Chronic Leukemia

Question 1

How do we define chronic leukemia and what patient population is it usually found in?

Answer 1

Neoplastic proliferation of mature circulating lymphocytes

Older patients

Question 2

What is the prototypical chronic leukemia called, how do we characterize it, and what are the specific markers for it?

Answer 2

Chronic lymphocytic leukemia

Proliferation of naive B cells co expressing CD5 and CD20

Question 3

What is the classic sign on microscope for CLL?

Answer 3

Smudge cells

Question 4

Involvement of LNs leads to what and what is the specific term for it?

Answer 4

Generalized LAD and is called small lymphocytic lymphoma.

Question 5

3 complications of CLL and explain each one?

Answer 5

1. Low antibodies because these B cells are neoplastic and not productive, so they don’t eventually become a plasma cell that produces antibodies.
2. Not only do they not produce antibodies, but they create antibodies against their RBCs so they have an autoimmune hemolytic anemia.
3. Because of the small lymphocytic lymphoma, they can get a large B cell lymphoma.

Question 6

How do we characterize Hairy Cell Leukemia?

Answer 6

Proliferation of mature B cells characterized by hairy cytoplasmic processes

Question 7

What is the marker for Hairy cell leukemia and what are the 3 clinical features?

Answer 7

TRAP
Splenomegaly because of RED pulp
Dry tap on bone marrow aspiration
LAD is usually absent

Question 8

Explain the treatment of Hairy Cell Leukemia?

Answer 8

Give 2 CDA, which is an adenosine deaminase blocker which will lead to high and toxic levels of adenosine to all the B cells.

Question 9

How do we characterize Adult T Cell Leukemia/Lymphoma, what is it highly associated with and what two places in the world do we see it most commonly?

Answer 9

Proliferation of mature CD4 T cells
Associated with HTLV1
Japan and Caribbean

Question 10

3 clinical features of ATLL?

Answer 10

Rash, generalized LAD and hepatosplenomegaly, and lytic bone lesions with hypercalcemia.

Question 11

What is a common clinical feature of T Cell Leukemia and why?

Answer 11

Skin rashes because they like to go to the skin

Question 12

What other condition has punched out or lytic bone lesions and how do we distinguish them from one another?

Answer 12

Multiple myeloma, but ATLL will have that rash.

Question 13

How do we characterize Mycosis Fungoides?

Answer 13

Proliferation of mature CD4 T cells that infiltrate the skin causing rash, plaques or nodules.

Question 14

What layer of the skin do we find the cells in and what do we call them?

Answer 14

Epidermis

Pautrier Microabscesses

Question 15

If these cells spread to blood what syndrome does it lead to and what do we call the lymphocytes that are in the blood?

Answer 15

Sezary syndrome

Cerebriform nuclei