Haematological Malignancies Flashcards
1
Q
Classification is based on…
A
Clinical features, morphology, immunophenotyping and genetic alterations
2
Q
Cancer of the myeloid stem cell causes…
A
Acute leukaemia
3
Q
Cancer of the lymphoid stem cell causes…
A
Acute leukaemia
4
Q
Cancer of the plasma cell causes…
A
Myeloma
5
Q
Cancers of the B, T, and NK cells cause…
A
B, T and NK cell lymphomas
6
Q
Cancers of the RBCs, platelets or granulocytes cause…
A
Myeloproliferative / myelodysplastic neoplasms
7
Q
Granulocytes include…
A
Eosinophils, basophils and neutrophils
8
Q
Is myeloid neoplasm morphology normal or abnormal?
A
Either
9
Q
Myeloid neoplasms are all…
A
Clonal disorders of haematopoeisis
10
Q
Morphology of myeloproliferative neoplasms:
A
Increased mature-appearing cells
11
Q
Are myeloproliferative neoplasms acute or chronic?
A
Chronic
12
Q
Myeloproliferative neoplasms have a variable risk of transformation to…
A
Acute myeloid leukaemia
13
Q
Morphology of myelodysplastic syndromes:
Neutrophils usually have 3 lobes
A
Reduced number of cells and reduced lobes in neutrophils
14
Q
Are myelodysplastic syndromes acute or chronic?
A
Chronic
15
Q
Risk of myelodysplastic syndromes transforming to AML?
A
30%
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
17
Q
PV (myeloproliferative, too many RBCs) =
A
Polycythaemia vera
18
Q
ET (myeloproliferative, too many platelets)
A
Essential thrombocytopenia
19
Q
PM (myeloproliferative, fibrosis in BM)
A
Primary myelofibrosis
20
Q
CML (myeloproliferative, 9-22 translocation on the Philadelphia chromosome)
A
Chronic myeloid leukaemia
21
Q
Loss of normal BM function in acute leukaemia causes…
A
Anaemia, fatigue, fever, infection, bruising, bleeding
22
Q
Infiltration of organs in acute leukaemia causes…
A
Hepatomegaly, splenomegaly, lymphadenopathy (mediastinal mass in lymphoblastic)
23
Q
Which type of acute leukaemia develops mediastinal mass?
A
Lymphoblastic
24
Q
CNS symptoms in acute leukaemia?
A
Headache, nausea, nerve palsy
25
Which acute leukaemia does Auer Rods indicate?
Myeloid
26
Leukaemia treatment is guided by testing for?
Minimal residual disease
27
Which medical emergency can be suggested by WCC>100 and lymphoma mass>10cm?
Tumour lysis syndrome
28
TLS cellular breakdown causes what?
Hyperuricaemia
29
Three symptoms of TLS are?
Arrhythmia, renal failure, neuromuscular irritability
30
TLS can be treated with which drugs?
Allopurinol or rasburicase
31
The translocation of chromosomes 15 and 17 bringing together RARA and PML genes causes which condition?
Acute promyelocytic leukaemia
32
High PT, high APTT, high D-dimers
| Low fibrinogen, low platelets, low TT:
Acute promyelocytic leukaemia
33
Cure for acute promyelocytic leukaemia?
ATRA and arsenic
34
What are lymphoid neoplasms?
Clonal tumours of B, T or NK cells
35
Where does the B cell neoplasia responsible for B lymphoblastic leukaemia / lymphoma occur?
Bone Marrow
36
Where does the B cell neoplasia responsible for Mantle cell lymphoma occur?
Interfollicular area
37
Where does the B cell neoplasia responsible for follicular lymphoma occur?
Follicular area
38
Where does the B cell neoplasia responsible for Burkitt lymphoma occur?
Follicular area
39
Where does the B cell neoplasia responsible for Hodgkin's lymphoma occur?
Follicular area
40
Where does the B cell neoplasia responsible for MALT lymphoma occur?
Perifollicular area
41
Where does the B cell neoplasia responsible for plasmacytoma occur?
Perifollicular area
42
Where does the T cell neoplasia responsible for T lymphoblastic lymphoma / leukaemia occur?
Thymus and BM
43
Where does the T cell neoplasia responsible for peripheral (mature) T cell + NK cell lymphomas / leukaemia occur?
Spleen, mucosa, peripheral blood, skin, organ specific, follicle
44
Which haematological malignancy can be detected through clonal abnormal Ab secretion?
Plasma cell myeloma
45
15-20% of plasma cell myelomas are...
Light chain
46
Prognosis of plasma cell myelomas is based on what?
Genetics, albumin and beta-2 microglobulin
47
Hypercalcaemia, renal failure, lytic lesions, anaemia, recurrent infections and amyloid plaques are symptoms of which haematological malignancy?
Plasma cell myeloma
48
How do you diagnose plasma cell myeloma?
Paraprotein and serum free light chains
49
What do 50% of plasma cell myeloma patients present with?
Renal insufficiency
50
What are the three effects on the kidney of cast nephropathy?
Reduced GFR, interstitial nephritis and tubular nephropathy
51
What is the effect of cast nephropathy on the glomerulus?
No effect
52
What are the two main conditions that cause renal insufficiency in PC myeloma?
Cast nephropathy or secondary AL amyloidosis
53
What is the histological triad of cast nephropathy?
Proximal tubular injury, waxy casts in distal tubules and interstitial fibrosis
54
Is secondary AL amyloidosis a nephrotic or nephritic syndrome?
Nephrotic
55
How does secondary AL amyloidosis affect the glomerulus?
Glomerular deposition of light chains (nephrotic syndrome)
56
How do you diagnose secondary AL amyloidosis?
Biopsy or BM aspirate and trephine
57
Acute leukaemia with blast cells > 100 can cause which complication?
Hyperviscosity syndrome
58
Acute leukaemia, Waldenstroms macroglobulinaemia and polycythaemia vera can all cause which complication?
Hyperviscosity syndrome
59
Is myeloma acute or chronic?
Chronic
60
Is myeloma curable?
No
61
When do we treat myeloma?
When symptomatic
62
What is the mainstay of myeloma treatment?
Supportive
63
What is given for bone protection?
Bisphosphonates
64
How do we treat a first myeloma relapse in the young patient?
Stem cell transplant
65
Definition of lymphoma:
Replacement of normal lymphoid structures with malignant cells
66
What cell-type of NHL is most common?
B cell
67
What is the commonest high grade B-NHL?
Diffuse large B-cell lymphoma
68
What is the commonest low grade B-NHL?
Follicular lymphoma
69
Morphology of Hodgkin's lymphoma (HL)?
Reed-Sternberg cells (owl eyes)
70
In which lymph nodes does HL normally arise?
Upper body
71
In which lymph nodes does NHL normally arise?
Anywhere
72
Lymphoma can be...
Extra-nodal
73
What is a lymphoma tumour made up of?
Cancer surrounded by reactive cells
74
Lymphoma shared symptoms:
Hepatomegaly, splenomegaly, extra-nodal sites, fever, lymphadenopathy, malaise
75
Differentials for HL:
Alcohol-induced pain, Pal-Ebstein fever, mediastinal mass
76
Differentials for NHL:
Itches
77
What are the features of Pal-Ebstein fever?
40 degrees fever every two weeks
78
(Lymphoma) 1 site
Stage I
79
(Lymphoma) 2 or more sites, one side of diaphragm
Stage II
80
(Lymphoma) 2 or more sites, both sides of the diaphragm
Stage III
81
(Lymphoma) Spleen involvement
Stage III
82
(Lymphoma) Extra-lymphatic site
Stage III
83
(Lymphoma) Diffuse involvement of extra lymphatic sites +/- nodal disease
Stage IV
84
t(14;18)
Follicular lymphoma
85
t(11;14)
Mantle cell lymphoma
86
t(8;14)
Burkitt lymphoma
87
Deletion 17p-
Chemoresistance
88
Myd88 mutation
Waldenstrom macroglobulinaemia
89
BRAF mutation
Hairy cell leukaemia
90
p53 mutation
Chemoresistance
91
High grade B cell lymphoma treatment?
Chemo and Rituximab
92
Early low grade (symptomatic) lymphoma cure?
Radiotherapy
93
Hodgkin's stage I/II treatment regimen:
2-4 cycles of chemo and radio
94
Hodgkin's stage III/IV treatment regimen:
6 cycles of chemo
95
Novel therapies for lymphoma?
Brentuximab, Nivolumab
96
Temperature > 38 degrees and neutrophils < 0.5 x 10^9 =
Neutropenic Sepsis
97
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?
Neutropenic Sepsis
98
What is the R-CHOP regimen used to treat?
Diffuse large B-cell lymphoma
99
What does the acronym 'R-CHOP', which represents a chemo regimen for NHL, stand for?
Rituximab, Cyclophosphamide, Doxorubicin, Vincristine, Prednisolone
100
40-70% BM involvement in which NHL?
Follicular lymphoma
101
Treatment for symptomatic follicular lymphoma?
6-8 cycles of chemo and rituximab
102
How does chronic lymphocytic leukaemia present?
Asymptomatic lymphocytosis
103
Where is chronic lymphocytic leukaemia found?
Peripheral blood, BM and lymph nodes
104
What are the symptoms of chronic lymphocytic leukaemia?
Fatigue, weight loss, anorexia, infection, bulky lymphadenopathy, BM failure and splenomegaly
105
What are the bloodworm findings in chronic lymphocytic leukaemia?
AI haemolytic anaemia, thrombocytopenia, hypogammaglobulinaemia and T cell defects
106
(Chronic lymphocytic leukaemia) 2 lymph node areas or under:
Stage A
107
(Chronic lymphocytic leukaemia) 3 lymph node areas or over:
Stage B
108
(Chronic lymphocytic leukaemia) Haemoglobin 10g/dL or over; platelets 100 x 10^9/L or under:
Stage C
109
(Chronic lymphocytic leukaemia) Isolated lymphocytosis:
Stage 0
110
(Chronic lymphocytic leukaemia) Lymphadenopathy:
Stage I
111
(Chronic lymphocytic leukaemia) Splenomegaly:
Stage II
112
(Chronic lymphocytic leukaemia) Lymphadenopathy + Splenomegaly:
Stage III
113
(Chronic lymphocytic leukaemia) Haemoglobin 10g/dL or over; platelets 100 x 10^9/L or under:
Stage IV
114
Ibrutinib is a targeted treatment for...
Chronic lymphocytic leukaemia
115
Idelalisib is a targeted treatment for...
Chronic lymphocytic leukaemia
116
Venetoclax is a targeted treatment for...
Chronic lymphocytic leukaemia
117
Obinutuzumab is an Ab treatment for...
Chronic lymphocytic leukaemia
118
Ofatumumab is an Ab treatment for...
Chronic lymphocytic leukaemia
119
Chemoimmunotherapy for chronic lymphocytic leukaemia:
FCR, FR, BR, CR, ORR
120
What is the principle treatment for myeloma?
Analagous stem cell transplant
121
When do we treat lymphoma with a stem cell transplant?
Relapse
