Deck 9: Chronic Myelogenous Leukemia

Question 1

A 52-year-old male presents to the office for his annual checkup. He complains of increasing fatigue and weight loss regardless of his diet, which he admits consists mainly of fast food and frozen dinners. Upon exam, pain is elicited when palpating the left upper quadrant and his spleen measures 12cm. You suspect the patient may have CML. What would be the typical CBC findings for this type of patient?

A) RBC greater than 70x106
B) Neutrophils greater than 10,000
C) Platelets greater than 450,000
D) Lymphocytes greater than 6,000

Answer 1

B
Explanation: Neutrophils make up the majority of abnormal cells produced in CML patients. The number of RBC and the number of platelets are usually lower due to tumor burden. This type of leukemia only affects neutrophils, basophils and eosinophils.

Question 2

Andrew is a 55-year-old Jewish male who was recently diagnosed with Chronic Myelogenous Leukemia. He has a past medical history of Hodgkins lymphoma as a teenager and a 30-pack year history of smoking. Which of the following factors most likely contributed to his new diagnosis of CML?

A) History of Hodgkins lymphoma
B) Ashkenazi Jewish decent
C) 30 pack year history of smoking
D) His age

Answer 2

A
Explanation: No connection has been made between his Jewish descent and CML, so this cannot contribute to his new diagnosis. His 30-pack year history of smoking may have contributed to his condition, but no clear connection has been made between smoking and CML. 55 is the average age at presentation, but not a significant predisposing factor. Ionizing radiation used to treat lymphoma is the only known predisposing factor of CML.

Question 3

Which of the following is NOT a symptom of CML?

A) Easy bruising
B) Infection
C) Nausea
D) Abdominal pain

Answer 3

C
Explanation: Infection, easy bruising and abdominal pain are all symptoms of CML. Nausea is the only answer that is not.

Question 4

What type of detection methods are used for patients where the Philadelphia chromosome is not identifiable by routine cytogenetic analysis?

A) FISH
B) VDRL
C) Gel electrophoresis
D) ELISA

Question 5

Which of the following is NOT a criteria of blast crisis?

A) Night sweats
B) Fever
C) Fatigue
D) Splenomegaly

Question 6

A 57 year old white male presents to your clinic with increasing fatigue for the past 2 years. You decide to order a CBC and peripheral blood smear. The CBC shows a decrease in RBC's and an unusually high number of WBC's. The blood smear shows 16% blasts. Based on these results you suspect CML. According to these results, which phase of CML if this patient experiencing?

A) Chronic phase
B) Blastic phase
C) Acute phase
D) Accelerated phase

Question 7

What is the mechanism of action of Imatinib mesylate (Gleevec)?

A) Inhibits the activity of the BCR/ABL oncogene to keep the number of blasts low
B) Recognizes the mutated cells, attaches to them, and induces apoptosis
C) Upregulating the activity of interferons to increase host defense mechanisms and protect healthy cells from invasion
D) A ribonucleotide reductase inhibitor which damages the DNA/RNA, preventing the cell to duplicate

Question 8

Which of the following is a proven curative treatment for Chronic Myelogenous Leukemia?

A) Imatinib mesylate
B) Stem cell transplant
C) Hydroxyurea
D) Dasatinib

Question 9

Response to treatment with Imatinib mesylate is monitored by all of the following EXCEPT:

A) Immunity response
B) Hematologic response
C) Cytogenetic response
D) Molecular response

Question 10

What of the following is NOT a major side effect that may occur after allogeneic hematopoietic stem cell transplantation?

A) Hemorrhage during surgery
B) The host succumbing to infection
C) Graft rejection
D) Graft-vs-host disease