Term
| What is the difference between acute and chronic leukemia? |
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Definition
Acute leukemia: minimally differentiated cells; >20% blasts in bone marrow
Chronic leukemia: more mature differntiated cells |
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Term
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Definition
Viral like prodrome (fever, sore throat, lethargy)
Kids may present with limpness, bone pain, easy bruising and fever
Exam shows pallor, widespread petechiae/purpura, multiple ecchymoses and bleeding
Signs of Extramedullary spread with adenopathy, hepatosplenomegaly, testicular/CNS involvement |
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Term
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Definition
Leukocyte count: Increased or Decreased
Plt: Marked decrease
LDH and Uric Acid: INcreased
Biopsy: CALLA+, TdT+
CXR, LP, and CT to rule out mediastinal involvement and brain mets |
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Term
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Definition
Induction: Induce remission (vincristine + prednisone + daunorubicin
Consolidation: To kill residual leukemia (High dose methotrexate)
Maintenance: Maintain remission (daily Methotrexate, 6-MP, or both)
80% achieve long term remission for kids |
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Term
| What are the symptoms of AML? |
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Definition
Fatigue bruising, anemia, Fever Leukemia cutis (small painless skin lesions), history of frequent infections.
DIC, gingival hyperplasia or CNS involvement |
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Term
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Definition
Myelocytic cell lines: Increased
Leukocyte Alkaline Phosphatase (LAP): Decreased
Hypruricemia due to cell turnover
Myeloblasts with Auer Rods
Biopsy shows blasts +myeloperoxidase stain, Auer rods, and cytogenetic tests |
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Term
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Definition
Induction: cytsine arabinoside + anthracycline
Consolidation:
Exceptions: All-trans-retinoic acid for induction and maintenance for promyelocytic form (AML-3)
Allogenic BMT considered for pts with poor prognostic factors or those <60 yrs. |
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Term
| 70 yo man presents with fatigue. PE is unrevealing but a routine CBC shows lymphocytosis with a normal hematocrit and platelet count. What is the next step and what is the likely diagnosis? |
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Definition
Get a peripheral blood smear
CLL |
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Term
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Definition
Incidental finding of lymphocytosis
Lymphadenopathy, fatigue, hepatosplenomegaly |
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Term
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Definition
Isolated lymphocytosis with normal hematocrit and platelets
Peripheral smear shows small lymphocytes and smudge cells
Biopsy for confirmation |
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Term
| What is found on Bone Marrow Biopsy in CLL? |
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Definition
Infiltrated with lymphocytes
Aberrant CD5+ expression |
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Term
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Definition
No treatment indicated for asymptomatic patients
Anemia and thrombocytopenia are treated with fludarabine
May be associated with autoimmune hemolytic anemia and immune thrombocytopenia which are treated with splenectomy and/or steroids. |
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Term
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Definition
Routine CBC demonstrates leukocytosis with myeloid precursors
Fatigue, fever, mlaise, decreased exercise tolerance, weight loss, and night sweats
Blast Crisis presents as fever, bone pain, wt loss and splenomegaly |
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Term
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Definition
Hairy cell leukemia: (Pancytopenia in elderly, Malignancy of B lymphocytes, CD11c +)
Aplastic anemia
Myelofibrois (dry bone tap) |
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Term
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Definition
Prominent myeloid cells with basophilia
LAP: Decreased
B12 level: increased
Confirm wiht t(9,22) Philadelphia chromosome bcr-abl via karyotype, PCR, or fluroscence in situ hybridization (FISH) analysis of blood or marrow aspirate. |
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Term
| What is the treatment for CML? |
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Definition
| Sharl Azar MD's main man Brian Drucker MD from Oregon Health Sciences University in Portlandia developed the first good first-line therapy called GLEEVEC (Imatinib mesylate) a Tyrosine kinase inhibitor which rapidly leads to remission, by eliminating the CML clone. Pure Brilliance from Oregon! Who says people go there to retire? |
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