Hematologic Malignancy Flashcards
Best diagnostic test for Hodgkin Lymphoma?
Lymph node excisional biopsy
Stage I Hodgkin Lymphoma?
One LN region
Stage II Hodgkin Lymphoma?
2+ LN regions on 1 side of diaphragm
Stage III Hodgkin Lymphoma?
2+ LN regions on both sides of diaphragm
Stage IV Hodgkin Lymphoma?
Extranodal sites
Best treatment for Stage I + II Hodgkin Lymphoma?
ABVD chemotherapy, then XRT
Best treatment for Stage III + IV Hodgkin Lymphoma?
ABVD chemotherapy
Best management for female who undergoes CTX + XRT for Hodgkin Lymphoma?
Begin mammogram screening earlier … Due to increased risk of secondary breast CA
Exposure that increases risk of Non-Hodgkin Lymphoma?
CXT + XRT treatment of Hodgkin Lymphoma
Virus associated with Non-Hodgkin Lymphoma?
HTLV1
Best treatment for low-grade Non-Hodgkin Lymphoma?
Observation
Best treatment for high-grade Non-Hodgkin Lymphoma?
R-CHOP chemotherapy
Plasma cell % that diagnoses Multiple Myeloma?
> 10%
M protein spike that diagnoses Multiple Myeloma?
> 3 mg/dL
Precursor to Multiple Myeloma?
MGUS … Monoclonal Gammopathy of Undetermined Significance
Best treatment for MGUS?
None
Appearance of Multiple Myeloma on XR?
Lytic lesions
Imaging study of choice for Multiple Myeloma?
XR (skeletal survey) … bone scan won’t show lytic lesions
Patient with Multiple Myeloma develops acute back pain with neurologic symptoms – diagnosis?
Cord compression
Patient with Multiple Myeloma develops acute back pain with neurologic symptoms – diagnosis?
Start corticosteroids, Order MRI, XRT + neurosurgery consult
Clinical presentation of Waldenstrom Macroglobulinemia?
Hyperviscosity Syndrome … blurry vision, HA, dizziness
Best treatment for Waldenstrom Macroglobulinemia?
Plasmapheresis
Myelodysplastic syndrome chromosome with best prognosis?
5q deletion
Appearance of Pseudo-Pelger-Huet Syndrome on blood smear?
Bilobed nuclei
Most common cause of death in AML?
Infection
DOC for patients with Myelodysplastic syndrome with 5q deletion?
Lenalidomide
4 myeloproliferative syndromes?
CML, Polycythemia vera, Idiopathic myelofibrosis, essential thrombocytopenia
Complication of 4 myeloproliferative syndromes?
AML
Change to LAP in 4 myeloproliferative syndromes?
Low … LAP = marker of cell maturity
Consequence of t(9;22) mutation in CML?
Increased tyrosine kinase activity
Change to EPO level in polycythemia vera?
Decreased
3 treatments of choice for polycythemia vera?
ASA, Phlebotomy, Hydroxyurea
Change to EPO level in secondary polycythemia?
Increased
2 aspects of clinical presentation of Idiopathic myelofibrosis?
Splenomegaly, anemia
Appearance of blood smear in Idiopathic myelofibrosis?
Tear-shaped RBCs
What accounts for Tear-shaped RBCs in Idiopathic myelofibrosis?
Bone marrow fibrosis
Clinical presentation of Essential Thrombosis?
Thrombosis + Hemorrhage
What accounts for Thrombosis in Essential Thrombosis?
Excessive platelet count
What accounts for Hemorrhage in Essential Thrombosis?
Defective platelet function
DOC for Essential Thrombosis?
Hydroxyurea
Lab finding seen in AML?
Pancytopenia
Genetic mutation responsible for AML?
t(15;17)
Best treatment for AML?
ATRA … (all trans retinoic acid)
Appearance of AML on blood smear?
Blasts with Auer rods
Complication of AML?
DIC
What accounts for development of DIC in AML?
Cytoplasmic granules in malignant cells release procoagulant
Composition of Auer rods in AML?
Lysosomes
Treatment that is protective against renal failure in tumor lysis syndrome?
Allopurinol
What accounts for appearance of mediastinal mass in ALL?
T cell invasion of thymus
CD___ indicates favorable prognosis in ALL?
CD10
Poor prognostic factor in ALL?
t(9;22) … unlike BCR-ABL being a good prognostic factor in CML
Best stain for blasts in ALL?
TdT
AE of vinblastine?
Bone marrow suppression
AE of vincristine?
Peripheral toxicity
DOC for treatment of CML?
Imatinib
MOA of Imatinib in treatment of CML?
Inhibition of tyrosine kinase
65 yo male presents for abnormal labs; HGB = 12, WBC = 66,000 with 96% small lymphocytes, PL = 120; PE shows no LAD, no splenomegaly – diagnosis
CLL
65 yo male presents for abnormal labs; HGB = 12, WBC = 66,000 with 96% small lymphocytes, PL = 120; PE shows no LAD, no splenomegaly – treatment of choice?
Observation
CD factors that are (+) in CLL?
CD5, CD23
Clinical presentation of CLL?
Typically asymptomatic … but also Widespread LN enlargement
AE of Fludarabine (used to treat CLL)?
Leukopenia
NML prophylaxis for Pneumocystis jiroveci?
TMP-SMX
If patient is allergic to sulfa, what is alternate prophylaxis for Pneumocystis jiroveci?
Dapsone
Which test needs to be performed prior to giving patient prophylactic dapsone?
G6PD test
2 aspects of clinical presentation for Hairy Cell Leukemia?
Pancytopenia, Splenomegaly
Specific staining for Hairy Cell Leukemia?
TRAP
DOC for treatment of Hairy Cell Leukemia?
2-CDA