Find the true statement

[K06100]

A 55-year-old woman who was successfully
treated with chemotherapy for breast cancer
several years ago presents to her primary care
physician complaining of 2 months of easy
bruising, bleeding gums, fatigue, and shortness
of breath. On physical examination she has a
low-grade fever and several bruises in different
locations on her body. She does not have jugular
venous distention. No masses are palpable
on breast examination. Heart and lung examination
are within normal limits. Abdominal examination
is signifi cant for hepatosplenomegaly.
Her WBC count is 35,000/mm³. Her
WBCs are myeloperoxidase positive. Which of
the following statements regarding patients carrying
this diagnosis is true?

(A) Incidence decreases with increasing age
(B) Previous chemotherapy does not affect risk
for developing the disease
(C) Prognosis is not affected by the cytogenetics
of the disease
(D) Retinoic acid was once used to treat this
disease but is no longer part of the current
treatment
(E) They are at increased risk for stroke

[anomali]

I guess C........since the AML(if i'm not wrong) is secondary to the chemotherapy she received for breast cancer, the prognosis may not depend on the cytogenetics

[Anders]

Originally Posted by K06100

A 55-year-old woman who was successfully
treated with chemotherapy for breast cancer
several years ago presents to her primary care
physician complaining of 2 months of easy
bruising, bleeding gums, fatigue, and shortness
of breath. On physical examination she has a
low-grade fever and several bruises in different
locations on her body. She does not have jugular
venous distention. No masses are palpable
on breast examination. Heart and lung examination
are within normal limits. Abdominal examination
is signifi cant for hepatosplenomegaly.
Her WBC count is 35,000/mm³. Her
WBCs are myeloperoxidase positive. Which of
the following statements regarding patients carrying
this diagnosis is true?

(A) Incidence decreases with increasing age
(B) Previous chemotherapy does not affect risk
for developing the disease
(C) Prognosis is not affected by the cytogenetics
of the disease
(D) Retinoic acid was once used to treat this
disease but is no longer part of the current
treatment
(E) They are at increased risk for stroke

Would go with C

[step_enhancer]

I will go with A ....

[K06100]

The correct answer is E. This patient presents
with a thrombocytopenic picture and with leukocytosis.
Her positive myeloperoxidase test is
diagnostic for AML. Complications of this disease
include leukostasis leading to hyperviscosity
retinopathy, transient ischemic attacks/cerebrovascular
accidents, tumor lysis syndrome
(while undergoing treatment), gingival hyperplasia,
central nervous system involvement, recurrent
infection, and disseminated intravascular
coagulation (especially with M3 subtype).
Answer A is incorrect. The incidence of AML
increases with age. Persons with AML who are
>60 years old have a poor prognosis.
Answer B is incorrect. Environmental risk
factors for developing leukemia include radiation,
chemotherapy (especially with alkylating
agents and topoisomerase inhibitors), benzene
exposure, and smoking.
Answer C is incorrect. Cytogenetics and subtype
are extremely important in determining
prognosis and effectiveness of treatment in
AML. Poor prognostic factors include monosomies
of chromosomes 5 or 7, deletion of 5q,
and complex karyotype.
Answer D is incorrect. Retinoic acid will often
help induce remission in the promyelocytic
form of AML (M3 subtype).