Case studies in Leukemia and Lymphoma

Question 1

Myelodysplastic syndromes (MDS) occurs due to age-related acquired genetic damage to?

It is marked by what blood cell conditions?

Answer 1

1) Hematopoietic cells

2) Cytopenias and dysmorphic blood cells

Question 2

What symptoms may we find on physical examination that point towards acute myeloid leukemia?

Answer 2

1) Petechiae

2) Conjunctival pallor

Question 3

What lab values may we acquire that point towards acute myeloid leukemia?

Answer 3

1) Elevated WBC

2) Low platelet count

Question 4

What would a Peripheral blood smear show for suspected acute myeloid leukemia?

Answer 4

Large cells with large nuclei and visible nucleoli

Question 5

What would flow cytometry show for suspected acute myeloid leukemia?

Where would it be highest?

Answer 5

1) Myeloid blasts

2) Bone marrow

Question 6

A patient with AML arising from MDS with have what presentation?

Answer 6

1) Anemia
2) Thrombocytopenia
3) Neutropenia

Question 7

When starting chemotherapy on an AML patient, what should the process be?

Answer 7

1) 2 week course based on AML subtype and genetic profile

2) Recheck bone marrow at 2 weeks

Question 8

What can cause fever in a patient that has AML?

Answer 8

Severe neutropenia leading to infection

Question 9

What do you treat a neutropenic patient with to get their count back up?

Answer 9

GM-CSF

Question 10

What is Induction chemo?

What is Consolidation chemo?

What is Maintenance chemo?

Answer 10

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

Question 11

What symptoms may we find on physical examination that point towards acute promyelocytic leukemia?

Answer 11

1) Purpura

2) Conjunctival pallor

Question 12

What lab values may we acquire that point towards acute promyelocytic leukemia?

Answer 12

1) Low WBC
2) Low platelet
3) High PT/aPTT time
4) Low fibrinogen
5) High D-dimer

Question 13

In Disseminated Intravascular Coagulation (DIC), endothelial injury and anticoagulant dysfunction cause?

Answer 13

Widespread thrombin release

Question 14

What is a significant histological finding seen in acute promyelocytic leukemia?

Answer 14

Auer rods

Question 15

What genetic finding confirms diagnosis of Acute Promyelocytic Leukemia?

Answer 15

t(15;17)

Question 16

In Acute Promyelocytic Leukemia, the leukemic cells express?

What does each do?

Answer 16

1) Tissue Factor which activates factor X

2) Annexin II which converts plasminogen into plasmin

Question 17

Patients with Acute Promyelocytic Leukemia with DIC are immediately treated with?

Answer 17

1) Platelet transfusion

2) Factor replacement

Question 18

What is comprised of the special chemotherapy tailored to Acute Promyelocytic Leukemia?

Answer 18

1) Arsenic trioxide

2) All trans retinoic acid (vitamin A derivative)

Question 19

What are two fatal consequences of Acute Promyelocytic Leukemia with DIC?

Answer 19

1) Pulmonary hemorrhage

2) Cerebral hemorrhage

Question 20

What physical findings can be found on exam in patients with chronic myeloid leukemia?

Answer 20

Splenomegaly

Question 21

What lab findings can be found in patients with chronic myeloid leukemia?

Answer 21

1) Normocytic anemia
2) Very high WBC (leukocytosis)
3) Low Leukocyte Alkaline Phosphatase

Question 22

As WBC count gets closer to 100, what condition should be your first thought?

Answer 22

Leukemia

Question 23

What will the buffy coat look like in a centrifuged sample for a patient with leukemia?

Answer 23

Thick buffy coat layer

Question 24

When is positive Leukocyte Alkaline Phosphatase (LAP) staining seen?

Answer 24

Leukemoid reactions

Question 25

What does absent LAP staining indicate?

Answer 25

Neoplasm

Question 26

What bone marrow findings do we see in patients with CML?

Answer 26

1) Hypercellularity of white cells 2) Pseudo-Gaucher cells (blue-green macrophages) 3) t(9:22) Philadelphia chromosome

Question 27

In the Philadelphia chromosome, what rearranged gene creates a protein that causes a constitutively active tyrosine kinase?

Answer 27

BCR-ABL

Question 28

What is the treatment for CML? What is its MOA?

Answer 28

1) Imatinib (Gleevec) | 2) Tyrosine kinase inhibitor

Question 29

What do you use to monitor CML? With what testing?

Answer 29

1) BCR-ABL | 2) Fluorescence in-situ hybridization (FISH) or PCR

Question 30

So what defines successful treatment for CML?

Answer 30

1) White count normalizes (Hematologic response) | 2) Negative BCR-ABL PCR (Molecular response)

Question 31

What do we see in the accelerated phase (CML-AP)?

Answer 31

1) Circulating blasts 10-19% 2) Thrombocytopenia 3) Basophilia

Question 32

What do we see in the blast phase (CML-BP), aka “Blast crisis”?

Answer 32

Circulating blasts 20% or higher

Question 33

What symptoms and findings should raise suspicion for malignant lymphadenopathy and should be biposed?

Answer 33

1) Subclavian LAD 2) Fixed, hard LAD 3) Lymph node >4 cm

Question 34

A tender LAD is often categorized as?

Answer 34

Benign

Question 35

Flow cytometry works best for what conditoin?

Answer 35

Non-Hodgkin's lymphoma

Question 36

What is the only way to diagnose Hodgkin Lymphoma? Why?

Answer 36

1) Excision/excisional biopsy | 2) To be able to view diagnostic Reed-Sternberg cells

Question 37

Burkitt lymphoma is an example of a lymphoma that is likely to present with a what type of mass?

Answer 37

Rapidly enlarging mass

Question 38

What is the translation for Burkitt lymphoma? The genes invovled?

Answer 38

1) t(8;14) | 2) IGH/MYC

Question 39

What chemotherapy is used for Burkitt lymphoma with CNS involvement?

Answer 39

Chemo with intrathecal administration

Question 40

What condition causes the patient’s urine output decreases dramatically and there are increases in potassium, serum creatinine, and BUN? It is successfully treated with?

Answer 40

1) Tumor lysis syndrome | 2) Aggressive hydration

Question 41

Involvement of what tissue/system are more likely with this lymphoma than other NHL types?

Answer 41

CNS and bone marrow

Question 42

Pruritus and chest pain from taking a drink are symptoms of what condition?

Answer 42

Hodgkin Lymphoma

Question 43

What is very effective in treating Hodgkin Lymphoma?

Answer 43

Chemo

Question 44

When may a Hodgkin Lymphoma not produce any symptomatology?

Answer 44

When its limited to a mediastinal mass

Question 45

What physical findings can be found in a patient with chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL)?

Answer 45

1) Conjunctival pallor 2) Petechiae 3) Axillary and cervical LAD

Question 46

CLL/SLL often presents as? It is found and diagnosed in?

Answer 46

1) Asymptomatic | 2) Peripheral blood

Question 47

If CLL/SLL begins to progress what happens?

Answer 47

1) Bone marrow involvement | 2) Richter’s transformation (transition to high grade lymphoma)