Case studies in Leukemia and Lymphoma Flashcards
Myelodysplastic syndromes (MDS) occurs due to age-related acquired genetic damage to?
It is marked by what blood cell conditions?
1) Hematopoietic cells
2) Cytopenias and dysmorphic blood cells
What symptoms may we find on physical examination that point towards acute myeloid leukemia?
1) Petechiae
2) Conjunctival pallor
What lab values may we acquire that point towards acute myeloid leukemia?
1) Elevated WBC
2) Low platelet count
What would a Peripheral blood smear show for suspected acute myeloid leukemia?
Large cells with large nuclei and visible nucleoli
What would flow cytometry show for suspected acute myeloid leukemia?
Where would it be highest?
1) Myeloid blasts
2) Bone marrow
A patient with AML arising from MDS will have what presentation?
1) Anemia
2) Thrombocytopenia
3) Neutropenia
When starting chemotherapy on an AML patient, what should the process be?
1) 2 week course based on AML subtype and genetic profile
2) Recheck bone marrow at 2 weeks
What can cause fever in a patient that has AML?
Severe neutropenia leading to infection
What do you treat a neutropenic patient with to get their count back up?
GM-CSF
What is Induction chemo?
What is Consolidation chemo?
What is Maintenance chemo?
1) Initial chemo to induce a remission
2) Intensifying chemo to make sure no cancer cells are left in the body
3) Longer term therapy to maintain the remission and prevent relapse for certain cancers
What symptoms may we find on physical examination that point towards acute promyelocytic leukemia?
1) Purpura
2) Conjunctival pallor
What lab values may we acquire that point towards acute promyelocytic leukemia?
1) Low WBC
2) Low platelet
3) High PT/aPTT time
4) Low fibrinogen
5) High D-dimer
In Disseminated Intravascular Coagulation (DIC), endothelial injury and anticoagulant dysfunction cause?
Widespread thrombin release
What is a significant histological finding seen in acute promyelocytic leukemia?
Auer rods
What genetic finding confirms diagnosis of Acute Promyelocytic Leukemia?
t(15;17)
In Acute Promyelocytic Leukemia, the leukemic cells express?
What does each do?
1) Tissue Factor which activates factor X
2) Annexin II which converts plasminogen into plasmin
Patients with Acute Promyelocytic Leukemia with DIC are immediately treated with?
1) Platelet transfusion
2) Factor replacement
What is comprised of the special chemotherapy tailored to Acute Promyelocytic Leukemia?
1) Arsenic trioxide
2) All trans retinoic acid (vitamin A derivative)
What are two fatal consequences of Acute Promyelocytic Leukemia with DIC?
1) Pulmonary hemorrhage
2) Cerebral hemorrhage
What physical findings can be found on exam in patients with chronic myeloid leukemia?
Splenomegaly
What lab findings can be found in patients with chronic myeloid leukemia?
1) Normocytic anemia
2) Very high WBC (leukocytosis)
3) Low Leukocyte Alkaline Phosphatase
As WBC count gets closer to 100, what condition should be your first thought?
Leukemia
What will the buffy coat look like in a centrifuged sample for a patient with leukemia?
Thick buffy coat layer
When is positive Leukocyte Alkaline Phosphatase (LAP) staining seen?
Leukemoid reactions
What does absent LAP staining indicate?
Neoplasm
What bone marrow findings do we see in patients with CML?
1) Hypercellularity of white cells
2) Pseudo-Gaucher cells (blue-green macrophages)
3) t(9:22) Philadelphia chromosome
In the Philadelphia chromosome, what rearranged gene creates a protein that causes a constitutively active tyrosine kinase?
BCR-ABL
What is the treatment for CML?
What is its MOA?
1) Imatinib (Gleevec)
2) Tyrosine kinase inhibitor
What do you use to monitor CML?
With what testing?
1) BCR-ABL
2) Fluorescence in-situ hybridization (FISH) or PCR
So what defines successful treatment for CML?
1) White count normalizes (Hematologic response)
2) Negative BCR-ABL PCR (Molecular response)
What do we see in the accelerated phase (CML-AP)?
1) Circulating blasts 10-19%
2) Thrombocytopenia
3) Basophilia
What do we see in the blast phase (CML-BP), aka “Blast crisis”?
Circulating blasts 20% or higher
What symptoms and findings should raise suspicion for malignant lymphadenopathy and should be biposed?
1) Subclavian LAD
2) Fixed, hard LAD
3) Lymph node >4 cm
A tender LAD is often categorized as?
Benign
Flow cytometry works best for what condition?
Non-Hodgkin’s lymphoma
What is the only way to diagnose Hodgkin Lymphoma?
Why?
1) Excision/excisional biopsy
2) To be able to view diagnostic Reed-Sternberg cells
Burkitt lymphoma is an example of a lymphoma that is likely to present with a what type of mass?
Rapidly enlarging mass
What is the translocation for Burkitt lymphoma?
The genes involved?
1) t(8;14)
2) IGH/MYC
What chemotherapy is used for Burkitt lymphoma with CNS involvement?
Chemo with intrathecal administration
What condition causes the patient’s urine output to decrease dramatically along with an increase in potassium, serum creatinine, and BUN?
It is successfully treated with?
1) Tumor lysis syndrome
2) Aggressive hydration
Involvement of what tissue/system are more likely with Burkitt lymphoma than other NHL types?
CNS and bone marrow
Pruritus and chest pain from taking a drink are symptoms of what condition?
Hodgkin Lymphoma
What is very effective in treating Hodgkin Lymphoma?
Chemo
When may a Hodgkin Lymphoma not produce any symptomatology?
When its limited to a mediastinal mass
What physical findings can be found in a patient with chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL)?
1) Conjunctival pallor
2) Petechiae
3) Axillary and cervical LAD
CLL/SLL often presents as?
It is found and diagnosed in?
1) Asymptomatic
2) Peripheral blood
If CLL/SLL begins to progress what happens?
1) Bone marrow involvement
2) Richter’s transformation (transition to high grade lymphoma)
