Haematology Flashcards
amount of plasma cells in myeloma
> 10% plasma cells in bone marrow
prevalence of MGUS in >70yr
10%
difference between smouldering and MM
lack of symptoms in smouldering (does not satisfy clinical sx)
mechanism of hypercalcaemia in MM
plasma cells secrete RANK-ligand which stimulates osteoclasts
purpose of autologous SCT transplants
to allow for giving high dose chemotherapy
purpose of allogeneic SCT
1) allows for chemo with repalcement of marrow with healthy cells
2) Immune response against malignancy
Donor recipient matching in HSCT
HLA
Class I - HLA-A, -B, -C
Class II - HLA-DRB1, DQB1, DPB1
standard BMT considers 6 loci (so 12 alleles between 2 parents)
Alternatives to mismatch transplant
haploidentical relative (half-match) (higher risk of GVHD) Umbilical cord blood - more permissive of HLA mismatches (used more frequently in paediatrics)
PBSC - peripheral blood stem cells
Collection; GvHD risk and graft failure risk
G-CSF mobilisation and apheresis
Exclusive source for autologous (and most allogeneic)
Higher chronic GvHD risk than marrow
Lower graft failure rate
When are bone marrow donor sources preferred?
Non-malignant disease (e.g. aplastic anaemia) as no benefit from GvHD
3 criteria for HSCT
- Does the disease require a transplant
- Suitable available donor
- Patient sufficiently fit
Most common indications for autologous transplant
MM
NHL
Hodgkin’s
Most common indications for allogeneic transplant
AML ALL NHL MDS CML (less common with immunotherapy)
Donor priorities
Matched sibling, matched unrelated, haplo, cord
what recovers first after a HSCT
NK cells, then CD8, then CD4, then B cells
acuteGVHD timing and involvement
Within 100 days of BMT
Predominantly skin, gut, liver
chronicGVHD manifestation
predominantly fibrotic process
prevention of chronic GVHD
cyclophosphamide
open chromatin
chromosomes open and actively transcribing DNA
sign of aggressive malignancy
What biopsy is preferred for diagnosis of lymphoma
excisional biopsy
Lymphoma stageing
I - lymph nodes in 1 group
II - lymph nodes multiple groups in 1 side of the body
III - lymph node groups on both sides of the body
IV - organ involvement (excluding spleen; or stage E disease which is the involvement of an adjacent organ to the lymph nodes)
A or B based on whether they have B symptoms
What is the significance of B symptoms
That they have larger disease bulk
When is a diagnostic LP indicated in lymphoma
ALL, aggressive lymphomas w evidence of stage IV disease
High risk sites
High LHD
Chemo regimen for early stage Hogkin’s
ABVD
local radiotherapy
more cycles if unfavourable disease
Chemo regimen for advanced stage Hogkin’s
ABVD
Lines of treatment for DLBCL
R-CHOP x 6
H-hyperCVAD x 8
Mini-R-CHOP in older adults
What factors prognosticate lymphoma
age LHD ECOG Stage >1 2 or more extranodal sites
IPI - international prognostic index
Burkitt’s chemotherapy regime
R-CODOX-M/R-IVAC
Primary CNS lymphoma cell lineage origin
B cells due to lymphoid tissue in brain
What immunodeficiency is BTK deficiency associated with
Brunton’s gammaglobuinaemia
What haematological conditions is ibrutinib used to treat
CLL, mantle cell leukaemia
PE mortality - sudden death and 1 week mortality
25% and 30%
optimal treatment duration for VTE
In general, there is a low recurrence rate after 3 months
there is a low absolute risk for provoked distal DVTs so maybe they only need 6 weeks of anticoagulation
After 3 months, there is an assessment to determine indefinite continuation of anticoagulation
what provocation factor of VTE is assoc w the lowest recurrence rate
surgery (<1%)
what age group is associated with a higher early recurrence
younger patients
who to consider indefinite low dose NOAC after 3 mo anticoagulation
everyone aside from transient provoking and distal DVT
anticoagulation management in non low risk surgery
Warfarin - determine if bridging is required
- bridging is associated with increased bleeding but no benefit to thromboembolism
- very high risk to consider bridging (AF w CHADVASC >6, SSE within 3 months, mitral stenosis)
NOAC - does not need bridging because similar half life to LMWH
- low risk of thrombosis (0.4%)
- stop 48hr pre-op (72 hr if CKD, dabigatran or high risk consequences of bleeding)
- normally recommence NOAC 2-3 days
SEE SLIDES
How to monitor dabigatran post op
dilute thrombin clotting time
