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Additional CSO Cards > Chapter 14: hematological > Flashcards

Chapter 14: hematological Flashcards

1
Q

_____% of cancers diagnosed in the US are hematologic

A

10% and account for 9% cancer deaths

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2
Q

Risk factors for blood cancers

A

White male > 65 y/o
past chemo and radiation
Smoking
Exposure to toxins (agent orange) and weakened immune system
Obesity

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3
Q

Higher BMI in adulthood is ______ associated with hematological cancer risk

A

Positively

**sufficient evidence that lack of body fatness decreases risk for multiple myeloma

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4
Q

Leukemia is characterized by an ________ (increase/decrease) production of WBC

A

Increased production but they’re immature which impairs the ability to fight infection & produce RBC/platelets

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5
Q

Name the 4 main types of Leukemia

A
  1. Acute lymphoblastic leukemia
  2. Chronic lymphocytic leukemia
  3. Acute myeloid leukemia
  4. Chronic myeloid leukemia
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6
Q

Signs/symptoms of leukemia

A

Anorexia, wt loss, anemia, enlarged lymph nodes, abdominal swelling/spelanomegaly, bone/joint pain, signs of bleeding

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7
Q

Is Hodkin’s Lymphoma or Non-Hodkin’s Lymphoma more prevalent?

A

Non-Hodkin’s, over 60 different types

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8
Q

What are the 2 most common types of non-hodkins lymphoma?

A
  1. Diffuse Large B Cell Lymphoma - fast growing
  2. Follicular lymphoma - slow growing
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9
Q

What is an aggressive sub-type of lymphoma called?

A

Double-hit diffuse b cell lymphoma

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10
Q

What are 3 signs/symptoms of leukemia that are not typically present with lymphoma?

A

Bone pain, anemia, splenomegaly (yet may have abdominal swelling)

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11
Q

What is a plasma cell neoplasm?

A

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

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12
Q

What is the most common plasma cell neoplasm?

A

Multiple Myeloma (90%)

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13
Q

What is the name of the pre-cancerous plasma cell neoplasm?

A

Monoclonal Gammopathy of Undetermined Significance (MGUS)

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14
Q

Most cases of Monoclonal Gammopathy of Undetermined Significance are benign, however 25% convert to ________ or another B-cell related disorder

A

Multiple Myeloma

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15
Q

Multiple Myeloma is classified by the _____ protein it produces, which does not fight infection.

A

M

Can build up in the urine/blood, thus causing damage to the kidneys/other organs

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16
Q

What is the difference between multiple myeloma & plasmacytoma?

A

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

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17
Q

What are the 2 types of plasmacytoma?

A
  1. Solitary Plasmacytoma - uncommon, found in the bone. Treated with radiation and sometimes surgery
  2. Extramedullary plasmacytoma - more common, found in soft tissue (usually upper respiratory) and treated with surgery.
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18
Q

What is Amyloidosis?

A

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.

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19
Q

What’s the difference between a bone marrow biopsy & bone marrow aspirate

A

Biopsy - just marrow
Aspirate - marrow and piece of bone

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20
Q

Is TNM system used for staging of hematological cancers?

A

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

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21
Q

What is the name of the staging system for lymphomas?

A

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

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22
Q

_______ is the standard of treatment for AML

A

Chemotherapy
(induction & consolidation)

Sometimes targeted therapy or radiation is used for specific sites

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23
Q

What is the goal of induction therapy & how is this confirmed?

A

To achieve remission

Bone marrow biopsy 14-21 days after starting. Sometimes requires 2 rounds.

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24
Q

Define consolidation

A

Treatment aimed to destroy leukemia cells that survived induction but are undetectable by tests

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25
Q

Define “induction failure”

A

2 courses of induction therapy without achieving remission

*allogenic HCT effective in 25-30% with induction failure

26
Q

Define allogenic

A

Comes from a different person within the same species

27
Q

What are the 3 main options for consolidation therapy?

A
  1. Chemotherapy
  2. Autologous HCT
  3. Allogenic HCT
28
Q

_______ is the only cure for AML

A

HCT transplant, yet this is associated with high morbidity/mortality (especially in older adults)

29
Q

What are the 3 stages for AML treatment?

A
  1. Induction
  2. Consolidation
  3. Years of maintenance

*HCT for high risk disease

30
Q

What are the 3 phases of CML?

A
  1. Chronic
  2. Accelerated
  3. Blastic

-Goal is to prevent it from going from one stage to the next

31
Q

What are the treatment recommendations for each stage of CML?

A
  1. Chronic - tyrosine kinase inhibitors “ib”
  2. Accelerated - clinical trial or more TKIs
  3. Blastic - allogenic HCT needed
32
Q

Discuss treatment for CLL

A

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

33
Q

T/F: Myeloid leukemias require transplant for cure while lymphocytic leukemias need for high risk disease

A

True

34
Q

High dose _______ is currently the most commonly wide conditioning agent used for autologous HCT with Multiple Myeloma

A

Melphalan

35
Q

T/F: HCT are more common w/ lymphomas than leukemias

A

FALSE - they aren’t first line treatment and may be used in refractory

36
Q

T/F: Lymphomas respond better to radiation than leukemias

A

True - very regularly used, with or without chemotherapy

37
Q

What is “Indolent Lymphoma”

A

“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

38
Q

What is CAR T-cell Therapy used for

A

Large B cell lymphoma or B-cell precursor ALL

Think “Cardi-B”

Side effect - cytokine release syndome (neurotoxicity)

39
Q

What is the prevalence of malnutrition for hematological cancers

A

27-50%, mostly d/t treatment (not the actual cancer)

40
Q

Tumor-related malnutrition is less common w/ blood cancers but may be related to some _______ & _______

A

lymphomas & amylodosis

41
Q

The _______ screening tool has been found to be effective in assessing nutrition risk in patients with ALL

A

PG-SGA

42
Q

Who’s at higher risk per nutrition screenings, AML or ALL? Why?

A

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

43
Q

The PG-SGA contains these 4 components

A
  1. Wt change
  2. Intake change
  3. Symptoms/side effects
  4. Change in functional status/activities
44
Q

Weight loss of >/= _____ in the 6 months prior to HCT has been found to negatively affect transplant outcomes

A

10%

*Improved survival with overweight/obese compared with underweight patients

45
Q

Use of these 2 drugs given together for AML commonly results in CINV

A

Cytarabine (7 days) + anthracycline (usually Daunorubicin)

46
Q

Nutrition assessment/intervention for patients with MM should place a focus on _________ health

A

Bone health

*up to 75% have osteopenia or osteoporosis and many get fractures during their disease

47
Q

Vitamin D & calcium supplementation may be especially important w/ ________ medications

A

Bisphosphate (strengthen the bones)

i.e. zolendronic acid ^ alendronateq

48
Q

Calcium recommendations

A

1000 mg - men 50-70
1200 mg - women & men 71+

49
Q

RDA for vitamin D

A

600 IU (1-70 y/o)
800 IU (70+)

50
Q

To mitigate risk for sarcopenia, focus on preserving lean body mass & consider involving _______ with nutrition

A

PT

51
Q

RDs can play a big role in advocating for evaluation of ___________ status d/t various research showing poor outcomes w/ deficiencies

A

Vitamin D

52
Q

What is the tolerable upper limit for Vitamin D

A

4000 IU

53
Q

D/t build-up of M protein, ______ disease is common in patients with MM

A

Renal (elevated creatinine, AKI). It’s even one of the components used to diagnose MM.

Amyloids frequent involve the kidneys as well

54
Q

The Academy of Nutrition & Dietetics recommends f/u for patients with CKD every ____ - ____ months

A

1-3 (more for higher risk, i.e. malnutrition)

55
Q

Why is amyloidosis a nutrition concern?

A

It often impacts the GI tract (salivary glands, enlarged tongue, malabsoprtion, liver involvement)

Kidneys very frequently involved as well (may require sodium & fluid restrictions)

56
Q

Asparaginase is usually included in a pediatric regimen for ALL but may also be used in adults. 2 common side effects include:

A
  1. Hypertriglyceridemia
  2. Pancreatitis
57
Q

D/t use of antrhacycline containing chemotherapies, _________ events remain a long-term risk factor for lymphoma survivors

A

Cardiovascular

58
Q

_______ is a long-term risk factor for survivors of MM

A

Osteoporosis

59
Q

Take caution w/ _______ supplementation w/ renal disease

A

calcium

60
Q

Although the reason is not fully known, development of _______ is a risk for hematological cancer survivors

A

Diabetes (think hypothyoridism & metabolic syndome)

61
Q

T/F: CINV tends to be more severe in younger pts

A

True

Additional CSO Cards (26 decks)

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