Question 1

Compare and contrast WHO and FAB classification systems of AML.

Accepted Answer

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Question 2

The WHO classification system of AML incorporates which of the following?

Accepted Answer

The WHO classification system of AML incorporates all three of the listed factors: morphology of the proliferating cells, immunophenotyping, and cytogenetic analysis. This comprehensive approach helps to ensure accurate diagnosis and appropriate treatment planning for patients with AML.

Question 3

Why are Auer rods seen only in myeloblasts?

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Question 4

A patient presents with acute leukemia, with blasts identified by a positive CD34, CD13, and CD33.Less than 3% of the blasts stain positive for MPO and SBB.Which category of AML is the most likely diagnosis for this patient?

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Question 5

What is the definition of acute leukemia, according to the World Health Organization?

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Question 6

Explain how bone marrow analysis helps establish an AML diagnosis.

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Question 7

A patient presents with 25% blasts (nonerythroid), 34% monocytic cells, and 31% granulocytic cells in the bone marrow.The peripheral blood smear has 10% monocytes.The alpha-naphthyl esterase and chloroacete esterase are positive.What is the probable diagnosis based on these findings?

Accepted Answer

The presence of blasts, monocytic cells and granulocytic cells in the bone marrow, along with positive alpha-naphthyl esterase and chloroacete esterase, suggest Acute myelomonocytic leukemia (AML-M4). The peripheral blood smear with 10% monocytes is also a characteristic finding in AML-M4.

Question 8

Use the case below to answer the following questions:
A 57-year-old male is admitted with suspicion of AML. Preliminary CBC results show a high WBC count with 47% blasts present. Cytochemical staining shows negative reactions with MPO, SBB, and NSE. Platelet peroxidase staining was positive. Immunophenotyping was also ordered.
-Predict the results of the immunophenotyping panel based on the information already given.

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Question 9

List the common cytochemical stains used in the detection of AML, and predict their results in AML.

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Question 10

A patient presents with bleeding, and is found to be in DIC.The peripheral smear contains hypergranular promyelocytes.The white count is slightly elevated.The bone marrow contains cells with multiple Auer rods with a clear blue cytoplasm.What is the probable type of AML?

Accepted Answer

The presence of hypergranular promyelocytes and cells with multiple Auer rods in the context of acute myeloid leukemia (AML) suggests a diagnosis of AML with t(15;17)(q22;q12), which is characteristic of acute promyelocytic leukemia (APL). This subtype is specifically associated with the t(15;17) translocation, leading to the PML-RARA fusion gene, a hallmark of APL.

Question 11

An APL patient has been undergoing ATRA therapy for the last 5 weeks.A repeat bone marrow and cytogenetic analysis are performed at the end of the treatment cycle.Bone marrow shows no evidence of leukemic cells, and cytogenetic anomalies were not detected.Based on this information, what is the status of the patient?

Accepted Answer

The absence of leukemic cells in the bone marrow and normal cytogenetics indicate that the patient is in remission, which is the desired outcome of ATRA therapy for APL. Relapse would manifest as the reappearance of leukemic cells in the bone marrow and/or an abnormal karyotype. Engraftment refers to the successful engraftment of donor cells in the case of hematopoietic stem cell transplantation and is not applicable in this scenario.

Question 12

Traditional therapy in APL includes pharmacological concentration of RA (ATRA) and chemotherapy.What is the function of the chemotherapy component in this treatment protocol?

Accepted Answer

Chemotherapy in APL aims to eradicate the leukemic stem cells, which are responsible for the maintenance and progression of the disease. While ATRA induces maturation of promyelocytes, and binds with PML/RAR gene to repress transcription, chemotherapy targets the proliferating and self-renewing leukemic stem cells, thereby reducing the chances of relapse. Cytolysis of malignant promyelocytes is not a primary objective of chemotherapy in APL.

Question 13

Use the case below to answer the following questions:
A 57-year-old male is admitted with suspicion of AML. Preliminary CBC results show a high WBC count with 47% blasts present. Cytochemical staining shows negative reactions with MPO, SBB, and NSE. Platelet peroxidase staining was positive. Immunophenotyping was also ordered.
-What is the most likely diagnosis?

Accepted Answer

The presence of blasts and positive platelet peroxidase staining points to a diagnosis of acute megakaryoblastic leukemia. The negative cytochemical stains for myeloperoxidase (MPO), Sudan black B (SBB), and neuron-specific enolase (NSE) suggest a lack of differentiation along the myeloid lineage. The immunophenotyping results may confirm this diagnosis.

Question 14

The patient presents with acute leukemia.The blast morphology is of neutrophil lineage with Auer rods and pseudo-Pelger-Huët nuclei; the immunophenotype is positive for CD33, CD13, CD34, and CD56 with a positive TdT, myeloperoxidase, and Sudan Black B.Cytogenetic analysis reveals a t(8;21)(q22;q22) translocation in the majority of the blasts.Which classification of AML best fits this morphology, immunophenotyping, and cytotechemistry?

Accepted Answer

The blast morphology, immunophenotyping, and cytogenetic analysis suggest a diagnosis of AML with recurrent genetic abnormalities, specifically t(8;21)(q22;q22). This translocation is characteristic of AML with maturation (AML-M2) and is associated with a better prognosis than other AML subtypes.

Question 15

Which of the following markers are positive for monoblasts?

Accepted Answer

Monoblasts are typically positive for HLA-DR, CD33, and CD14, making all of the listed markers correct for identifying monoblasts.

Quiz 23: Acute Myeloid Leukemias