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Senior - Oncology > 3 - Leukemias > Flashcards

3 - Leukemias Flashcards

1
Q

What is leukemia?

A

Malignancy of hematopoietic progenitor cell -> uncontrollable proliferation and marrow replacement

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2
Q

Acute phase

A

Blasts > 20 percent

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3
Q

Chronic phase

A

Blasts < 20 percent

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4
Q

Effects of too many blasts

A

Bone marrow “replacement”

Solid organ infiltration

Coagulation activation

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5
Q

Etiologies of AML

A 
Radiation
Prior chemo
Marrow toxic drugs
Benzene
Pre-existing d/o’s
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6
Q

Clinical approach to leukemia

A

Myeloid or lymphoid?

Myeloid - myeloproliferative d/o’s

Lymphoid - lymphomas

Acute or chronic?

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7
Q

Median age of AML

A

60 yrs

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8
Q

Peak age of ALL

A

3 to 7 yrs

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9
Q

80% of adult acute leukemia is which type?

A

AML

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10
Q

80% of acute leukemias of childhood are which type?

A

ALL

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11
Q

BLUF for ages in acute leukemia

A

Myelogenous - adults

Lymphoblatic - kids

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12
Q

Sxs of acute leukemias

A 
Fatigue
Anorexia
Weight loss
Fever 
SOB
Bleeding
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13
Q

Which acute leukemia associated with DIC?

A

Acute promyelocytic leukemia

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14
Q

Infection risks in acute leukemia?

A

Due to decreased neutrophils

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15
Q

PE for acute leukemias

A 
Pallor
Petechiae
Bone / joint pain
Gingival hypertrophy due to leukemic infiltration 
Hepatosplenomegaly 
Lymphadenopathy (ALL)
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16
Q

Sxs of hyper-leukocytosis (WBC >100K)

A

Impaired circulation
HA
Confusion
Dyspnea

Urgent txt - leukapheresis and chemo

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17
Q

Definitive dx of acute leukemia>

A

Bone marrow bx

18
Q

Labs for acute leukemias

A

CBC - pancytopenia
Variable WBC’s
Anemia, typically severe
Decreased platelets

19
Q

Smear for ALL

A

Lymphoblasts

20
Q

Smear for AML

A

Myeloblasts

21
Q

Auer rod (eosinophilic, rod-shaped granule) - think:

A

AML

22
Q

W/u for acute leukemias

A

Bone marrow bx ASAP (distinguish ALL vs AML)

AML = relative emergency

REFER to HEME-ONC

23
Q

CNS involvement common in which acute leukemia?

A

ALL

Perform LP

24
Q

First step in txt of acute leukemia?

A

Induction chemo with goal of complete remission

25
Q

What does remission look like?

A

Normal peripheral blood, normal bone marrow (decreased blast to no blast), normal clinical status (disappearance of all signs and sxs)

26
Q

Induction

A

Implies induction of remission - very aggressive chemotherapy in order destroy visible leukemic cells but doesn’t always lead to cure

27
Q

Post-remission therapy

A

Under control, now cure it

Standard chemo, stem cell transplant

28
Q

CNS prophylaxis?

A

Done with ALL - intrathecal chemo with or without cranial irradiation

29
Q

Prognosis for acute leukemia?

A

Cure rate
• Under 60 years: post-remission chemo leads to cure of
35-40% of patients • Under 60 years and allogeneic bone marrow transplant:
curative 50-60% of patients • Cure rates for older patients approx 10-15%

30
Q

Median age of CML?

A

55 yrs

31
Q

Features of CML

A

Philadelphia chromosome
Bcr/abl
Fatigue / splenomegaly / bone pain

+++WBC in chronic phase

May progress to accelerated or blast phase

Imatinib = 1st line txt

32
Q

CLL

A

Chronic lymphocytic leukemia

Replication of a malignant clone of mature B
cell leading to progressive accumulation of
immune- incompetent lymphocyte
• Inadequate antibody production from abnormal B cells

33
Q

MC leukemia in adults in western countries>

A

CLL

MC’ly found in older guys (70 yrs)

34
Q

Sxs of CLL

A

Painless swollen cervical lymph nodes that wax and wane

Fatigue

Some asymptomatic

CBC - absolute lymphocytosis

35
Q

MC finding in CLL

A

Lymphadenopathy

Usually cervical, supraclavicular, axillary

Firm, round, freely mobile, nontender

36
Q

Hallmark of CLL

A

Isolated lymphocytosis (absolute count >5k)

37
Q

Smudge cells, think:

A

CLL

38
Q

Txt for CLL

A

If early, asymptomatic - observe

If advanced (progressive fatigue, anemia, thrombocytopenia, symptomatic lymphadenopathy, repeat infections) - treat -> chemo, rituximab, bone marrow transplant (tailored to patient)

39
Q

Richter’s transformation?

A

75 y/o dude with CLL, suddenly loses weight night sweats,

aggressive diffuse large b-cell non-Hodgkin lymphoma

5-8 month median survival

40
Q

Why couldn’t Chloe comb her hair?

A

She had leukemia

Senior - Oncology (5 decks)

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