    <p>They are important independent predictors of disease progression and survival. (C)</p> Signup and view all the answers

    What is the estimated percentage of pediatric Acute Lymphoblastic Leukemia (ALL) cases associated with high hyperdiploidy (>50 chromosomes)?

    <p>25% (C)</p> Signup and view all the answers

    Which of the following is NOT considered one of the ‘odd numbered’ chromosomes associated with good risk cytogenetics in Multiple Myeloma (MM)?

    <p>Chromosome 13 (A)</p> Signup and view all the answers

    Which of the following is a characteristic of AML?

    <p>Is typically characterized by clonal chromosomal abnormalities in 50-60% of cases (C)</p> Signup and view all the answers

    What is the significance of the karyotype 46,XY,-7 in a patient with MDS?

    <p>This karyotype suggests a poor prognosis and is associated with monosomy 7, a clonal acquired chromosomal abnormality. (D)</p> Signup and view all the answers

    Which of these options are considered favorable cytogenetic groups within the WHO classification of AML?

    <p>Normal Karyotype (NK) (A)</p> Signup and view all the answers

    Which of the following statements is TRUE about MDS?

    <p>MDS is a group of heterogeneous clonal hematopoietic stem cell disorders. (B)</p> Signup and view all the answers

    Which of the following is NOT a subtype of MDS?

    <p>Acute Myeloid Leukemia (AML) (C)</p> Signup and view all the answers

    What is the significance of the presence of del(5q) in a patient with MDS?

    <p>It indicates a relatively good prognosis, but a poor prognosis is associated with combined other anomalies. (B)</p> Signup and view all the answers

    What is the role of cytogenetic analysis in MDS?

    <p>It helps determine the subtype of MDS and may provide prognostic information. (A)</p> Signup and view all the answers

    Which of the following statements accurately describes the relationship between cytogenetic abnormalities and prognosis in MDS?

    <p>Specific cytogenetic abnormalities can significantly impact prognosis, with some associated with favorable outcomes and others with unfavorable. (A)</p> Signup and view all the answers

    Flashcards

    Cytogenetics

    The study of chromosome structure and function, especially in relation to cancer.

    Chromosomal abnormalities

    Changes in the normal structure or number of chromosomes often found in cancer cells.

    Oncogenes

    Genes that, when mutated or expressed aberrantly, can lead to cancer development.

    Hematological malignancies

    Cancers that affect blood, bone marrow, and lymph nodes, often linked to chromosomal changes.

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    Clonal chromosomal abnormalities

    Specific, identical chromosomal changes that arise in cancer cells from a single precursor cell.

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    Hematological Malignancy

    Cancers affecting blood cells and bone marrow, including leukemia and lymphoma.

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    Leukemia

    A type of cancer that affects blood cells and bone marrow, leading to uncontrolled growth of blood cell precursors.

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    Lymphoma

    Malignancies that arise from lymphatic tissue, affecting lymph nodes and immune function.

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    Etiology of Hematological Malignancies

    Causes include unknown origins, oncogene mutations, environmental factors, and genetic predispositions.

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    Environmental Causes

    Factors like ionizing radiation, chemicals, and viruses that can contribute to hematological malignancies.

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    Incidence in Hematological Malignancies

    More common in adults than children and more frequent in males than females.

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    Recurrent Chromosomal Aberrations

    Chromosomal abnormalities that are specific to certain types of hematological malignancies, aiding in diagnosis and classification.

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    Myelodysplastic Syndromes (MDS)

    A group of disorders caused by poorly formed or dysfunctional blood cells, often diagnosed with bone marrow analysis.

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    Karyotype

    A karyotype describes the number and appearance of chromosomes in a cell, here represented as 46,XY,-7.

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    MDS

    Myelodysplastic syndromes (MDS) are a group of disorders caused by poorly formed or dysfunctional blood cells.

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    Monosomy 7

    Monosomy 7 refers to the loss of one chromosome 7, linked with poor prognosis in patients.

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    AML

    Acute Myeloid Leukaemia (AML) is a heterogeneous group of blood cancers characterized by the rapid growth of abnormal cells.

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    Cytogenetic abnormalities

    Cytogenetic abnormalities in AML occur in about 50-60% of new patients, affecting their prognosis.

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    Risk stratification in MDS

    Risk stratification in MDS is used to predict patient outcomes based on cytogenetic findings.

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    Refractory anemia

    Refractory anemia is a subtype of MDS where the bone marrow does not produce enough healthy blood cells.

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    5q- syndrome

    The 5q- syndrome is defined by the deletion of part of chromosome 5, often resulting in a better prognosis in MDS.

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    Median Survival Times

    Average survival durations based on chromosomal abnormalities in CML.

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    Acute Lymphoblastic Leukemia (ALL)

    A type of cancer affecting lymphoid cells, characterized by excessive lymphoblasts in the blood.

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    Chronic Myeloid Leukemia (CML)

    A myeloproliferative neoplasm from unrestrained expansion of stem cells.

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    Philadelphia Chromosome

    The derivative formed by t(9;22) in CML, crucial for diagnosis.

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    High Hyperdiploidy

    Presence of more than 50 chromosomes, common in 25% of pediatric ALL cases, associated with good prognosis.

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    Keystone Chromosomes in ALL

    Chromosomes 4, 10, and 17 are linked to a good prognosis in high hyperdiploidy.

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    Tyrosine Kinase Inhibitors (TKIs)

    Targeted therapy for CML, including imatinib and others.

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    Hypodiploidy in ALL

    A karyotype with 44 or fewer chromosomes; ≤43 chromosomes are associated with very poor outcomes.

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    Progression of CML

    CML can progress from chronic phase to accelerated or blast crisis phases.

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    Multiple Myeloma (MM)

    A cancer of plasma cells, often occurring in middle-aged individuals, with various symptoms including bone pain and anemia.

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    Good Risk Cytogenetics in MM

    Hyperdiploidy (48-74 chromosomes) is a favorable prognostic factor in multiple myeloma.

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    Poor Prognostic Features in MM

    Key genetic abnormalities such as del(17p), del(13q), and t(4;14) indicate a worse outcome for patients.

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    Chronic Lymphocytic Leukemia (CLL)

    The most common adult leukemia, mainly affecting B-cells, with a notable male predominance and genomic predictors of progression.

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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.

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