Blood Cancer's Flashcards
What is CLL? What is typically found on smear?
Chronic lymphocytic leukemia (CLL) accounts for about 25% of the leukemias in the United States. It most commonly presents with asymptomatic leukocytosis with white blood cell (WBC) counts greater than 50,000/μL. It is typically seen in males over the age of 65, and there is a high incidence among whites. Most patients present assymptomatically, and CLL is found through bloodwork; however, some patients may present with painless lymphadenopathy. As the disease progresses, patients may develop the following signs: lymphadenopathy, splenomegaly (40%), hepatomegaly (20%), anemia, and recurrent infections. Five percent to 10% of patients will present with B symptoms, which include unintentional weight loss ≥10% of body weight within the previous 6 months, fevers of >38°C (>100.5°F) for ≥2 weeks without evidence of infection, drenching night sweats without evidence of infection, and extreme fatigue. Smudge cells are typically found on the blood smear. Therapy is indicated for patients when they have advanced-stage disease, high tumor burden, severe disease-related B symptoms, or repeated infections. Goals of treatment include ameliorating symptoms and improving progression-free and overall survival. There is no current treatment that cures CLL.
What is AML? Smear findings?
AML is the most common acute leukemia in adults. It accounts for less than 10% of leukemias in children under 10 years old. The median age of diagnosis is 65 years old. It results from a proliferation of myeloid cells. AML has been associated with both genetic abnormalities and environmental factors.
Typical symptoms include: fatigue, history of recurrent infections, fever, pallor, easy bruising, and hepatosplenomegaly. Hepatosplenomegaly is only seen in < 10% of patients. Symptoms of anemia (shortness of breath, weakness, dyspnea on exertion) are generally present. Lymphadenopathy is uncommon. General fatigue is usually the presenting symptom and will likely be present for a while before diagnosis. If fever is present, it is most likely related to an infection and should be rapidly worked up. Pancytopenia is common on laboratory evaluation. Blood smear shows large myeloblasts with notched nuclei and Auer rods. Once the diagnosis of acute myeloid leukemia (AML) is established, induction chemotherapy is given with the goal of rapidly restoring normal bone marrow function.
What is CML? What is chromosome finding? Treatment options?
CML has three phases: a chronic phase (present at the time of diagnosis in approximately 85 percent of patients), an accelerated phase (neutrophil differentiation becomes progressively impaired and leukocyte counts are more difficult to control with treatment), and blast crisis (resembles acute leukemia). CML is due to the proliferation of mature myeloid cells, is commonly seen in middle-aged adults, and is more prevalent among persons with a history of radiation exposure. The presence of the Philadelphia chromosome is pathognomonic for CML. 20-50% of patients are asymptomatic. Symptomatic patients typically present with constitutional symptoms including fatigue, weight loss, night sweats, fever, and splenomegaly. Patients may have abdominal pain and discomfort. Abdominal pain may be present in the left upper quadrant. Splenomegaly may cause irritation of the phrenic nerve and referred left shoulder pain (Kehr’s sign). Treatment options for patients with CML are varied and include: potential cure with allogeneic hematopoietic cell transplantation (HCT), disease control without cure using tyrosine kinase inhibitors (TKIs), or palliative therapy with cytotoxic agents.
What is ALL? findings?
Acute lymphocytic leukemia (ALL) typically presents with signs of bone marrow failure due to the replacement with immature blast cells. The classic picture is a young child between the ages of 2 and 5 years who presents with fatigue, bone pain, pallor, fever, and neutropenia with or without anemia and thrombocytopenia. Hepatomegaly (64%) and/or splenomegaly (61%) are the most common clinical findings in association with childhood leukemia. Lymphadenopathy and fever are present in about half of patients. About half of children present with bleeding, and three-quarters have a platelet count <100,000/μL at diagnosis. Musculoskeletal pain is found in about 43% of cases. Testicular enlargement is rare (<1%). Most children with newly diagnosed ALL are treated based on research protocols based on prognostic indicators at the time of presentation.
What is Hodgkin’s disease?
Hodgkin’s disease exists in four major subtypes, with the most common being nodular sclerosing Hodgkin’s lymphoma, which makes up as many as 80% of all Hodgkin’s-type cases. The most common presentation of Hodgkin’s disease is painless lymphadenopathy. Up to 75% of patients with Hodgkin’s also present with a mediastinal mass. Constitutional symptoms such as unexplained weight loss, fever, and night sweats have been shown to be present in up to 40% of patients. These symptoms are important for prognosis. In adults, pruritis and alcohol-induced pain may occur. Hodgkin’s disease is staged using the Ann Arbor classification. Treatment is guided by the stage of disease. The majority of patients will be cured of their lymphoma, but treatment-related toxicities may also cause death.
