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Malignant haematology > Chronic lymphocytic leukaemia > Flashcards

Chronic lymphocytic leukaemia Flashcards

1
Q

What is CLL

A

Type of blood cancer occurs due to monoclonal proliferation of B lymphocytes

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2
Q

Who gets CLL

A

Older adults
Exceedingly rare in children
More common in men

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3
Q

Causative factors

A

Cause unknown but more likely if:
Deletion in chromosome 13 can be 11 or 17 too
FH - 6-9x risk if first degree family had
Immunity - HIV/AIDS 3x likely

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4
Q

Pathophysiology of CLL

A

CD5+, CD23+ clonally expand, low surface IgGs
-> accumulation lymphocytes bone marrow -> lymph nodes and other lymphoid tissues

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5
Q

Main mechanisms of CLL

A

Deletion of chromosome
Hypogammaglobinaemia and haematopoieses
Transformation to aggressive forms

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6
Q

Genetic changes in CLL

A

13q chromosome deletion 50^
deletions at 11q, 17p (p53 tumour supressor) chromosomes

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7
Q

What is 17q deletion CLL ass with

A

p53 tumour supressor gene inactivated
Rapid progression, short remission, decreased overall survival

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8
Q

What haem disorders are people with CLL more likely to get

A

AI haemolytic anaemias
AI thrombocytopenia

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9
Q

What can CLL transfomr to

A

B cell pro lymphocytic leukaemia -> non hodgkin lymphoma

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10
Q

What is richters transformation

A

Richters transformetion = CLL -> diffuse large B cell lymphoma

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11
Q

Clinical features CLL

A

Often asymptomatic esp in early stages
Symmetrical enlarged lymph nodes
hepatomegaly/splenomegaly
Anaemia - tired
Recurrent infections as low Igs
Bleed/brusie - TO

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12
Q

Signs that CLL is active

A

B cell symptoms
Frequent sev night sweats
Unezplained weight loss >10% BW in last 6 months
High fever absence infection >38

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13
Q

Investigating CLL what do

A

FBC
Reticulocyte count
Direct antiglobulin test - DAT
immunophenotype
Biochem and serum IgGs
Peripheral blood smear

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14
Q

What do lymphocytes do in CLL

A

> 5000 B lymphcytes/uL - lymphocytosis

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15
Q

What test confirms CLL

A

Immunophenotyping of lymphocytes

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16
Q

How confrim lymphocytosis

A

Peipheral blood smear
Small lymphcytes - scant cytoplasm and nuclei w clumped chromatic
Smudge cells

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17
Q

What are smudge cells

A

Artefacts from damaged lymphocytes in slide prep as so fragile

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18
Q

What cells are suggestive of CLL on smear

A

Smudge cells

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19
Q

What genetic test should be performed on all patients before treatment with CLL

A

Detect TP53 gene
Adverse prognosis if deleted
Determines treatment

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20
Q

Additional investigaitons for CLL

A

Bone marrow aspiration and biopsy - before therapy as baseline
DAT/coombs test - in all anaemic patients and before commencing therapy
Imaging - CT scan chest abdo pelvis - uropathy or AW obstruction from lymph node compression on organ or structures

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21
Q

What do DAT/coombs test for

A

All anaemic patients and before commencing therapy look for AI related haemolytic anaemia

22
Q

Mantle lymphoma vs CLL

A

Mantly lymphoma doesnt express CD23 antigen

23
Q

Marginal zone lymphoma vs CLL

A

similar presentation and immunophenotype as CLL, but typically has a bright surface immunoglobulin and CD20, and bone marrow examination often reveals lymphocytes with notched nuclei.

24
Q

How tell B cell pro-lymphocytic leukaemia from CLL

A

> 55% prolymphocytes CD5 negative circulating cells

25
Q

What staging is used for CLL

A

Binet staging

26
Q

Stage A of CLL

A

> 10g/dL Hb, platelets at least 100x109/L, < 3 lymph node areas invovled

27
Q

Stage B CLL

A

Stage A but >3 lymoh node areas involved

28
Q

Stage C CLL

A

Hb <10g/dL
PLatelets <100x109 or both

29
Q

What is one are of lymph nodes

A

Lymphadenopathy in one area of body irrelevant of if one or both sides

30
Q

Strategy w early CLL

A

Watch and wait - regularly monitor

31
Q

Indicaitons for chemotherapy in CLL

A

Evidence progressive marrow failure
Massive or progressive or symptomatic splenomegaly or lymphadenopathy
Progressive lymphocytosis >50% increase 2 months
Lymphocyte doubling time <6 months
AI anemia or TP not repsonding to prednisolone
ONe or more of CLL related smyptoms

32
Q

CLL related symptoms indicating treatment

A

Night sweats
High fever
Extreme fatigue
Unintentional weight loss >10%

33
Q

Initial therapy for CLL without Tp53 deletion

A

Fludarabine
Cyclophosphamide
Rituximab
FCR

34
Q

First line treatment CLL if FCR not appropriate

A

Bendamistine
For Stage B/C

35
Q

3rd option for treatment CLL if dont tolerate other two

A

Obinutuzumab combo w chlorambucil

36
Q

What use in Tp53 mutations CLL

A

Ibrutinib
Alemtuzumab

37
Q

What treat AI cytopenia with

A

Corticosteroids

38
Q

Why are steroids sometimes given before chemo

A

Improve bone marrow function where theres significant bone marrow infiltration

39
Q

Relapsed vs refractory CLL

A

Relapse - Disease responded to therapy but after 6 > months stopped responding
Refractory - doesnt result in remission but more be stable or gets worse within 6 months last treatment

40
Q

Curative treatmetn CLL

A

HSCT

41
Q

Complications CLL

A

Infection - defctive complement, t cell dysunction, low neutrophils
Anaemia incl AI haemolytic - warm antibody type
Transformation to other lymphoma
Hyperviscosity syndrome
Malignancies - higher risk seconadry

42
Q

Richters sydnrome symtpoms

A

Sudden and dramatic increase in size of lymph nodes in neck, axilla, abdo (spleen) or groin
Drmatic unexplained weight loss gever and night sweats

43
Q

Clinical features hyperviscosity syndorme

A

Extremely high WCC ->
Altered CNS function/resp insufficiency
Headahce, dizzy, vertiy=go, hearing loss, visual disturb, nystagmus

44
Q

Most common secondary malginancies risk higher w CLL

A

Melanoma, soft tissue sarcoma, colorectal cancer, lung cancer, SCC, BCC

45
Q

Risk factors for worse prognosis CLL

A

Older
Men
Tp52 and 17p dletion
Trisomy 12
Lymphocyte doubling time < 12 months
Diagnosis at later stage

46
Q

What features mean survival >10 years

A

Lymphocytosis only in CLL

47
Q

What intermediate features mena survival of around 7 years

A

Lymphadenopathy, hepatomegaly or splenomegaly + lymphocytosis

48
Q

What parameters mean survival likely <4 years w CLL

A

Hb <110
Platelets <100,000/mm3

49
Q

Normal bone marrow what made up of

A

50% fat
50% cellular acitivty

50
Q

What makes a leukaemia acute vs chronic

A

Acute - arrested before differentation eg blasts
Chronic - mature cell mutation

51
Q
A

Malignant haematology (16 decks)

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