Clinical WBC oncology Flashcards
Cornerstone of Diagnosis of hematological oncology.
Excisional Biopsy
The Ann Arbor staging is best to guide treatment of what type of lymphoma.
Hodgkins Lymphomas
-progression of this disease is a continuous spread from the source node to adjacent nodes making the AA staging a better predictor for morbidity.
-non Hodgkins lymphomas can spread to random sites throughout the body and generate a high stage on the AA scale even if the disease is not very dangerous
Which types of cancers are easier to treat and why? High grade or low Grade?
High Grade: even though they are more aggressive, they tend to be more localized which eases guidance of therapy.
Low Grade: often microscopic disease occurs at distant sites from the primary cancer site and treatment will miss these cells.
Which 3 concepts are crucial for classification of hematologic malignancies?
- Morphology (light microscopy)
- Immunology (tumor markers)
- Molecular Biology (karyotyping, gene mutations)
How can immunophenotyping differentiate Small Lymphocytic Lymphoma, Follicular Lymphpoma, and Mantle Cell Lymphoma using CD5 and CD23 markers?
SLL: CD5 + CD23+
FL: CD5- CD23 +/-
MCL: CD5+ CD23-
What are the chromosomal translocations that can lead to:
Follicular Lymphoma
Burkitt Lymphoma
Mantle Cell Lymphoma
FL: t(14:18)
BL: t(8:14)
MCL: t(11:14)
When is CLL treated?
Only when symptoms present: B symptoms (night sweats, fever, weight loss) Lymphadenitis Lymphadenopathy that hinders QOL Recurrent Infections
When dealing with cytogenetics of CLL, what two things indicate a poor prognosis for the patient?
- CD38+ marker detection
- Deletion of genetic material at position 17p on the p53 gene (don’t give chemo with this mutation, the patient will be unresponsive and may actually exacerbate the condition)
When should you treat multiple myeloma?
When any one of the CRAB symptoms are present Hypercalcemia Renal Failure Anemia Bone invasion leading to lytic lesions
What is MGUS?
Monoclonal Gammopathy of Uncertain Significance
-high levels of IgM in circulation
What chance does MGUS have for progressing to a multiple myeloma?
Increase of 1%/year from the time of diagnosis
What are Bence Jones Proteins?
Light chains of Ab that end up in the kidneys creating casts in the urine (proteinuria). Often indicative of some kind of plasma cell dyscrasia.
How does Multiple Myeloma cause amyloidosis?
Circulating light chains aggregate and deposit in tissues.
What conditions are associated with Philadelphia chromosome?
t(9:22)
- common with CML
- if seen in ALL: indicates very poor prognosis
Which cellular stain is used to indicate any aggressive indolent lymphoma?
KI67
Which medication was recently indicated for Mantle Cell Lymphoma?
Ibrutinib
-inhibits Bruton’s tyrosine kinase, an enzyme that activates transcription factors in B cells for proliferation
Describe the molecular biology of Follicular Lymphoma.
t(14:18) leads to constant activation of bcl-2, an anti-apoptotic gene
What chemotherapy regimen is given for Diffuse Large B Cell Lymphoma?
CHOP-R Cyclophosphamide Hydroxydaunorubicin Oncovin Prednisone Rituximab
What is the Tx for Diffuse Large B Cell Lymphoma relapse?
If possible, allogeneic bone marrow transplant
chemo doesn’t respond as well to relapsing B lymphomas
Name the only monoclonal treatment approved for low Grade Lymphomas.
Rituxan (Rituximab)
What two conditions lead to adverse effects or toxicity when using Rituxan?
First Infusion (possible immune response) Low Tumor Cell Count (with low number of tumor cells, drug toxicity can spread to normal cells)
Hallmark of Hodgkins Lymphoma.
Reed Sternberg cell:
bi-nucleate
CD30+
Most common site and presentation of patients with Hodgkins Lymphoma.
Painless enlargement of cervical or supraclavicular lymph nodes.
When suspecting Hodgkins Disease relapse, why is it important to perform a tissue biopsy on the enlarged lymph nodes?
Often, patients with a history of Hodgkins Lymphoma will have non-functioning enlarged lymph nodes remaining from the first time the disease occurred. If the physician suspects a relapse, he or she must make sure the enlarged node is cancerous before administering therapy.
Describe the 4 stages in the Ann Arbor Staging System.
Basically
1. Single lymph node (LN) or single region
- Two LN or a LN and another region or organ all on the same side of the diaphragm
- LN or ogans affected on both sides of the diaphragm
- Both sides of the diaphragm with multiple non-lymphatic organs involved
Benefits of the multi-drug regimen ABVD over MOPP.
ABVD is not leukogenic (causing leukemia years later)
ABVD has less chance of causing sterility
Describe the chemotherapeutic agent ADC
Brentuximab vedotin
- Ab conjugate drug (meaning its a drug that is bound to an antibody)
- binds to CD30 marker on Reed Sternberg cells (cancerous cells of Hodkins Lymphoma)
- Ab in endocytosed activating the chemotherapy toxin ONLY in the RS cell.
ALL is a very treatable disease in children. What are the two treatment regimens?
Simple radiation works very well and is curative
However, in patients with the Philedelphia Chromosome t(9:22) an allogeneic bone marrow transplant is needed
What are the treatment regimens for CLL?
CLL only needs treatment if it is symptomatic (resulting from cytopenia). Drug used is Fludarabine (purine analog to inhibit DNA synthesis)
However, in patients with the deletion at 17p of the p53 gene, a marrow transplant is required
Describe Tumor Lysis Syndrome
Breakdown of tumor cells leads to hyperkalemia, hyperphosphatemia, and hypocalcemia. Results in cardiomyopathy, uric acid nephropathy, and renal failure.
Tx for Tumor Lysis Syndrome
Allopurinol IV fluids Bicarb dialysis Phoslo/amphogel (binds phosphate, prevents it from binding calcium and blocking kidneys)
Which Cancer is associated with DIC?
AML M3 (pro-myelocyte with t(15:17)) -the primary granules in the pro-myelocytes are released and signal the coagulation cascade to operate without regulation
Which CML therapy works in a leukemia that has a T315I mutation?
Ponatinib
-tyrosine kinase inhibitor
