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71 Cards in this Set
- Front
- Back
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MC etiology of AML ****
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unknown
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other etiologies of AML ****
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radiation exposure, prior chemo, bone marrow toxic drugs, environmental exposure (benzene, radon), preexisting bone marrow disorders (PNH, MPD, MDS)
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Cause of CLL
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No definitive cause or association
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What account for majority of clinical manifestations of leukemias?
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effects of the over production of immature, abnormal cells
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Clinical manifestations of leukemias (3 general)
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bone marrow replacement, solid organ infiltration, coagulation activation
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Which leukemias are more associated with myeloproliferative disorders?
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myeloid leukemias
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Which leukemias are more associated with lymphomas?
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lymphoid leukemias
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For adults, which leukemia is the primary acute disease?
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AML
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For adults, which leukemia is the primary chronic disease?
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CLL
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When is there a rapid initiation of therapy for AML?
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blast count greater than 50,000, DIC, and hyperviscosity syndrome
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When should bone marrow biopsy be done for AML?
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ASAP
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Prognosis for leukemia
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Most will die of the disease or its tx (chemo ends up killing patient)
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What cells cause hyperviscosity in AML ?
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WBCs are clogging the blood as opposed to RBCs in PV; same symptoms will occur
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Where will the leukocytosis and blasts be seen in leukemia?
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peripheral blood smear (not on CBC)
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Median age for AML
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65
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What symptoms will cause you to suspect AML?
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fatigue, bleeding, and fevers with STRIKINGLY ABNORMAL CBC RESULTS
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What will be seen on peripheral blood smear in AML?
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blast cells showing AUER RODS (needle like inclusion bodies)
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Three methods used to detect AML
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bone marrow biopsy, cytogenetics, and immunophenotyping
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What might cytogenetic testing show in AML?
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may reveal cellular genetic abnormalities associated w/ certain types of leukemias (i.e. 15:17 translocation in 98% of AML M3 cases)
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What is the purpose of immunophenotyping?
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to determine which type of white cell surface antigens are present
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Auer Rods are the distinguishing factor for what disease
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AML
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What is staging?
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process of determining the extent of spread of a malignany (used to determine tx options and prognosis)
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Why is staging limited use in AML?
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"because the tumor has ""liquid"" characteristics not solid"
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What is the translocation found in Acute Promyelocytic Leukemia- AML M3 cases?
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15:17 translocation
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What is used to treat Acute Promyelocytic Leukemia- AML M3?
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retin A medication---high cure rate
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Clinical presentation of AML
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fevers, malaise, weight loss, and fatigue; infiltrative symptoms, hematologic symptoms, infectious symptoms
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Infiltrative symptoms of AML
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gingival hyperplasia, diffuse tender bony tenderness
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Hematologic symptoms of AML
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pancytopenia, thrombocytopenia (oral petechiae, epistaxis), DIC, hyperviscosity
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What causes hyperviscosity in AML?
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hyperleukocytosis
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What are examples of thrombocytopenia in AML?
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mucocutaneous bleeding like oral petechiae
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What leukemia in particular causes DIC?
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AML M3
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What is functional neutropenia?
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the cells are there, they just don’t work to fight the bacteria---patients get superinfections
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Why is there diffuse bony tenderness in AML?
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marrow replacement by immature cells causes it
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General impression of patients with AML
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Patients are sick
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What is first stage of AML tx?
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Induction---very aggressive chemo in order to completely destroy the leukemic cells
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3 options for post induction tx of AML
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maintenance- chemo less intense than induction; consolidation- chemo of similar intensity to induction; intensification- more prolonged and intense
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What is the goal of AML tx?
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complete remission
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What lab values are considered remission in AML?
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platelet count >100 K; WBC > 1000, bone marrow with less than 5% blasts
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Explain maintenance chemo
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less intense than induction therapy
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Explain consolidation chemo
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chemo of similar intensity to induction
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Explain intensification chemo
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more intense or prolonged than induction therapy
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What percentage of patients achieve initial complete remission in AML?
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60-70%
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How long does AML remission usually last?
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1 year
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"What tx has the best chance for ""cure"" in AML? "
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allogeneic bone marrow transplant
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Performance status 0- definition
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asymptomatic
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Performance status 1- definition
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symptomatic, fully ambulatory
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Performance status 2- definition
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symptomatic, in bed LESS than 50% of the day
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Performance status 3- definition
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symptomatic; in bed MORE than 50% of the day
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Performance status 4- definition
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bedridden
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Lymphocytosis in the setting of characteristic immunophenotypes.
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Chronic Lymphocytic Leukemia (CLL)
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Lab values in CLL ****
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>5000 lymphocytes in peripheral blood, >30% of bone marrow cells as lymphocytes
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Description of Low Risk CLL
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Stage 0--lymphocytosis in blood or bone marrow
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Description of Intermediate Risk CLL
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Stage I- Lymphocytosis and enlarged lymph nodes; Stage II- Lymphocytosis and enlarged liver or spleen with or without lymphadenopathy
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Description of Stage I CLL
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lymphocytosis and enlarged lymph nodes
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Description of Stage II CLL
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lymphocytosis and enlarged liver of spleen with or without lymphadenopathy
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Description of Stage 0 CLL
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lymphocytosis in blood or bone marrow
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Description of Stage III CLL
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lymphocytosis and anemia with or without large liver, spleen, or lymph nodes
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Description of High Risk CLL
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Stage III- lymphocytosis and anemia w/ or w/o liver, spleen, or lymph nodes; Stage IV- lymphocytosis and thrombocytopenia w/ or w/o anemia or organ enlargement
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Description of Stage IV CLL
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lymphocytosis and thrombocytopenia w/ or w/o anemia and organ enlargement
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Clinical presentation of CLL
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often incidental finding; solid organ manifestations, hematologic manifestations of anemia and thrombocytopenia, Richter's syndrome (CLL that leads to Large Cell Lymphoma), increase infectious risk, increased risk of second malignancies
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What is Richter's syndrome?
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CLL that advances to Large cell lymphoma
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CLL Tx
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chemo, radiation, monoclonal antibodies (specific to CD marker), bone marrow transplant
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prognosis for CLL as opposed to AML
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better prognosis for CLL
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This condition is a relative emergency.
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AML
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Most common leukemia
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CLL
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Not all ____________ is CLL.
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lymphocytosis
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What are the B symptoms (disease related systemic symptoms) of CLL?
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weight loss greater than 10% in last 6 mths, extreme fatigue, fevers >38 for more than 2 weeks, night sweats
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What would be considered progressive lymphocytosis in CLL?
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greater than 50% increase over 2 mths, lymphocyte doubling time less than 6 mths
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Why is there massive splenomegaly in CLL?
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T cells are cytotoxic and break down or make dysfunctional WBCs and RBCs
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What are general indications for tx in CLL?
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disease related symptoms, progressive marrow failure, autoimmune cytopenias, massive splenomegaly, massive lymphadenopathy, progressive lymphocytosis
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What will be seen with progressive marrow failure in CLL?
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progressively worsening anemia or thrombocytopenia
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