Haematological cancers Flashcards
What are the different classifications of blood cancers?
Acute Vs. Chronic
Lymohoblastic/cytic Vs. myeloid
Lymphomas
All WBCs are myeloid except B and T lymphocytes
What is associated with ALL?
Ionising radiation during pregnancy
Down’s syndrome
Childhood
What are the symptoms of ALL?
Anaemia (low Hb), infection (low WCC), bleeding (low platelets)
Hepato/splenomegaly
Lymphadenopathy (mediastinal)
CNS involvement - CN palsies, meningism
What tests should be done for suspected ALL?
Blood film - blast cells
CT/CXR - lymphadenopathy
Lumbar puncture - CNS involvement
How is ALL treated?
Remission induction: Vincristine, predinisolone
CNS prophylaxis: methotrexate, RT
Maintenance: As above with mercaptopurine as well (monthly)
Marrow transplantation
What is associated with AML?
Down’s
Long term complication of CT (for lymphoma)
Myelodysplastic states
What are the symptoms of AML?
Anaemia, infection, bleeding, DIC (release of thromboplastin)
Hepato/splenomegaly
Gum hypertrophy
Skin involvement
What tests should be done for suspected AML?
Biopsy - Auer rod differentiate it from ALL
Raised WCC, blasts normally in the marrow
How is AML treated?
Chemotherapy: intensive (leads to neutropenia and low platelets) - daunorubicin, cytarabine
Bone marrow transplant
What do tests show to indicate myelodysplastic syndromes?
Pancytopenia, low reticulocytes, increased marrow cellularity
How are myelodysplastic syndrome treated?
RBC/platelet transfusions
Erythropoietin
Stem cell transplant
What medication should be given with CT for AML?
Allopurinol (for gout)
Raised levels of urate following tumour lysis
What is associated with CML?
Male
40-60 years
Philadelphia chromosome - BCR-ABL gene
What is the philadelphia chromosome?
Reciprocal translation of long arms of 9 and 22
Produces a fusion forming gene -> tyrosine kinase activity
What are the symptoms of CML?
Weightloss, fever, sweats
Gout (purine breakdown), bleeding, abdominal discomfort
Splenomegaly, hepatomegaly, anaemia, bruising
What tests should be done for CML?
High Wbc, B12, urate
Low/normal Hb, platelets
How is CML treated?
Imatinib - for Philadelphia chromsome
(dasatinib, nilotinib, bosutinib, also hydroxycarbamide)
Stem cell transplant and ALL treatment
What is CLL associated with?
Most common
Mutations, trisomies, deletions
What are the symptoms of CLL?
May be none
Anaemia, infection prone, weight loss, sweats, anorexia
Enlarged, rubbery, non-tender nodes
Spleno/hepatomegaly
What tests should be done for CLL?
Raised lymphocytes
AI haemolysis, marrow infiltration, low Hb, neutrophils, platelets
How is CLL treated?
Fludaribine, retuximab, cyclophosphamide
Steroids for AI haemolysis
RT for spleno/hepatomegaly
Stem cell transplant
What cells are found in Hodgkin’s lymphone (HL)?
Reed-Sternberg cells (have 2x mirror image nuclei)
CD15 markers
What are the associations of HL?
Young adults, elderly
Affected sibling, EBV, SLE, post-transplant
What are the symptoms of HL?
Enlarged, non-tender ‘rubbery’ superficial lymph nodes (cervical, axillary)
Fever, weight loss, night sweats, pruritis, lethargy
Lymphadenopathy, cachexia, anaemia, spleno/hepatomegaly
What tests should be done HL?
Lymph node excision biopsy
Bloods - high ESR, low Hb
High LDH - high cell turnover
How is HL treated?
RT with short courses of Chemo
Longer courses of chemo - ABVD
Adriamycin, bleomycin, vinblastine, dacarbazine
What are some associations with non-Hodgkin’s lymphoma (NHL)?
Normally B cell lymphomas
Immunodeficiency - HIV, drugs
H.pylori, toxins, congenital
What are the symptoms of NHL?
Superficial lymphadenopathy
Extranodal disease:
- gastric MALT (H. pylori)
- non-MALT gastric lymphomas
- Small bowel lymphomas
Fever, night sweats, weight loss (less common than HL)
Pancytopenia - anaemia, infection bleeding (low platelets)
What tests should be done for NHL?
Bloods - LDH = increased cell turnover
Marrow and node biopsy
How is NHL managed?
RT - localised disease
Chlorambucil - diffuse disease
IFN-a/retuximab - remission maintenance
High grade: R-CHOP
Retuximab, cyclophosphamide, hydroxydaunorubicin, vincristine, prednisolone
What Abs are found in myeloma?
IgG or IgA
What are the symptoms of myeloma?
Osteolytic bone regions - backache Hypercalcaemia Anaemia, neutropenia, thrombocytopenia Recurrent bacterial infections Renal impairment
What do tests for myeloma show?
Normocytic, normochromic anaemia
High ESR, urea, creatinine, calcium
How is myeloma treated?
CT - lenalidomide, bortezomib, dexamethasone
Bisphosphonate
Treat symptoms
Stem cell transplant
