L7 - Leukemia And Lymphoma Cases

Question 1

What is an absolute neutrophil count (ANC)?

Answer 1

WBC x (neutrophil % + band %)

Question 2

Severe neutropenia is defined as an ANC of what value?

Answer 2

<500

Question 3

Empiric coverage is targeted for which organism first for neutropenic fever?

Answer 3

Gram negative organism (pseudomonas)

Question 4

What is the 1st line of Abx for pseudomonas coverage?

Answer 4

Cefepime, piperacillin-taxobactam, meropenem, ceftazidine

Add MRSA coverage with vancomycin as well (if concern for line infection, PNA or soft tissue infection)

Question 5

If a neutropenic fever persists 48 hours after onset of abx therapy what should be added?

Answer 5

Fungal coverage with amphotericin B and voriconazole

Question 6

When should the bone marrow be rechecked for AML pts on chemo?

Answer 6

Recheck after 2 weeks

Question 7

What is required prior to giving chemo to AML pts?

Answer 7

Central line placement

Question 8

What is a common infection that can occur from a central line??

Answer 8

Fungal infection (most commonly candida)
Can be tested with a silver stain
Central cath will need to be replaced

Question 9

What is induction chemo?

Answer 9

Initial chemo to induce a remission

Question 10

What is consolidation chemo?

Answer 10

Intensifying chemo to make sure no cancer cells are left in the body

Question 11

What is maintenance chemo?

Answer 11

For some cancers longer term therapy to maintain the remission and prevent relapse

Question 12

A low LAP score is seen with what diagnosis?

Answer 12

CML

Question 13

What is a LAP score?

Answer 13

Positive staining is seen in reactive conditions —> leukemoid reaction
Absent staining indicates an abnormal myelocyte population —> neoplasm

Question 14

What are common ways to test for a Philadelphia chromosome?

Answer 14

Karyotype analysis (burdensome and can be subjective)
FISH
BCR-Abl PCR

Question 15

What test is the most sensitive for testing the Philadelphia chromosome?

Answer 15

Amplification PCR

Question 16

What are the stages of CML progression?

Answer 16

Chronic phase (<10% blasts)

Accelerated phase (10-19% circulating blasts) 
-thrombocytopenia and basophilia 

Blastic phase (>20% blasts) 
-blast crisis 

BCR-ABL increases with each progression

Question 17

What are the three biopsy types?

Answer 17

Fine needle aspiration
Needle biopsy
Excision/excisional biopsy

Question 18

What is a fine need aspiration?

Answer 18

Liquid sample for metastatic cells or flow cytometry
Worst type of biopsy
Will never be a test/board answer

Question 19

What is flow cytometry?

Answer 19

Assessing the clonal nature of cells

Question 20

What is a needle biopsy?

Answer 20

Solid core of tissue

Evaluation for metastatic cells and flow cytometry

Question 21

What is excision/excisional biopsy?

Answer 21

Best way to diagnose lymphoma

Only way to diagnose Hodgkin lymphoma