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CFT II > Exam 4 - Leukemia & Multiple Myeloma > Flashcards

Exam 4 - Leukemia & Multiple Myeloma Flashcards

1
Q

how does the progenitor cell type decide what kind of cancer will occur in abnormal hematopoiesis?

A

if it is a common myeloid progenitor cell = myeloproliferative disease

if it is a common lymphoid progenitor cell = lymphoproliferative disease

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2
Q

what are the 2 types of leukemia seen? what defines them? what is the odd ball out that isn’t a leukemia but has a leukemic stage?

A
  1. acute - proliferation of immature cells (blasts)
  2. chronic leukemia - neoplastic proliferation of mature cells
  3. odd ball - lymphoma with a leukemic phase, stage V lymphoma!!!
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3
Q

what are the 3 types of acute leukemia that we see clinically?

A
  1. acute myeloid leukemia
  2. mixed phenotype or undifferentiated acute leukemia
  3. acute lymphoid leukemia - b cell, t-cell, or NK cell in origin
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4
Q

what are the 2 types of chronic leukemia that we see clinically?

A
  1. chronic lymphoid - b cell, t cell, or NK cell
  2. chronic myeloid
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5
Q

how do you determine if you’re dealing with a lymphoid or myeloid leukemia & if it is acute or chronic?

A

mostly done using flow cytometry

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6
Q

in a normal dog, what are the normal lymphocyte subsets seen in the peripheral blood?

A

t cell 80% - mostly CD4+ t helper cells, lesser cytotoxic CD8+ t cells

b cells 15%

~5% NK cells/double negative T cells (CD4-/CD8-)

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7
Q

for leukemia, the chronic type is most often _________ cell & the acute type is most often ________ cell but can be _____ cell

A

chronic - t cell

acute - b cell, but can be t cell

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8
Q

what are the two main categories of neoplasia seen in lymphoproliferative disease?

A

lymphoma & leukemia

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9
Q

what are the subsets of disease seen in lymphoma?

A

t cell or b cell

t cell is further differentiated

large t cell lymphoma - characterized by large immature lymphoblasts

small indolent t cell - characterized by small mature lymphocytes

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10
Q

why is CD34 an important stem cell marker?

A

it implies an acute phenotype & is expressed by both myeloid & lymphoid lineages!!!! can be used to make a presumptive diagnosis of acute leukemia

some exceptions - some t cell acute leukemias do not express CD34

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11
Q

does the absence of CD43 rule out acute t cell leukemia? does its presence confirm it?

A

nope

presence confirms diagnosis of acute leukemia

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12
Q

what does a stage V lymphoma mean?

A

there is involvement of the bone marrow, so these patients could have circulating neoplastic lymphocytes in their blood (which technically is a leukemia, but it’s not because it’s arising from the lymphoma)

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13
Q

acute or chronic primary leukemia patients can have soft tissue involvement, so disease that originates in the bone marrow & infiltrates the soft tissue, which can look like what?

A

primary large cell lymphoma

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14
Q

a dog has primary large cell lymphoma that shows bone marrow involvement, what kind of lymphoma is this classified as?

A

stage V lymphoma

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15
Q

why is it important to differentiate between stage V lymphoma & primary leukemia with soft tissue involvement?

A

significantly impacts prognosis!!!!

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16
Q

what is lymphocytic leukemia? is chronic or acute more common?

A

proliferation of neoplastic lymphocytes in the bone marrow +/- circulating blood

chronic more common than acute!!

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17
Q

what dogs are predisposed to getting lymphocytic leukemia?

A

middle aged to older dogs - goldens & GSD

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18
Q

what dog breeds are predisposed to getting b cell chronic lymphocytic leukemia?

A

middle aged small breed dogs - exception of english bulldog (happens when they are young)

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19
Q

what characterizes acute lymphoid leukemia? what is seen cytologically?

A

lymphoid precursor neoplasm

b cell acute lymphoid leukemia (90%) - CD21+, CD3-, CD4-, & CD8-

t cell acute lymphoid leukemia (10%) - CD3+, CD4-, CD8-, & CD21-

intermediate to large cells with moderate amount of basophilic cytoplasm & less condensed chromatin

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20
Q

what characterizes chronic lymphoid leukemia? what is seen cytologically?

A

3 forms!!!

t cell chronic lymphocytic leukemia is most common - CD3+/CD8+ granular lymphocytes

b cell chronic lymphocytic leukemia - CD21+

atypical chronic lymphocytic leukemia - represents a combination of immunophenotype - CD3-/CD8+, CD3+/CD4-/CD8-, CD3+/CD4+/CD*+, & CD3+/CD21+

small, mature, well-differentiated lymphocytes

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21
Q

what clinical signs are associated with acute lymphocytic leukemia? what treatment is indicated? what is the prognosis?

A

usually sick!! pyrexia, history of fever of unknown origin, anorexia, lethargy, moderate to marked cytopenias, may have soft tissue involvement, mild to moderate enlargement of the lymph nodes/liver/spleen

aggressive supportive care & CHOP

very poor prognosis

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22
Q

what clinical signs are associated with chronic lymphocytic leukemia? what treatment is indicated? what is the prognosis?

A

incidental finding - asymptomatic!! no or mild cytopenias, may have soft tissue involvement, mild to moderate enlargement of the LN/liver/spleen

lymphocytes may function abnormally - monoclonal gammopathies, IMHA, red cell aplasia, & hypercalcemia

low dose oral chemo - pred & chlorambucil

excellent prognosis! normalization/remission of lymphocyte count is expected in 70% of cases (max response can take several months b/c not rapidly dividing cells)

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23
Q

T/F: therapy is not always indicated for chronic lymphocytic leukemia, but active surveillance is imperative

A

true

24
Q

what criteria must be met for starting chemo for a dog with chronic lymphocytic leukemia?

A

lymphocyte count > 30,000

hematological abnormalities (anemia, thrombocytopenia, neutropenia)

peripheral lymphadenopathy

hepatic/splenic enlargement

any clinical signs

25
Q

what is the concern for progressive disease in chronic lymphocytic leukemia?

A

can progress/transform into aggressive lymphoma (richter’s syndrome) with a MST of 1.5 months

26
Q

what is the importance of immunophenotyping all chronic lymphocytic leukemia patients?

A

important for prognosis

T CLL - 930 days
B CLL - 480 days
A CLL - 22 days, VERY BAD

27
Q

what is the treatment used for A CLL?

A

morbidity associated with effacement of bone marrow - sepsis & DIC

supportive care - fresh whole blood transfusions, abx, fluid therapy, nutritional therapy

chop based protocol - prognosis with treatment, 16 days to 3 months

28
Q

what is the prognosis for myeloid leukemias?

A

acute myeloid - very grave

chronic myeloid - variable

myelocytic, megakaryocytic, erythrocytic, monocytic, etc

29
Q

what are the most common acute myeloid leukemias?

A

monocytic most common

myelomonocytic follows

30
Q

what treatment is used for acute myeloid leukemias? what is the prognosis?

A

supportive care - treatment usually unrewarding, CHOP protocol + cytosine arabinoside

MST 1-2 weeks, lucky to get them out of the hospital

31
Q

what treatment is used for chronic myeloid leukemias? what is the prognosis?

A

has the BCR-ABL chromosomal abnormality, so theoretically can be treated wih GLEEVEC

fairly resistant to treatment, so can try hydroxyurea

patients enter the terminal phase relatively quick - poor prognosis

32
Q

T/F: in cats, acute leukemia has neoplastic malignant infiltrates in organs

A

true

33
Q

what was the most common leukemia seen in the FeLV era?

A

acute leukemia - t-cell, 60-80% of FeLV cats were t-cell positive

34
Q

how is leukemia characterized in cats?

A

bony marrow aspiration with > 30% abnormal blast cells = acute leukemia

bone marrow aspirate with > 15% mature lymphocytes = chronic leukemia

35
Q

T/F: leukemia is rare in cats

A

true

36
Q

what is the treatment for chronic leukemia in cats?

A

pred & chlorambucil - 90% response rate

37
Q

what is the most common myeloma disorder seen in animals?

A

multiple myeloma - plasma cell origin

others include extramedullary plasmacytoma, IgG macroglobulinemia, & solitary osseous plasmacytoma

38
Q

what is multiple myeloma?

A

systemic proliferation of malignant plasma cells or their precursor arising as a clone of a single cell with range of differentiation of plasma cells varying from normal to large anaplastic round cells called plasmablasts

39
Q

what are plasmablasts?

A

binucleate & multinucleate cells

high mitotic index

atypia

40
Q

what is the m component in multiple myeloma?

A

overproduction of a single immunoglobulin or component of immunoglobulin that can be represented by any class of the entire Ig or only a portion of the molecule (light chain/bence jones, or heavy chain)

41
Q

what are the most common m components seen in dogs & cats with multiple myeloma? what does it mean if the m component is IgM?

A

dogs - IgA or IgG

cats - IgG:IgA (5:1)

IgM = waldenstrom’s

42
Q

what is the pathology associated with multiple myeloma?

A

high circulation of levels of m component which makes the blood thick/nasty

bone or organ infiltration

43
Q

what are some examples of pathological conditions that multiple myeloma is associated with?

A

bone disease, bleeding diathesis, hyperviscosity syndrome, renal disease, etc

44
Q

how is multiple myeloma associated with causing bone disease?

A

isolated & discrete osteolytic lesions or diffuse osteopenia - bones engaged in hematopoiesis most commonly involved (ribs, vertebrae, pelvis, metaphyses of long bones), so pathologic fractures are common

pretty common in dogs/cats - up to 2/3 of the cases

45
Q

how is multiple myeloma associated with causing bleeding diathesis?

A

most common presenting complaint!!!!!

caused by the m component - inhibits platelet aggregation & release of platelet factor 3, absorption of minor clotting proteins, & functional decrease in calcium

1/3 of dogs will have clinical evidence of bleeding, & 50% will have abnormal PT/PTT - cats only 1/4 will be showing signs

46
Q

how is multiple myeloma associated with causing hyperviscosity syndrome?

A

result of increased serum viscosity - magnitude depends on M component factors, but most common with IgM (biggest one)

affects 20-40% of dogs

symptoms - bleeding diathesis, neuro signs, eye abnormalities (retinal hemorrhage), increased cardiac workload, cardiomyopathy, +/- CHF

47
Q

how is multiple myeloma associated with causing renal disease?

A

dogs & cats will likely have azotemia due to bence jones proteinuria (light chains are normally filtered through the glomerulus, so their presence results in protein precipitates & causes renal tubular damage)

tumor infiltration into renal tissue

hypercalcemia, amyloidosis, decreased perfusion (due to hyperviscosity syndrome), dehydration, & ascending UTI

48
Q

how is multiple myeloma associated with causing hypercalcemia?

A

mostly dogs, 50%, 25% in cats

due to the production of osteoclast activating factor from neoplastic cells that is then exacerbated by renal disease

49
Q

how is multiple myeloma associated with causing cytopenias?

A

normocytic, normochromic non-regenerative anemias - up to 2/3 dogs & cats

thrombocytopenia - more common in cats than dogs, 50%

leukopenia - 80% dogs!!!! 1/3 cats!

50
Q

what clinical signs are seen in dogs with multiple myeloma? what about cats?

A

dogs - lethargy & weakness most common, anorexia/weight loss, lameness, bleeding, ocular problems

cats - lethargy/weakness most common, anorexia, pallor, ocular changes, vomiting/diarrhea, pu/pd

51
Q

how is multiple myeloma diagnosed?

A

bone marrow aspirate & cytology - document bone marrow plasmacytosis (normal is <5% plasma cells) - dogs > 20% marrow plasmacytosis & cats > 10 marrow plasmacytosis

demonstration of serum or urine myeloma proteins

plasma cell clonality/PARR to confirm came cell lineage

imaging - rads to look for osteolytic lesions, abdominal ultrasound in cats, organ involvement

52
Q

how is multiple myeloma treated in dogs?

A

tumor cell mass & seconardy systemic effects are treated

chemo - melphalan & prednisone

radiation - palliation of bone lesions

86% objective response rate - reasonably good cancer to have for a dog

MST 930 days, median remission 601 days

53
Q

T/F: in animals with multiple myeloma, their immunoglobulin levels are decreased

A

true

54
Q

how is multiple myeloma treated in cats?

A

cats have a 50-83% response rate with median survival time varying from 4-13 months

treat the tumor mass & secondary systemic effects, radiation for bone lesions, & chemo - melphalan & prednisolone

55
Q

what are negative prognostic factors for multiple myeloma in dogs?

A

hypercalcemia, bence jones proteinuria, excessive bone lysis, renal disease, & a high neutrophil: lymphocyte ratio

CFT II (28 decks)

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