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Sem 6: SAM 2 > Hemolymphatic Neoplasias > Flashcards

Hemolymphatic Neoplasias Flashcards

1
Q

List classifications of lymphoid leukemias

A
  1. Lymphoblastic leukemia
  2. Lymphocytic leukemia
  3. Multiple myeloma
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2
Q

List classifications of myeloid leukemias

A
  1. Granulocytic / myeloblastic
  2. Monocytic leukemia
  3. Megakaryocytic leukemia
  4. Erythroleukemia

(RBCs, granulocytes, PLTS: anything arising from bone marrow. NOT lymphocytes or plasma cells)

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3
Q

What is the diagnostic test of choice to differentiate non-neoplastic reactive lymphocytosis vs neoplasia?

A

FLOW cytometry

(Can do PARR too to see monoclonal vs polyclonal gammopathy, but it won’t say T vs B cell)

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4
Q

How can Flow Cytometry be helpful in diagnosis of suspect neoplasia?

A
  • Can differentiate reactive lymphocytosis from neoplasia
  • Differentiates between T vs B cell (prognostic indicator)
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5
Q

What are the limitations of PARR?

A
  • Can’t distinguish AML vs ALL
  • False positives with Ehrlichia canis and Lyme disease (tick borne diseases causing monoclonal gammopathy)
  • Cant differentiate high grade from low grade lymphoma
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6
Q

What dog breeds are overrepresented to developing Lymphoma?

A
  1. Boxers
  2. Bull mastiff
  3. Goldens
  4. Airedale
  5. Rotties
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7
Q

What is the most common anatomical location for lymphoma in dogs?

A
  • Multicentric (80%) affecting multiple LNs throughout the body
  • Generalized, painless lymphadenopathy

(Alimentary Lymphoma is #2 in dogs)

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8
Q

What is the first step in diagnosing a patient presenting with generalized lymphadenopathy and non specific CS of weight loss?

A
  • Cytology of LN with wood pecker / fenestration technique using a needle without the syringe attached

(avoid suction to avoid rupture of cells)

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9
Q

What cells are present in a normal lymphnode?

A
  • 90% small lymphocytes
  • 10% other cells

(makes it impossible to diagnose small cell/lymphocytic lymphoma with FNA)

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10
Q

What can you see on LN cytology that is indicative of reactive lymphocytosis?

A
  • 80% small lymphocytes
  • 20% plasma cells
  • some neuts and macs

(polyclonal gammopathy)

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11
Q

What are the 3 most common lymphomas seen in dogs?

A
  1. Diffuse, LARGE (lymphoblastic) B cell lymphoma (most common)
  2. Peripheral T cell lymphoma
  3. Low grade indolent/ T zone lymphoma

(Top 2 are high grade, aggressive)

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12
Q

How can Stage 1 Lymphoma in dogs present?

A
  • Solitary enlarged lymph node
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13
Q

How can Stage 2 Lymphoma in dogs present?

A
  • Enlarged regional LNs on same half of the body (cranial or caudal half)
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14
Q

How can Stage 3 Lymphoma in dogs present?

A

All peripheral lymphnodes enlarged

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15
Q

How can Stage 4 Lymphoma in dogs present?

A

Liver/Spleen/Mediastinum with or without peripheral lymphnode enlargement

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16
Q

How can Stage 5 Lymphoma in dogs present?

A

Bone marrow or non lymphoid tissue involvement (Skin, eyes, kidney, brain)

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17
Q

What is the CHOP protocol?

A

C = Cyclophosphamide
H = Doxorubicin
O = Vincristine (Oncovin)
P = Prednisone

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18
Q

What are negative prognostic indicators associated with lymphoma?

A
  • Higher stage
  • If systemic illness
  • T cell worse than B cell
  • If previously on steroids
  • Evidence of mediastinal mass (Most likely T cell)
  • Minimal response to therapy
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19
Q

What treatment protocol is reccomended for dogs and cats with lymphocytic lymphoma?

A
  • Prednisone / Prednisolone + Chlorambucil if presenting with CS or another indication to treat
  • May not need any therapy if indolent course
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20
Q

How can lymphocytic lymphoma be definitively diagnosed?

A

Need Flow Cytometry

(FNA not helpful with small cell lymphoma)

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21
Q

What are the other anatomical locations for lymphoma in dogs other than the lymph nodes?

A
  • Mediastinal lymphoma (resp signs, chest mass)
  • Liver
  • Spleen
  • Extra nodal (GI tract, brain, nasal cavity, kidney)
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22
Q

How does the grade of lymphoma affect treatment plan?

A
  • High grade lymphoma uses CHOP
  • Low grade / Lymphocytic / Small cell lymphoma uses Pred + Chlorambucil or sometimes nothing if indolent course and patient is clinically well
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23
Q

An owner wants to know the response rate before deciding on using the CHOP protocol for her dog with lymphobastic lymphoma, what do you tell her?

A
  • 80-90% of dogs with high grade lymphoma respond to CHOP
  • Complete remission that lasts on average 9-12 months
  • MST ~ 12 months

(overall sooo worth it, compared to 4-6 weeks without tx!)

24
Q

What is the MST for a canine patient diagnosed with high grade lymphoblastic lymphoma if no treatment is pursued?

A

4-6 weeks without tx 😢

Recommend CHOP!

25
Q

What is the most common lymphoma seen in dogs?

A. Lymphoblastic B cell lymphoma
B. Lymphocytic B cell lymphoma
C. Lymphoblastic T cell lymphoma
D. Lymphocytic T cell lymphoma

A

A. Lymphoblastic B cell lymphoma

(high grade, diffuse Large B cell lymphoma)

26
Q

What can you offer at the least for a patient with high grade lymphoma and an owner with financial restrictions?

A

Prednisone, MST of 1-2 months when used alone

(compared to 4-6 weeks with no tx)

27
Q

What is the MST in dogs with Small cell lymphoma?

A
  • > 1.5 years

(longer MST than large cell)

28
Q

What is the most common location for lymphoma in older cats?

A

Alimentary / GI lymphoma most common

(vs multicentric lymphoma in dogs)

29
Q

What % of lymphoma cases are associated with FELV+ or FIV+ cats as of today?

A

<15%

(way more common years ago before vaccine)

30
Q

What are common locations for lymphoma in older cats?

A
  1. Alimentary / GI tract
  2. Nasal lymphoma
  3. Renal lymphoma
  4. Multicentric affecting peripheral LNs
31
Q

What signalment in cats is most common with mediastinal lymphoma?

A
  • Young cats
  • often Siamese
  • Often FeLV+
32
Q

What is the most common result to get back on Flow cytometry from a cat with lymphoma?

A
  • Lymphocytic, small cell, mature T cell lymphoma
33
Q

True or False: B cell lymphoma is more common in cats than dogs

A

False! T cell lymphoma most common in cats

B cell most common in dogs

34
Q

Which of the following is true?

A. Cats most commonly get lymphoblastic lymphoma
B. Dogs most commonly get T cell lymphoma
C. Cats most commonly get small cell lymphoma
D. Dogs usually get small cell lymphoma

A

C. Cats most commonly get small cell lymphoma

T cell lymphocytic most common in cats
B cell lymphoblastic most common in dogs

35
Q

What is the treatment protocol of choice for a cat with lymphocytic lymphoma?

A
  • Prednisolone +/- Chlorambucil is 1st line
  • Adjunct cyclophosphamide (2nd line) if failure to respond

(CHOP not recommended for small cell, only large cell/blastic)

36
Q

What is the treatment protocol for a cat with lymphoblastic lymphoma?

A
  • COP > CHOP
  • Avoid doxorubicin in cats due to risk of kidney injury

MST ~ 1 yr with COP, poor prognosis without tx

37
Q

What is the MST for a cat with lymphocytic lymphoma?

A

MST of 2 years if on Prednisolone +/- Chlorambucil

38
Q

When is multi agent chemotherapy recommended in cats with lymphoma?

A

Only if lymphoblastic/large cell (which is less common in cats)

Use COP > CHOP in cats

39
Q

What is the top Ddx that must be ruled out with GI lymphoma in cats?

A
  • IBD !! (mixed population of cells, need IHC to differentiate)
40
Q

What is the MST for lymphoma of large granular lymphocytes in cats?

A

Weeks :(
most aggressive form, not treated with chemo

41
Q

What is the MST for lymphoblastic GI lymphoma in cats?

A

MST ~1 year if treated with COP/CHOP

(weeks to months if no tx)

41
Q

What is a good supplement to give to a cat with lymphoma?

A

B12

(Cobalamin is a negative prognostic indicator associated with lymphoma in cats!!)

42
Q

When is protein electrophoresis indicated?

A

If hyperglobinemia on bloodwork

43
Q

What can be seen on bloodwork in a patient with multiple myeloma?

A
  • Hyperglobinemia
  • Hypercalcemia
  • Cytopenias
  • Proteinuria
44
Q

What evidence must be present for diagnosis of multiple myeloma?

A
  1. Monoclonal gammopathy in serum
  2. Monoclonal gammopathy in urine (Bence-Jones proteins)
  3. Lytic bone lesions
  4. Plasma cell infiltrate in bone marrow or other organ (liver, spleen)

Must have 2/4

45
Q

What are negative prognostic indicators associated with multiple myeloma?

A
  • Proteinuria
  • Hypercalcemia
  • Extensive lytic bone lesions
46
Q

What is the chemotherapy agent of choice for treatment of multiple myeloma?

A
  • Melphalin
47
Q

What is the MST of multiple myeloma in dogs and cats treated for multiple myeloma?

A

Dogs MST ~ 1.5 years with tx
Cats MST ~ 8 months with tx

48
Q

What is the treatment protocol for CLL?

A
  • Chemo may not impact survival/be needed if no signs
  • MST of 1-3 years
  • Pred and Chlorambucil if presenting with CS
49
Q

What is the MST of ALL?

A
  • Days to weeks with Pred
  • 1.5 months with CHOP

very aggressive, poor prognosis

50
Q

A large buffy coat present in serum can be consistent with which hemolymphatic neoplasia?

A

ALL / Acute lymphoblastic leukemia

51
Q

How is polycythemia vera treated?

A

Phlebotomy + Chemo for MST ~ 1-3 years

52
Q

DDx for an elevated RBC count/elevated PCV?

A
  • Dehydration
  • Cardiac disease
    -Pulmonary disease
  • Renal tumor
  • Polycythemia vera
53
Q

What is the most common form of leukemia in dogs?

A

Chronic lymphocytic leukemia

(myeloid leukemia is rare)

54
Q

Lymphoma in the GI tract is considered what Stage?

A

Stage very aggressive

55
Q

Where is the most common locations for Lymphoma in cats?

A
  • Stomach and GI tract
  • Nasal cavity

Sem 6: SAM 2 (26 decks)

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