Deck 24: Acute Lymphoblastic Leukemias

Question 1

Which of the following subtypes is associated with adult-onset ALL?

A)L1
B)L2
C)L3
D)Burkitt's lymphoma

Answer 1

L2

Question 2

Which of the following is an expected finding in the peripheral blood smear of an ALL patient?

A)A normal platelet count
B)The presence of nucleated RBCs
C)A decreased platelet count
D)An absolute increase in mature lymphocytes

Answer 2

A decreased platelet count

Question 3

A 5-year-old patient has been diagnosed with Pre-B cell ALL.Routine cytogenetic analysis confirms the presence of the Philadelphia chromosome.What does this mean for the patient?

A)The patient is in remission.
B)The patient has relapsed.
C)The patient has a poor prognosis.
D)More aggressive treatment is needed.

Answer 3

The patient has a poor prognosis.

Question 4

B-lymphoblasts in ALL exhibit which of the following markers on their surface that is also helpful in their identification?

A)CD4
B)CD2
C)CD10
D)HLA-DR

Question 5

Acute lymphoblastic leukemia is defined by the WHO as having a blast count that is which of the following?

A)Greater than or equal to 30%
B)Greater than or equal to 20%
C)Greater than or equal to 50%
D)Greater than or equal to 80%

Question 6

A phenotype workup is performed on a suspected ALL patient.The results come back indeterminate based on evaluation of all common ALL antigens.What is the most likely reason for this occurrence?

A)The instrument performing the phenotype is malfunctioning.
B)An incorrect patient was drawn.
C)There is a problem in the interpretation of the data.
D)The patient is suffering an acute bilineage leukemia.

Question 7

Which of the following is a classic morphologic finding in the peripheral blood in ALL?

A)Increased WBC and platelets with increased lymphoblasts
B)Lymphoblasts, decreased platelets and decreased neutrophils
C)Lymphoblasts, increased platelets and increased neutrophils
D)Increased WBC, platelets, and neutrophils

Question 8

A patient 2 years of age presents with general fatigue, pallor, fever, and weight loss.The morphological exam reveals a normal leukocyte count, marked neutropenia and thrombocytopenia, with 35% blasts.A bone marrow smear reveals hypercellularity with neoplastic lymphoid cells.What cytochemical stains should be performed on the peripheral blood?

A)PAS, TdT
B)Iron stain and Wright-Giemsa
C)Sudan Black B, myeloperoxidase, and nonspecific esterase
D)PAS and acid phosphatase

Question 9

As part of their disease progression, ALL patients are at risk for developing which of the following?

A)Recurrent infections
B)Bleeding episodes
C)Fatigue
D)All of the above

Question 10

Which markers are found on lymphoblasts?

A)CD10
B)CD19
C)HLA-DR
D)All of the above

Question 11

Which of the following patient populations is most commonly afflicted with ALL?

A)Newborns
B)Adults
C)Pregnant females
D)Children

Question 12

Large cells with abundant, intensely basophilic cytoplasm with prominent cytoplasmic vacuolization are identified on a peripheral smear.Multiple basophilic nucleoli are present.A starry sky appearance is seen with fields of basophilic leukemic blasts with benign macrophages that have ingested tumor cells.What leukemia should be suspected with this morphology?

A)Acute undifferentiated leukemia
B)Acute lymphoblastic leukemia-Burkitt-type
C)Acute leukemia with lineage heterogeneity
D)Precursor T cell leukemia

Question 13

A patient has been confirmed with B cell ALL.Confirmation of ALL subtype has been inconclusive based on the tests conducted.Immunophenotyping has been ordered as a last means of confirming the subtype.Which markers would be ideal to help differentiate Pre-B cell ALL from Pro-B cell ALL?

A)CD34
B)CD19
C)CD10
D)CD20

Question 14

A technologist is reviewing a blood smear of a patient.She notices 85% blasts present, but is having a difficult time identifying the lineage.Cytochemical staining is subsequently performed, and the results for MPO, SBB, and NSE come back negative.Based on this information, what is the most likely lineage of the unknown blasts?

A)Monocytic
B)Lymphoid
C)Erythroid
D)Myeloid

Question 15

The technologist is reviewing a blood smear of a patient.He notices many immature blasts exhibiting prominent cytoplasmic basophilia and vacuolization.Cytogenetic analysis performed on this patient identified a translocation between chromosomes 8 and 14.Based on this information, what is the patient most likely suffering from?

A)Precursor B cell ALL
B)Precursor T cell ALL
C)ALL - Burkitt type
D)Cannot be determined based on the information given

Question 16

A peripheral blood smear of an ALL patient is displaying a homogeneous population of small blasts with scanty cytoplasm.Based on this information, what FAB classification of ALL is it?

A)L1
B)L2
C)L3
D)Burkitt's lymphoma

Question 17

Which of the following cytochemical stains would be most helpful in differentiating AML from ALL?

A)LAP
B)MPO
C)PAS
D)Wright's stain

Question 18

What cytochemical stains are negative in ALL but positive in AML?

A)PAS and myeloperoxidase
B)PAS and Sudan Black B
C)Non-specific esterase and myeloperoxidase
D)Acid phosphates and PAS

Question 19

ALL most often arises from a defect in which of the following?

A)CMP
B)CLP
C)PSC
D)Lymphoblast

Question 20

Which of the following markers would be helpful in differentiating cortical T cell ALL from medullary T cell ALL?

A)HLA-DR
B)TdT
C)CD2
D)CD1a

Question 21

The WHO classification of subgroups of ALL uses which criteria to help define the categories?

A)Cytochemistry and immunophenotyping
B)Cytochemistry and molecular analysis
C)Morphology of the blasts
D)Morphology, immunophenotyping and molecular analysis

Question 22

Questions 8-10: Use the case below to answer the following questions:
A mother takes her 6-year-old boy to see the pediatrician because of tiny pinpoint spots that appeared on his upper torso 3 days prior. The pediatrician orders a CBC, and it comes back abnormal. There are 70% blasts present, with a platelet count of 18 x 10⁹/L. A bone marrow aspirate and biopsy are performed, and confirm ALL. Cytogenetic and molecular testing was also ordered, but no results were present yet.
Which of the following cytochemical stains would be positive in this case?

A)MPO
B)LAP
C)NSE
D)PAS

Question 23

Explain how ALL and Burkitt-type ALL are different morphologically.

Question 24

Name at least five classifications of ALL, and explain how they are different.

Question 25

The most common form of ALL relapse in children is:

A)CNS leukemia.
B)BM relapse.
C)Relapse in extramedullary hematopoietic organs.
D)Relapse in the lymphatic system.

Question 26

Patients with ALL are at risk for developing which types of symptoms? Explain your answer.

Question 27

Questions 8-10: Use the case below to answer the following questions:
A mother takes her 6-year-old boy to see the pediatrician because of tiny pinpoint spots that appeared on his upper torso 3 days prior. The pediatrician orders a CBC, and it comes back abnormal. There are 70% blasts present, with a platelet count of 18 x 10⁹/L. A bone marrow aspirate and biopsy are performed, and confirm ALL. Cytogenetic and molecular testing was also ordered, but no results were present yet.
Which of the following sets of markers would be useful in differentiating B cell ALL from T cell ALL?

A)CD10, CD4, CD2, CD19, and CD22
B)HLA-DR, TdT, and CD10
C)CD34, Ig gene rearrangement, and TCR gene rearrangement
D)cIg, HLA-DR, and TdT

Question 28

A patient with ALL underwent chemotherapy.Results from hematologic, cytogenetic, and molecular analyses indicated that he entered complete remission.Four years later, on his routine follow-up, the peripheral blood results were in the normal range, and cytogenetic analysis revealed no abnormalities, but molecular analysis showed BCR/ABL transcripts that were found in the blasts at diagnosis 4 years ago.This patient can be said to:

A)Be in complete remission.
B)Be in molecular and cytogenetic remission.
C)Have minimal residual disease.
D)Have partial cytogenetic remission.

Question 29

Explain the molecular and cytogenetic profile of a patient with Burkitt's ALL.

Question 30

Morphological differences between ALL and Burkitt-type ALL include which of the following?

A)Cell size, nuclear shape, and nuclear chromatin
B)Cell size, cytoplasmic basophilia, and cellular heterogeneity
C)Nucleoli, cytoplasmic volume, and vacuolation
D)Cell size, cytoplasmic basophilia and vacuolation, and prominent nucleoli

Question 31

Explain why acute unclassified leukemias are difficult to identify.

Question 32

Which of the following is a positive predictive factor in children with precursor B-ALL?

A)High leukocyte count; less than 1 year of age
B)Low leukocyte count; 4-10 years of age
C)High leukocyte count; PBX/E2A translocation
D)Hyperdiploid chromosomes, high leukocyte count, less than 1 year of age

Question 33

Which leukemia reveals the laboratory findings of TdT+, CD7+, and CD3+?

A)Precursor T cell leukemia
B)Precursor B cell leukemia
C)Acute lymphoblastic leukemia-Burkitt-type
D)Acute undifferentiated leukemia

Question 34

Which phase of leukemia treatment is considered to induce complete remission of the disease, eradicating the leukemic blast population?

A)Induction therapy phase
B)CNS prophylactic phase
C)CNS prophylactic phase and maintenance chemotherapy phase
D)Maintenance chemotherapy phase

Question 35

Questions 8-10: Use the case below to answer the following questions:
A mother takes her 6-year-old boy to see the pediatrician because of tiny pinpoint spots that appeared on his upper torso 3 days prior. The pediatrician orders a CBC, and it comes back abnormal. There are 70% blasts present, with a platelet count of 18 x 10⁹/L. A bone marrow aspirate and biopsy are performed, and confirm ALL. Cytogenetic and molecular testing was also ordered, but no results were present yet.
Cytogenetic analysis confirms the presence of t (1, 14).This verifies which of the following types of ALL?

A)Precursor B cell ALL
B)Precursor T cell ALL
C)L1 (FAB)
D)Burkitt's lymphoma