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Haematological Malignancies Flashcards

1
Q

Classification is based on…

A

Clinical features, morphology, immunophenotyping and genetic alterations

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2
Q

Cancer of the myeloid stem cell causes…

A

Acute leukaemia

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3
Q

Cancer of the lymphoid stem cell causes…

A

Acute leukaemia

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4
Q

Cancer of the plasma cell causes…

A

Myeloma

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5
Q

Cancers of the B, T, and NK cells cause…

A

B, T and NK cell lymphomas

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6
Q

Cancers of the RBCs, platelets or granulocytes cause…

A

Myeloproliferative / myelodysplastic neoplasms

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7
Q

Granulocytes include…

A

Eosinophils, basophils and neutrophils

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8
Q

Is myeloid neoplasm morphology normal or abnormal?

A

Either

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9
Q

Myeloid neoplasms are all…

A

Clonal disorders of haematopoeisis

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10
Q

Morphology of myeloproliferative neoplasms:

A

Increased mature-appearing cells

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11
Q

Are myeloproliferative neoplasms acute or chronic?

A

Chronic

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12
Q

Myeloproliferative neoplasms have a variable risk of transformation to…

A

Acute myeloid leukaemia

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13
Q

Morphology of myelodysplastic syndromes:

Neutrophils usually have 3 lobes

A

Reduced number of cells and reduced lobes in neutrophils

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14
Q

Are myelodysplastic syndromes acute or chronic?

A

Chronic

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15
Q

Risk of myelodysplastic syndromes transforming to AML?

A

30%

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16
Q

Morphology of AML:

A

Decreased mature peripheral blood cells
Immature cells in the BM and periphery
Decreased RBCs and platelets
Increased white cell count

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17
Q

PV (myeloproliferative, too many RBCs) =

A

Polycythaemia vera

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18
Q

ET (myeloproliferative, too many platelets)

A

Essential thrombocytopenia

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19
Q

PM (myeloproliferative, fibrosis in BM)

A

Primary myelofibrosis

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20
Q

CML (myeloproliferative, 9-22 translocation on the Philadelphia chromosome)

A

Chronic myeloid leukaemia

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21
Q

Loss of normal BM function in acute leukaemia causes…

A

Anaemia, fatigue, fever, infection, bruising, bleeding

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22
Q

Infiltration of organs in acute leukaemia causes…

A

Hepatomegaly, splenomegaly, lymphadenopathy (mediastinal mass in lymphoblastic)

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23
Q

Which type of acute leukaemia develops mediastinal mass?

A

Lymphoblastic

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24
Q

CNS symptoms in acute leukaemia?

A

Headache, nausea, nerve palsy

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25
Q

Which acute leukaemia does Auer Rods indicate?

A

Myeloid

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26
Q

Leukaemia treatment is guided by testing for?

A

Minimal residual disease

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27
Q

Which medical emergency can be suggested by WCC>100 and lymphoma mass>10cm?

A

Tumour lysis syndrome

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28
Q

TLS cellular breakdown causes what?

A

Hyperuricaemia

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29
Q

Three symptoms of TLS are?

A

Arrhythmia, renal failure, neuromuscular irritability

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30
Q

TLS can be treated with which drugs?

A

Allopurinol or rasburicase

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31
Q

The translocation of chromosomes 15 and 17 bringing together RARA and PML genes causes which condition?

A

Acute promyelocytic leukaemia

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32
Q

High PT, high APTT, high D-dimers

Low fibrinogen, low platelets, low TT:

A

Acute promyelocytic leukaemia

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33
Q

Cure for acute promyelocytic leukaemia?

A

ATRA and arsenic

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34
Q

What are lymphoid neoplasms?

A

Clonal tumours of B, T or NK cells

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35
Q

Where does the B cell neoplasia responsible for B lymphoblastic leukaemia / lymphoma occur?

A

Bone Marrow

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36
Q

Where does the B cell neoplasia responsible for Mantle cell lymphoma occur?

A

Interfollicular area

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37
Q

Where does the B cell neoplasia responsible for follicular lymphoma occur?

A

Follicular area

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38
Q

Where does the B cell neoplasia responsible for Burkitt lymphoma occur?

A

Follicular area

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39
Q

Where does the B cell neoplasia responsible for Hodgkin’s lymphoma occur?

A

Follicular area

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40
Q

Where does the B cell neoplasia responsible for MALT lymphoma occur?

A

Perifollicular area

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41
Q

Where does the B cell neoplasia responsible for plasmacytoma occur?

A

Perifollicular area

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42
Q

Where does the T cell neoplasia responsible for T lymphoblastic lymphoma / leukaemia occur?

A

Thymus and BM

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43
Q

Where does the T cell neoplasia responsible for peripheral (mature) T cell + NK cell lymphomas / leukaemia occur?

A

Spleen, mucosa, peripheral blood, skin, organ specific, follicle

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44
Q

Which haematological malignancy can be detected through clonal abnormal Ab secretion?

A

Plasma cell myeloma

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45
Q

15-20% of plasma cell myelomas are…

A

Light chain

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46
Q

Prognosis of plasma cell myelomas is based on what?

A

Genetics, albumin and beta-2 microglobulin

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47
Q

Hypercalcaemia, renal failure, lytic lesions, anaemia, recurrent infections and amyloid plaques are symptoms of which haematological malignancy?

A

Plasma cell myeloma

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48
Q

How do you diagnose plasma cell myeloma?

A

Paraprotein and serum free light chains

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49
Q

What do 50% of plasma cell myeloma patients present with?

A

Renal insufficiency

50
Q

What are the three effects on the kidney of cast nephropathy?

A

Reduced GFR, interstitial nephritis and tubular nephropathy

51
Q

What is the effect of cast nephropathy on the glomerulus?

52
Q

What are the two main conditions that cause renal insufficiency in PC myeloma?

A

Cast nephropathy or secondary AL amyloidosis

53
Q

What is the histological triad of cast nephropathy?

A

Proximal tubular injury, waxy casts in distal tubules and interstitial fibrosis

54
Q

Is secondary AL amyloidosis a nephrotic or nephritic syndrome?

55
Q

How does secondary AL amyloidosis affect the glomerulus?

A

Glomerular deposition of light chains (nephrotic syndrome)

56
Q

How do you diagnose secondary AL amyloidosis?

A

Biopsy or BM aspirate and trephine

57
Q

Acute leukaemia with blast cells > 100 can cause which complication?

A

Hyperviscosity syndrome

58
Q

Acute leukaemia, Waldenstroms macroglobulinaemia and polycythaemia vera can all cause which complication?

A

Hyperviscosity syndrome

59
Q

Is myeloma acute or chronic?

60
Q

Is myeloma curable?

61
Q

When do we treat myeloma?

A

When symptomatic

62
Q

What is the mainstay of myeloma treatment?

A

Supportive

63
Q

What is given for bone protection?

A

Bisphosphonates

64
Q

How do we treat a first myeloma relapse in the young patient?

A

Stem cell transplant

65
Q

Definition of lymphoma:

A

Replacement of normal lymphoid structures with malignant cells

66
Q

What cell-type of NHL is most common?

67
Q

What is the commonest high grade B-NHL?

A

Diffuse large B-cell lymphoma

68
Q

What is the commonest low grade B-NHL?

A

Follicular lymphoma

69
Q

Morphology of Hodgkin’s lymphoma (HL)?

A

Reed-Sternberg cells (owl eyes)

70
Q

In which lymph nodes does HL normally arise?

A

Upper body

71
Q

In which lymph nodes does NHL normally arise?

72
Q

Lymphoma can be…

A

Extra-nodal

73
Q

What is a lymphoma tumour made up of?

A

Cancer surrounded by reactive cells

74
Q

Lymphoma shared symptoms:

A

Hepatomegaly, splenomegaly, extra-nodal sites, fever, lymphadenopathy, malaise

75
Q

Differentials for HL:

A

Alcohol-induced pain, Pal-Ebstein fever, mediastinal mass

76
Q

Differentials for NHL:

77
Q

What are the features of Pal-Ebstein fever?

A

40 degrees fever every two weeks

78
Q

(Lymphoma) 1 site

79
Q

(Lymphoma) 2 or more sites, one side of diaphragm

80
Q

(Lymphoma) 2 or more sites, both sides of the diaphragm

81
Q

(Lymphoma) Spleen involvement

82
Q

(Lymphoma) Extra-lymphatic site

83
Q

(Lymphoma) Diffuse involvement of extra lymphatic sites +/- nodal disease

84
Q

t(14;18)

A

Follicular lymphoma

85
Q

t(11;14)

A

Mantle cell lymphoma

86
Q

t(8;14)

A

Burkitt lymphoma

87
Q

Deletion 17p-

A

Chemoresistance

88
Q

Myd88 mutation

A

Waldenstrom macroglobulinaemia

89
Q

BRAF mutation

A

Hairy cell leukaemia

90
Q

p53 mutation

A

Chemoresistance

91
Q

High grade B cell lymphoma treatment?

A

Chemo and Rituximab

92
Q

Early low grade (symptomatic) lymphoma cure?

A

Radiotherapy

93
Q

Hodgkin’s stage I/II treatment regimen:

A

2-4 cycles of chemo and radio

94
Q

Hodgkin’s stage III/IV treatment regimen:

A

6 cycles of chemo

95
Q

Novel therapies for lymphoma?

A

Brentuximab, Nivolumab

96
Q

Temperature > 38 degrees and neutrophils < 0.5 x 10^9 =

A

Neutropenic Sepsis

97
Q

Tazocin (meropenem if fungal) +/- aminoglycoside (if shocked) +/- Teicoplanin/Vancomycin is an example of broad spec Abx with g-ve coverage. But in which condition would you commence this regimen?

A

Neutropenic Sepsis

98
Q

What is the R-CHOP regimen used to treat?

A

Diffuse large B-cell lymphoma

99
Q

What does the acronym ‘R-CHOP’, which represents a chemo regimen for NHL, stand for?

A

Rituximab, Cyclophosphamide, Doxorubicin, Vincristine, Prednisolone

100
Q

40-70% BM involvement in which NHL?

A

Follicular lymphoma

101
Q

Treatment for symptomatic follicular lymphoma?

A

6-8 cycles of chemo and rituximab

102
Q

How does chronic lymphocytic leukaemia present?

A

Asymptomatic lymphocytosis

103
Q

Where is chronic lymphocytic leukaemia found?

A

Peripheral blood, BM and lymph nodes

104
Q

What are the symptoms of chronic lymphocytic leukaemia?

A

Fatigue, weight loss, anorexia, infection, bulky lymphadenopathy, BM failure and splenomegaly

105
Q

What are the bloodworm findings in chronic lymphocytic leukaemia?

A

AI haemolytic anaemia, thrombocytopenia, hypogammaglobulinaemia and T cell defects

106
Q

(Chronic lymphocytic leukaemia) 2 lymph node areas or under:

107
Q

(Chronic lymphocytic leukaemia) 3 lymph node areas or over:

108
Q

(Chronic lymphocytic leukaemia) Haemoglobin 10g/dL or over; platelets 100 x 10^9/L or under:

109
Q

(Chronic lymphocytic leukaemia) Isolated lymphocytosis:

110
Q

(Chronic lymphocytic leukaemia) Lymphadenopathy:

111
Q

(Chronic lymphocytic leukaemia) Splenomegaly:

112
Q

(Chronic lymphocytic leukaemia) Lymphadenopathy + Splenomegaly:

113
Q

(Chronic lymphocytic leukaemia) Haemoglobin 10g/dL or over; platelets 100 x 10^9/L or under:

114
Q

Ibrutinib is a targeted treatment for…

A

Chronic lymphocytic leukaemia

115
Q

Idelalisib is a targeted treatment for…

A

Chronic lymphocytic leukaemia

116
Q

Venetoclax is a targeted treatment for…

A

Chronic lymphocytic leukaemia

117
Q

Obinutuzumab is an Ab treatment for…

A

Chronic lymphocytic leukaemia

118
Q

Ofatumumab is an Ab treatment for…

A

Chronic lymphocytic leukaemia

119
Q

Chemoimmunotherapy for chronic lymphocytic leukaemia:

A

FCR, FR, BR, CR, ORR

120
Q

What is the principle treatment for myeloma?

A

Analagous stem cell transplant

121
Q

When do we treat lymphoma with a stem cell transplant?

Cancer (10 decks)

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