Chapter 14: hematological Flashcards
_____% of cancers diagnosed in the US are hematologic
10% and account for 9% cancer deaths
Risk factors for blood cancers
White male > 65 y/o
past chemo and radiation
Smoking
Exposure to toxins (agent orange) and weakened immune system
Obesity
Higher BMI in adulthood is ______ associated with hematological cancer risk
Positively
**sufficient evidence that lack of body fatness decreases risk for multiple myeloma
Leukemia is characterized by an ________ (increase/decrease) production of WBC
Increased production but they’re immature which impairs the ability to fight infection & produce RBC/platelets
Name the 4 main types of Leukemia
- Acute lymphoblastic leukemia
- Chronic lymphocytic leukemia
- Acute myeloid leukemia
- Chronic myeloid leukemia
Signs/symptoms of leukemia
Anorexia, wt loss, anemia, enlarged lymph nodes, abdominal swelling/spelanomegaly, bone/joint pain, signs of bleeding
Is Hodkin’s Lymphoma or Non-Hodkin’s Lymphoma more prevalent?
Non-Hodkin’s, over 60 different types
What are the 2 most common types of non-hodkins lymphoma?
- Diffuse Large B Cell Lymphoma - fast growing
- Follicular lymphoma - slow growing
What is an aggressive sub-type of lymphoma called?
Double-hit diffuse b cell lymphoma
What are 3 signs/symptoms of leukemia that are not typically present with lymphoma?
Bone pain, anemia, splenomegaly (yet may have abdominal swelling)
What is a plasma cell neoplasm?
Often just referred to as multiple myeloma yet it encompasses other types.
Conditions in which plasma cells develop from B-cells in the bone marrow in response to infection from bacteria/viruses. The plasma cells make antibodies to fight this infection. Some plasma cell neoplasms are benign
What is the most common plasma cell neoplasm?
Multiple Myeloma (90%)
What is the name of the pre-cancerous plasma cell neoplasm?
Monoclonal Gammopathy of Undetermined Significance (MGUS)
Most cases of Monoclonal Gammopathy of Undetermined Significance are benign, however 25% convert to ________ or another B-cell related disorder
Multiple Myeloma
Multiple Myeloma is classified by the _____ protein it produces, which does not fight infection.
M
Can build up in the urine/blood, thus causing damage to the kidneys/other organs
What is the difference between multiple myeloma & plasmacytoma?
Multiple myeloma is the buildup of plasma cells in MULTIPLE areas of the body, including the spine, skull, long bones, ribs. Characterized by M cells.
Plasmacytomas form in just ONE area
What are the 2 types of plasmacytoma?
- Solitary Plasmacytoma - uncommon, found in the bone. Treated with radiation and sometimes surgery
- Extramedullary plasmacytoma - more common, found in soft tissue (usually upper respiratory) and treated with surgery.
What is Amyloidosis?
Not cancer, but occurs when insoluble amyloid proteins are deposited throughout the body organs (kidney, heart, nervous system, GI tract). This leads to organ dysfunction and death. Commonly associated w/ MM.
What’s the difference between a bone marrow biopsy & bone marrow aspirate
Biopsy - just marrow
Aspirate - marrow and piece of bone
Is TNM system used for staging of hematological cancers?
No -they do not normally form solid tumors
Instead classified by blood counts and leukemia cells found in other parts of the body (i.e. liver spleen)
Lymphoma uses Lugano Classification System
What is the name of the staging system for lymphomas?
Lugano Classification System
Involves # of lymph nodes, where they are relative to the diaphragm (one or both sides) and if there’s mets outside of the lymphatic system
_______ is the standard of treatment for AML
Chemotherapy
(induction & consolidation)
Sometimes targeted therapy or radiation is used for specific sites
What is the goal of induction therapy & how is this confirmed?
To achieve remission
Bone marrow biopsy 14-21 days after starting. Sometimes requires 2 rounds.
Define consolidation
Treatment aimed to destroy leukemia cells that survived induction but are undetectable by tests
Define “induction failure”
2 courses of induction therapy without achieving remission
*allogenic HCT effective in 25-30% with induction failure
Define allogenic
Comes from a different person within the same species
What are the 3 main options for consolidation therapy?
- Chemotherapy
- Autologous HCT
- Allogenic HCT
_______ is the only cure for AML
HCT transplant, yet this is associated with high morbidity/mortality (especially in older adults)
What are the 3 stages for AML treatment?
- Induction
- Consolidation
- Years of maintenance
*HCT for high risk disease
What are the 3 phases of CML?
- Chronic
- Accelerated
- Blastic
-Goal is to prevent it from going from one stage to the next
What are the treatment recommendations for each stage of CML?
- Chronic - tyrosine kinase inhibitors “ib”
- Accelerated - clinical trial or more TKIs
- Blastic - allogenic HCT needed
Discuss treatment for CLL
Can live a long time with it, usually don’t need immediate treatment. Difficult to cure.
Involves many options including chemo, targeted agents, radiation to specific areas, or HCT for high risk disease
T/F: Myeloid leukemias require transplant for cure while lymphocytic leukemias need for high risk disease
True
High dose _______ is currently the most commonly wide conditioning agent used for autologous HCT with Multiple Myeloma
Melphalan
T/F: HCT are more common w/ lymphomas than leukemias
FALSE - they aren’t first line treatment and may be used in refractory
T/F: Lymphomas respond better to radiation than leukemias
True - very regularly used, with or without chemotherapy
What is “Indolent Lymphoma”
“Lazy” lymphoma, slowly progressing subtype. Asymptomatic disease doesn’t require treatment… watchful waiting
Chemo, immunotherapy, or targeted therapy will start if developing symptoms or if tests indicate progression
What is CAR T-cell Therapy used for
Large B cell lymphoma or B-cell precursor ALL
Think “Cardi-B”
Side effect - cytokine release syndome (neurotoxicity)
What is the prevalence of malnutrition for hematological cancers
27-50%, mostly d/t treatment (not the actual cancer)
Tumor-related malnutrition is less common w/ blood cancers but may be related to some _______ & _______
lymphomas & amylodosis
The _______ screening tool has been found to be effective in assessing nutrition risk in patients with ALL
PG-SGA
Who’s at higher risk per nutrition screenings, AML or ALL? Why?
AML, likely d/t Cytarabine being included in the induction phase (various toxicities)
Also AML impacts other cells (RBC, platelets) which could further decrease desire to eat
Steroids are routine with ALL which may also prevent excess wt loss/inflammation
The PG-SGA contains these 4 components
- Wt change
- Intake change
- Symptoms/side effects
- Change in functional status/activities
Weight loss of >/= _____ in the 6 months prior to HCT has been found to negatively affect transplant outcomes
10%
*Improved survival with overweight/obese compared with underweight patients
Use of these 2 drugs given together for AML commonly results in CINV
Cytarabine (7 days) + anthracycline (usually Daunorubicin)
Nutrition assessment/intervention for patients with MM should place a focus on _________ health
Bone health
*up to 75% have osteopenia or osteoporosis and many get fractures during their disease
Vitamin D & calcium supplementation may be especially important w/ ________ medications
Bisphosphate (strengthen the bones)
i.e. zolendronic acid ^ alendronateq
Calcium recommendations
1000 mg - men 50-70
1200 mg - women & men 71+
RDA for vitamin D
600 IU (1-70 y/o)
800 IU (70+)
To mitigate risk for sarcopenia, focus on preserving lean body mass & consider involving _______ with nutrition
PT
RDs can play a big role in advocating for evaluation of ___________ status d/t various research showing poor outcomes w/ deficiencies
Vitamin D
What is the tolerable upper limit for Vitamin D
4000 IU
D/t build-up of M protein, ______ disease is common in patients with MM
Renal (elevated creatinine, AKI). It’s even one of the components used to diagnose MM.
Amyloids frequent involve the kidneys as well
The Academy of Nutrition & Dietetics recommends f/u for patients with CKD every ____ - ____ months
1-3 (more for higher risk, i.e. malnutrition)
Why is amyloidosis a nutrition concern?
It often impacts the GI tract (salivary glands, enlarged tongue, malabsoprtion, liver involvement)
Kidneys very frequently involved as well (may require sodium & fluid restrictions)
Asparaginase is usually included in a pediatric regimen for ALL but may also be used in adults. 2 common side effects include:
- Hypertriglyceridemia
- Pancreatitis
D/t use of antrhacycline containing chemotherapies, _________ events remain a long-term risk factor for lymphoma survivors
Cardiovascular
_______ is a long-term risk factor for survivors of MM
Osteoporosis
Take caution w/ _______ supplementation w/ renal disease
calcium
Although the reason is not fully known, development of _______ is a risk for hematological cancer survivors
Diabetes (think hypothyoridism & metabolic syndome)
T/F: CINV tends to be more severe in younger pts
True
