Haematological malignancies

Question 1

Which subtype of AML should be treated as a medical emergency?

Answer 1

Acute promyelocytic leukaemia (associated with high risk of DIC)

Question 2

What is the appearance of AML on blood count?

Answer 2

WCC high
Anaemia
Thrombocytopenia

Question 3

Treatment of AML

Answer 3

Chemo & stem cell transplantation

Question 4

Which 3 agents are typically used to treat ALL?

Answer 4

Vincristine, steroid, asparaginase

Question 5

What are the long term side effects of chemo treatment of ALL in children?

Answer 5

Endocrine problems
Secondary leukaemia
Cardiotoxicity

Question 6

When is the peak incidence of ALL?

Answer 6

Childhood

Question 7

What is the pathological hallmark of CML?

Answer 7

Philadelphia chromosome and the resulting chimeric BCR-ABL gene

Question 8

Clinical features of CML

Answer 8

Anaemia
Anorexia
Weight loss
Splenomegaly

Question 9

What is the preferred definitive drug treatment for patients with CML?

Answer 9

Imatinib

Question 10

What is the most common form of leukaemia in the western world?

Answer 10

CLL

Question 11

When should treatment be commenced in CLL?

Answer 11

When the patient develops significant symptoms, when the disease is progressing rapidly or when it is already at an advanced clinical stage

Question 12

What is the most effective treatment of hairy cell leukaemia?

Answer 12

Nucleoside analogues

Question 13

How does classical Hodgkin’s lymphoma present clinically?

Answer 13

Asymmetrical painless lymphadenopathy (cervical)

May have splenomegaly & hepatomegaly

Question 14

How is Hodgkin’s lymphoma diagnosed?

Answer 14

Reed-Sternberg cells on lymph node biopsy

Question 15

How are stages I & II Hodgkin’s lymphoma treated?

Answer 15

Radiotherapy (short course of chemo if unsuccessful)

Question 16

How are stages III & IV Hodgkin’s lymphoma treated?

Answer 16

Chemo plus radio if bulky disease

STC for younger patients who fail at chemo

Question 17

What factors can trigger NHL?

Answer 17

H. Pylori in MALT lymphoma
Hep C in marginal zone lymphoma
Immunosupression

Question 18

What are the characteristics of high grade NHL?

Answer 18

Large poorly differentiated lymphoid cells

Aggressive clinical course but are often curable

Question 19

What are the characteristics of low grade NHL?

Answer 19

Smaller better differentiated cells

More indolent clinically but havea tendency to relapse

Question 20

How does NHL present?

Answer 20

Painless lymphadenopathy in cervical region 
Extranodal involvement (intestinal, CNS, bone marrow)

Question 21

What is the prognosis of follicular lymphoma?

Answer 21

Typically disseminated at presentation, initial good response to therapy but increasing relapses
Median survival 6-10 years

Question 22

What is the commonest type of ‘high grade’ NHL?

Answer 22

Diffuse large B-cell lymphoma

Question 23

What is the prognosis of diffuse large B-cell lymphoma?

Answer 23

70-80% remission

50% cured

Question 24

What is the prognosis for mantle cell lymphoma?

Answer 24

Poor (typically disseminated with marrow involvement)

Question 25

How can MALT lymphoma be treated?

Answer 25

Antibiotics can lead to regression

Question 26

What is the prognosis for peripheral T-cell lymphomas?

Answer 26

Poor due to high incidence of extra-nodal disease