14: Hematologic Malignancies Flashcards
What are general risk factors for Hem Cancers?
Over 65 (except for Hodgkin’s—20-39 years old)
exposure to environmental toxins like benzene and Agent Orange
family hix of blood disorders
smoking
White race (except MM which is more common in Black race)
exposure to high dose radiation
inherited genetic
male
previous chemos
autoimmune disease, certain viral infections and weakened immune system
Does weight increase risk for Hem Cancers?
Yes — found those with a higher BMI in early adulthood was an increased risk for Hodgkins, non-Hodgkins lymphomas, AML, CML, CLL and MM
B-cell lymphoma was found to be the most consistently positively associated with weight/BMI
MM is the only one with evidence that lack of body fatness lowers risk though
Name the different types of Leukemia
Acute Lymphoblastic (ALL)
Acute Myeloid (AML)
Chronic Lymphoblastic (CLL)
Chronic Myeloid (CML)
What are general S/S for Leukemias?
bone/joint pain
decreased appetite
enlarged lymph nodes
fatigue
fever
multiple or lingering infections
night sweats
SOB
signs of bleeding (petechiae or increased bruising)
abd swelling
weight loss
anemia
splenomegaly
What are the two main types of Lymphoma?
What are the most common subsets of one of the types?
Hodgkins
Non-Hodgkins (has many subsets–60)
most common are diffuse large B-cell (DLBCL) which is fast growing (30% of NHL)
and Follicular Lymphoma, which is slow growing (20% of NHL)
What are the S/S of Hodgkins Lymphoma?
cough or chest pain
fatigue
fever
itching
night sweats
swelling in the lymph nodes
weight loss
What are the S/S of NHL?
abd swelling
fatigue
fever
night sweats
pain
skin rash or itchy skin
swelling in the lymph nodes
trouble breathing
weight loss
What are Plasma Cell Neoplasms?
What are the 3 malignant types?
plasma cells develop from B-cells in the bone marrow in response to infection from bacteria and viruses. The plasma cells produce antibodies to fight the infection. Some are benign, some are malignant.
Monoclonal gammopathy of undetermined significance (MGUS) - precancerous disease affects 3% of people over 50. Most benign, but 25% will convert to MM or another B-Cell related disorder
Plasmacytomas - a tumor of abnormal plasma cells in one location. Solitary (uncommon) are often in the bone and treated with radiation. Extramedullary are in soft tissue, usually upper respiratory tract and treated with surgery
MM - affects 90% of those with plasma cell neoplasm diagnosis. Mostly commonly in spine, skull, long bones and ribs. the M Protein that builds up in blood/urine can cause kidney damage
What is amyloidosis?
a rare disease caused by insoluble amyloid proteins being deposited in body organs like kidneys, heart, CNS, and GI tract. Over time the build up can cause organ dysfunction and death. Not cancer, but may be associated with MM
How is Leukemia staged?
by blood cell counds and accumulation of leukemia cells in other organs like liver or spleen
How is Lymphoma staged?
number and location of cancerous lymph nodes, whether the cancerous lymph nodes are on one or both sides of the diaphragm and whether the disease has mets outside of the lymphatic system
In general terms, what are the treatment options?
Typically, chemotherapy or possibly other anticancer agents will be used. Radiation and Surgery depends on the type/location.
Many, but not all, will have high dose chemo and then a stem cell transplant.
Leukemias require an allo (donor) HSCT.
Lymphoma and MM can often do an auto HSCT.
B-Cell Lymphoma and B-cell-precursor ALL are possible candidates for CAR-T if they are a failed Auto or deemed not strong appropriate for an auto.
What is the presence of malnutrition in Hem Cancers?
At diagnosis, it ranges from 27-50% — largely depends on S/S and Staging — did they have weight loss at diagnosis? Chemo may be a contributing factor during treatment.
What are some nutrition related comorbidities to be mindful of?
Renal Disease - particularly in MM since it can cause it as can the chemo itself, up to 50% have an elevated creatinine level
Diabetes - particularly worth monitoring since steroids are often part of treatment regimens. Possible to also cause steroid-induced hyperglycemia in non-diabetes.
Lipid Changes can occur from treatment
Osteoporosis is also common (partly due to age range of most patients). Bone lesions are very common in MM as well (est 75% of MM patients have osteoporosis)
What is one micronutrient that seems to be important to prognosis/relapse and should be monitored?
Serum Vitamin D — deficiency appears to be associated with poorer prognosis, relapse and longer hospital stays, decreased rates of remission
