Title: LAPD Leukemias

Chronic lymphocytic leukemia is a neoplastic proliferation of naive B cells that co-express CD5 and CD20
Extra: CD5 is normally in T cells, so this is abnormal

Q: AML may arise from pre-existing [...] syndromes and [...] disorders
A: myelodysplastic; myeloproliferative
Extra: - Myelodysplastic syndromes are stem-cell disorders involving ineffective hematopoiesis; results in defects in cell maturation of all nonlymphoid lineages
- Myeloproliferative includes essential thrombocythemia, polycythemia vera, primary myelofibrosis, chronic myeloid leukemia

Q: Myeloblasts may have crystal aggregates of [...], which are seen on blood smear as [...]
A: myeloperoxidase (MPO); Auer rods
Extra: Described as "azurophilic, needle-shaped cytoplasmic inclusions"

Q: Translocations of the ABL proto-oncogene with the breakpoint cluster region (BCR) on chromosome [...] are associated with:
[...] leukemia
[...] leukemia
A: 22; Chronic myelogenous; Adult acute lymphoblastic
Extra: - When seen in adult ALL, this is associated with POOR prognosis

Q: The t(15;17) translocation seen in acute promyelocytic leukemia results in disruption of the [...] receptor on chromosome 17
A: retinoic acid
Extra: RAR disruption blocks maturation and promyelocytes (blasts) accumulate

Q: AML is a neoplastic accumulation of [...] (>20%) in the bone marrow
A: myeloblasts
Back Extra: - i.e., acute myelogenous leukemia
- Can be seen on peripheral blood smear

Q: Transformation of CLL into diffuse large B-cell lymphoma presents clinically as a(n) [...] lymph node or spleen
A: enlarging
Back Extra: i.e., Richter transformation

Q: Acute leukemia is subdivided into [...] or [...] based on the phenotype of the blasts
A: ALL; AML
Back Extra: - ALL = precursors of lymphoblasts
- AML = precursors of myeloblasts

Q: Which is a lymphoid / myeloid neoplasm with widespread involvement of bone marrow?
[Leukemia or Lymphoma]
A: Leukemia
Back Extra: Tumor cells are usually found in peripheral blood

Q: T-cell ALL (leukemia or lymphoma) often presents with [...], particularly in the cervical, supraclavicular, and axillary lymph nodes
A: lymphadenopathy

Q: What demographic is most commonly associated with acute lymphoblastic leukemia (ALL)?
[Age group]
A: Children
Back Extra: vs. AML, which typically arises in older adults

Q: ALL is a neoplastic accumulation of [...] (> 20%) in the bone marrow
A: lymphoblasts

Q: [...]-cell ALL (leukemia or lymphoma) may present with SVC syndrome, stridor, dysphagia, or dyspnea
A: T
Back Extra: Due to large anterior mediastinal mass (thymus)
i.e. superior vena cava syndrome

Q: Acute myeloid leukemia (AML) most commonly arises in [age group]
A: older adults (median onset 65 years)

Q: One subtype of AML is [...], which is characterized by t([...];[...])
A: acute promyelocytic leukemia (APL); 15; 17

Q: [...]-ALL usually presents in [age group] as a(n) [...] mass, thus it is often referred to as acute lymphoblastic lymphoma
A: T; teenagers; mediastinal
Back Extra: T for T-ALL and Teenagers
Presents with:
- Lymphadenopathy
- Mediastinal mass (thymus and often associated with pleural effusions)
- SVC-like syndrome
- Tracheal obstruction (difficulty breathing)

Q: Adult T-cell leukemia typically presents in [demographic] and is TdT [...]
A: older adults; negative
Back Extra: Because TdT is a lymphoblast marker

Q: What is the most common leukemia in adults?
[...]
A: Chronic lymphocytic leukemia (CLL)
Back Extra: Note that the most common lymphoma in general is diffuse large B cell lymphoma (DLBCL)

Q: Acute [...] leukemia presents with fever, bone pain, weakness and fatigue
A: lymphoblastic
Back Extra: Due to infection, bone marrow expansion, and anemia

Q: What is the most common cause of death in patients with chronic lymphocytic leukemia (CLL)?
[...]
A: Infection (due to hypogammaglobulinemia)

Q: [...]blasts are characterized by positive nuclear staining for [...], which is a(n) [...]
A: Lympho; TdT; DNA polymerase
Back Extra: - Marker of pre-T and pre-B cells
- Absent in myeloid blasts and mature blasts

Q: [...] leukemia is associated with [...] cells and increased lymphocytes on blood smear
A: Chronic lymphocytic; smudge
Back Extra: - Due to collapse of fragile tumor cells during slide preparation
- CLL = Crushed Little Lymphocytes

Q: In patients with leukemia, unregulated growth and differentiation of WBCs in bone marrow results in [...]
A: marrow failure
Back Extra: Results in anemia (decreased RBCs), infections (decreased mature WBCs), and hemorrhage (decreased platelets)

Q: Chronic lymphocytic leukemia (CLL) presents with [WBC count]
A: leukocytosis
Back Extra: Primarily B-lymphocytes

Q: Acute leukemia may present acutely with symptoms of [...], [...], and/or [...] (despite leukocytosis)
A: anemia; thrombocytopenia; neutropenia
Back Extra: e.g., fatigue, bleeding, infection

Q: Myelodysplastic syndromes rarely may progress to [...] leukemia
A: acute myeloid

Q: Acute leukemias are typically associated with [...] circulating WBCs
A: increased
Back Extra: Rare cases present with normal or decreased WBCs

Q: Chronic lymphocytic leukemia may present with [painful/painless] [...] in the cervical, supraclavicular, and axillary lymph nodes
A: painless; lymphadenopathy
Back Extra: Due to infiltration of leukemic cells

Q: The blasts seen in acute leukemia are [size], immature cells, often with "punched out" [...]
A: large; nucleoli

Q: [Acute or Chronic] lymphocytic leukemia is a neoplastic proliferation of mature circulating lymphocytes
A: Chronic
Back Extra: - Thus causing a high WBC count
- Typically slower onset than Acute

Q: Chronic leukemia is usually insidious in onset and seen in [age group]
A: older adults

Q: [...]blasts are usually characterized by positive cytoplasmic staining for [...]
A: Myelo; myeloperoxidase (MPO)
Back Extra: Whereas lymphoblasts are characterized by positive cytoplasmic staining for periodic acid Schiff (PAS)

Q: Acute lymphoblastic leukemia usually presents [with/without] easy bruising/bleeding, fatigue, and fever
A: with
Back Extra: Due to thrombocytopenia, anemia, and neutropenia

Q: What cancer is associated with IgG-mediated immune hemolytic anemia?
[...]
A: Chronic lymphocytic leukemia (CLL)

B-ALL with t(9;22) has a(n) poor prognosis and is more commonly seen in adults
Back Extra: - Philadelphia(Ph) + ALL
- In contrast, B-ALL with t(12;21) has a good prognosis and is more commonly seen in children

Q: Risk factors for acute myeloid leukemia include prior exposure to [...] chemotherapy and [...]
A: alkylating; ionizing radiation

Q: Myelodysplastic syndromes usually present with increased blasts [...]%
A: < 20

Q: Chronic lymphocytic leukemia (CLL) presents as functional [...] and bone marrow crowding by neoplastic cells (dysfunctional WBCs despite leukocytosis)
A: pancytopenia (anemia and thrombocytopenia)
Back Extra: Due to:
- Autoantibodies
- Splenic sequestration
- Bone marrow crowding by neoplastic cells

Q: [...] leukemia/lymphoma may present with [...] bone lesions and hypercalcemia
A: Adult T-cell; lytic (punched-out)
Back Extra: Similar to multiple myeloma, but multiple myeloma does not cause a rash

Acute lymphoblastic lymphoma is defined as a neoplastic proliferation of lymphoblasts < 20% in the bone marrow + lymphoid mass
Back Extra: Whereas acute lymphoblastic leukemia is defined as blasts > 20% ± lymphoid mass

Q: In chronic lymphocytic leukemia, neoplastic cells exhibit increased expression of [proto-oncogene]
A: BCL-2
Back Extra: Inhibits apoptosis → prolongs cell survival

Q: T-ALL is characterized by lymphoblasts (TdT+) that express markers ranging from CD[...] to CD[...]
A: 2; 8
Back Extra: These are markers found on T-cells (i.e., CD4+ and CD8+ T-cells)

Q: Acute myeloid leukemia presents with [skin findings (2)] due to thrombocytopenia
A: petechiae and ecchymoses
Back Extra: Secondary to functional pancytopenia, which is thrombocytopenia, anemia, and functional neutropenia despite leukocytosis

B-ALL with t(12;21) has a(n) good prognosis and is more commonly seen in children
Back Extra: - In contrast, B-ALL with t(9;22) (Philadelphia chromosome) has a poor prognosis and is more commonly seen in adults

Q: [...] leukemia may transform into [...] via the [...] transformation
A: Chronic lymphocytic; diffuse large B-cell lymphoma (DLBCL); Richter

Q: Acute leukemia is defined as a neoplastic proliferation of blasts [...]% in the bone marrow
A: > 20

Q: [...] leukemia commonly involves lymph nodes, leading to generalized lymphadenopathy; thus called [...] lymphoma
A: Chronic lymphocytic; small lymphocytic
Back Extra: Typically asymptomatic with slow progression

Q: Disseminated intravascular coagulation (DIC) may occur secondary to malignancy, such as [...], due to activation of the coagulation cascade by primary granules
A: acute promyelocytic leukemia (APL)
Back Extra: - In contrast to adenocarcinoma which causes DIC due to activation of the coagulation cascade by mucin
- Promyelocytes secrete tissue factor → coagulation cascade activation → DIC

Q: While chronic lymphocytic leukemia (CLL) is typically asymptomatic, it sometimes presents with [...] and [...] bleeding
A: B symptoms; mucocutaneous
Back Extra: - B symptoms are constitutional symptoms (fever, night sweats, weight loss)
- Bleeding is due to thrombocytopenia

Q: The abnormal promyelocytes seen in acute promyelocytic leukemia (APL) contain numerous primary granules that increase risk for [...]
A: disseminated intravascular coagulation (DIC)
Back Extra: Auer rods can activate the coagulation cascade; DIC is common presentation

Q: T-cell ALL is caused by a mutation in a pre-T-cell in the [location]
B-cell ALL is caused by a mutation in a pre-B-cell in the [location]
A: thymus; bone marrow

Q: Leukemic cell infiltration of liver, spleen, lymph nodes, and [...] is possible
A: skin (leukemia cutis)
Back Extra: Patients with leukemia can develop hepatosplenomegaly

Q: [...] leukemia is associated with the t(12;21) translocation
A: Acute lymphoblastic
Back Extra: Specifically the B-ALL subtype

Q: One complication of chronic lymphocytic leukemia (CLL) is [...], which predisposes to infection
A: hypogammaglobulinemia
Back Extra: - Results in immunodeficiency (most common cause of death is infection)
- Due to decreased production of immunoglobulins by abnormal B-cells

Q: Exposure to benzene (plastics, rubber tire industries) is a risk factor for [leukemia]
A: acute myeloid leukemia
Back Extra: Also ionizing radiation and chemotherapy

Q: What clinical finding can distinguish adult T-cell leukemia/lymphoma (ATLL) from multiple myeloma?
[...]
A: ATLL causes a rash
Back Extra: Both may present with lytic bone lesions and hypercalcemia

Q: What cancer may be associated with IgM-mediated immune hemolytic anemia?
[...]
A: Chronic lymphocytic leukemia (CLL)
Back Extra: More commonly associated with IgG-mediated AIHA

Q: One complication of chronic lymphocytic leukemia is [specific] anemia
A: autoimmune hemolytic (AIHA)
Back Extra: More commonly associated with IgG-mediated AIHA, but can also be IgM-mediated AIHA

Q: Acute [...] may present with hepatosplenomegaly and lymphadenopathy due to infiltration by leukemic cells
A: lymphoblastic leukemia
Back Extra: - Can also present with testicular enlargement
- Acute myeloid leukemia (AML) rarely presents with lymphadenopathy; usually presents with cytopenia (≥ 1) instead

Q: Which form of radiation is associated with the following types of cancer?
[...]
Acute myeloid leukemia (AML)
Chronic myeloid leukemia (CML)
Papillary thyroid carcinoma
A: Ionizing radiation

Q: Bruising, petechiae, bleeding, non-tender lymphadenopathy, and hepatosplenomegaly in a child is suggestive of [diagnosis]
A: acute lymphoblastic leukemia
Back Extra: - Hepatosplenomegaly due to leukemic invasion of the spleen/liver
- Impaired platelet production due to invasion of the bone marrow

Q: What is the likely diagnosis in a child with bone pain, non-tender lymphadenopathy, and pancytopenia?
[...]
A: Acute lymphoblastic leukemia (ALL)
Back Extra: Pancytopenia → bruising and pallor

Q: Acute promyelocytic leukemia (APL) is treated with [...], a vitamin A derivative
A: all-trans-retinoic acid (ATRA)
Back Extra: Binds the altered receptor and causes the blasts to mature