Common BMT abbreviations & diseases Flashcards
AML*
acute myelogenous leukemia
=================================
- uncontrolled/cancerous growth of abnormal and immature blood cells (aka “leukemic blasts) of the myeloid line
- rapid onset
Pathology:
- acquired genetic damage of a developing stem cell in the bone marrow
- blasts “crowds out” normal cells
* causing function failure of the normal cells
* blocking the production of normal cells
S & S:
- leukemic cell growth in the marrow +/- the peripheral blood
- impaired production of normal cells
- anemia, thrombocytopenia, infections
Special considerations:
- HYPERLEUKOCYTOSIS
high WBC count (> 100/ul) which manifests by “sludging” of cells in the smaller blood vessels resulting venous engorgement in fundus of eye, headaches, altered mental orientation, SOB, pulmonary infiltrates, chest pain with myocardial ischemia, renal insufficiency etc.
- may consider leuko-reduce via apheresis prior to giving chemotherapy
Tx: Allopurinol (for build up of uric acid from cell breakdown)
APL (AML-M3)*
acute promyelocytic leukemia
=====================================
a type of AML associated with a translocation of genes between chromosome 15 and 17
Tx: ATRA (All- Trans Retinoic Acid) and ATO (arsenic trioxide), not required transplantation in many cases
Etiology of AML
- high dose irradiation exposure
- chronic benzene exposure
- alkylating agents in chemotherapy
- therapeutic radiation (dose and duration of exposure dependent)
- tobacco smoke
- CML
- Down’s Syndrome
ALL*
acute lymphocytic leukemia
================================
- cancerous growth of blood cells of lymphocytic line
- lymphoblasts seen in the marrow
- 88% from B lymphocyte development
- 12% from T lymphocyte development
Category:
Acute T lymphoblastic leukemia
Acute B lymphoblastic leukemia (pre-B cell lymphoblastic leukemia)
**Philadelphia (Ph chromosome) –> abnormalities of chromosome 22 change; poor prognosis and requires transplant for any hope of a cure
S&S:
- same as AML
- enlarge lymph nodes due to accumulation of lymphoblasts
- headaches and vomiting due to accumulation of lymphoblasts in lining of brain and spinal cord
Tx: intensive 3 year post-remission regimen = numerous LPs to treat the sanctuary sites of the spinal column, BMT (option for high risk pts)
CML*
chronic myelogenous leukemia
=================================
WBC and platelets mature and generally can function normally. Philadelphia chromosome translocation (t9;22) always present. Less severe early course of the disease
3 phrases:
1. CHRONIC - blood functions near normal; last for a couple of years
2. ACCELERATED - WBC and platelets may become abnormal, spleen may enlarge and pt feels ill; pts lose response to Tx
3. BLAST CRISIS - very abnormal counts, bleeding and infection occur, the usual S&S of AML show up [poor prognosis]
S&S:
- bone pain
- fever
- night sweats
- weight loss
- easy bruising
- +/- left-sided abdominal pain due to enlargement of spleen
Tx: Gleevec (Imatinib), BMT (option dependent on phase of disease, age and comorbidities)
CMML
chronic myelomonocytic leukemia
CLL*
chronic lymphocytic leukemia
==================================
slow-growing cancer of the lymphocyte which
- normally resides in blood, bone marrow, lymph glands and spleen
- may be characterized by an isolated elevation in the blood lymphocyte count ONLY, or
- may be associated with enlarged lymph glands, liver +/- spleen
- minimal change in blood counts and remain stable for relatively long time (5-20 years)
Tx: BMT (related/unrelated) for pts <= 65 years post induction failure
MDS*
myelodysplastic syndrome
===============================
- a group of disease in which the production of blood cells is SEVERELY DISRUPTED
- ~ 50% develop into AML, called “pre-leukemia”
- non-curable in most cases
Pathology:
- a significant proportion of blood cells are destroyed in the bone marrow due to their poor quality
- increased amount of blasts (abnormal immature blood cells), remained < 25%
- abnormally low RBCs, WBCs and platelets
- mature blood cells may not work properly
Tx: mainly supportive, BMT in younger pts
MM*
multiple myeloma
============================
- a malignant cancer of plasma cells (develops from B lymphocytes and produce antibodies)
- non-curable disease of the elderly
Pathology:
- increased breakdown in the bone resulting in “holes” in the bone structure
- also results in pathological fractures and spinal cord compression
- hypercalcemia (leading to kidney damage)
Tx: Pamidronate (once monthly), Allo transplant (optional)
AA
aplastic anemia
HLH
hemophagocytic lymphohistocytosis
DLBCL
diffuse large B-cell lymphoma
[most common type of non-Hodgkin lymphoma (NHL)]
SAA*
severe aplastic anemia
==============================
- not a bone marrow cancer
- an acquired disease that is characterized by failure of producing all types of blood cells
- fat cells present
Pathology:
- an abnormal response by pt’s own immune system directed against the bone marrow (autoimmune effect)
- low blood cell counts therefore at risk of infection and bleeding
Tx: immunosuppression (ATG/prednisone/Cyclosporine)
If in remission, pt will be maintained on a tapering CSA
if relapse, pt will be re-introduced CSA
**BMT may be required in extreme cases
PH +/-
Philadelphia chromosome positive/negative
Lymphoma*
- a group of cancers in the lymphatic system
- ONLY affect lymphoid line
- generally found outside the marrow
- malignant growth of lymphocyte crowding out healthy cells
- can start in and be spread to almost any part of the body
2 main groups:
Hodgkin’s
Non-Hodgkin’s
Tx: Chemo, Radiation, sometimes BMT. Auto transplant preferred since bone marrow is healthy), dependent on age, stage, type and grade of disease, and general health
Remission - based on number of lymph nodes remaining after treatment
Non- Hodgkin’s Lymphoma (NHL)*
- usually more widespread at diagnosis
- less regular, less predictable
Category:
- based on characteristics of cancerous cells
- indolent/ aggressive, OR
- low, intermediate, high grade
High grade = very aggressive
1. Burkitt’s
2. Lymphoblastic lymphoma
Burkitt’s lymphoma*
Very aggressive NHL
a fastest growing tumor
doubling in size q24hrs
poor prognosis depending on tumor size, if marrow is involved
high risk of tumor lysis syndrome
Lymphoblastic lymphoma*
affects T cells line
mostly young men
poor prognosis if marrow is involved
intermediate grade –> large cell lymphoma
low grade –> Follicular lymphoma (very slow growing and very hard to cure)
Hodgkin’s lymphoma*
a specialized form of lymphoma characterized by
1. present of REED STERNBERG CELL (a large malignant cell found in the hodgkin’s lymphoma tissues)
2. higher incidence in adolescents and young adults
3. cure rates > 80%
ARA-C
Cytarabine
BCNU
Carmustine
VP16
Etoposide
Flu
Fludarabine
Bu
Busulfan
TBI*
total body irradiation
===========================
Conditioning goal - immunosuppression and marrow ablation
Therapeutic goal -
eradiation of malignant cells
Advantage:
1. is able to reach sanctuary sites (eg. testes, CNS, skin)
2. dose homogeneity (dose distribution is even over the entire body)
3. no cross-reaction with other agents used for preconditioning Tx
4. no concerns related to excretions
5. dose distribution can be tailored (shielding/boosting)
Cy or CTX
Cyclophosphamide
ATG
Anti-thymocyte globulin (rabbit)
ATRA
All-Trans Retinoic Acid
CSA
Cyclosporine
MMF
Mycophenolate
