lect 4 Flashcards
What is the most common leukemia in children?
ALL (Acute Lymphoblastic Leukemia).
- (Pre-B-cell ALL)
What is the most common leukemia in adults?
CLL (Chronic Lymphocytic Leukemia).
- Slow but progressive course.
What defines ALL?
> 30% lymphoblasts. Common in children. Hydration and allopurinol are supportive care to prevent tumor lysis syndrome (can occur in all 4 leukemias).
Lymphadenopathy
Do bone marrow bx in any kiddo with anemia, abnormal WBCs, blasts form as atypical lymphocytes
Mediastinal mass
Normocytic anemia
LYMPHOBLASTS
Give allopurinol and IV fluids with elevated uric acids prior to chemo
Need to do CSF exam to r/o CNS leukemia
Prevent metabolic and infectious complications = immediate therapy of choice for pts
First line management = methotrexate
What is characteristic of CLL?
Smudge cells. Lymphocyte predominant. Occurs in adults
Can progress to RICHTER TRANSFORMATION - aggressive large B cell high grade lymphoma - LN enlargement, elevated LDH, monoclonal gammopathy
What is RAI’s clinical staging system for CLL?
■ Stage 0 = Low risk, bone marrow lymphocytosis >30%, Blood lymphocytosis > 5G/l
■ Stage 1 = intermediate risk, add on enlarged lymph nodes
■ Stage 2 = intermediate risk, add on enlarged spleen and/or liver
■ Stage 3 = high risk, add on anemia (Hgb < 11)
■ Stage 4 = high risk, add on thrombocytopenia (< 100k)
When does treatment for CLL usually start?
At stage 3.
What is Richter syndrome?
A complication of CLL where it transforms to a high grade non-hodking lymphoma: diffuse large cell lymphoma or prolymphocytic leukemia.
Presents with new onset of b sx: fever, weight loss AND large blast cells
What defines AML?
> 30% myeloblasts with Auer rods. Seen in adults. Risk factors: smoking, Down syndrome. Associated with DIC in APML. Can have leukemia cutis (skin manifestation) and gingival hyperplasia.
What is the defining mutation in CML?
Philadelphia chromosome - t(9;22).
What are common features of CML?
Fullness in the abdomen, LARGE SPLEEN or liver enlargement.
CML chronic phase -> accelerated phase: blasts increase to 10-19% -> blast crisis (transformation to AML with blasts over 20%)
What is the treatment for CML?
Tyrosine kinase inhibitors (TKIs), such as Imatinib (Gleevec, 1st gen). If one fails, switch to another TKI. TKIs should not be combined.
How do benign lymph nodes differ from malignant ones?
- Benign: <2cm, soft, <2 weeks, mobile, not attached, inguinal/submandibular, tender.
- Malignant: >2cm, hard/firm/rubbery, >2 weeks, fixed, attached (invasion), supraclavicular/epitrochlear/generalized, nontender.
What is characteristic of Hodgkin lymphoma?
Reed-Sternberg cells (large cells with binucleate/bilobed nucleus, “owl’s eye” appearance). Painless swollen lymph nodes, orderly spread (often localized to neck/axilla/inguinal), fever, night sweats, weight loss, itchiness after bathing. Rarely, lymph nodes can become painful after drinking alcohol.
What is the Ann Arbor Staging System for lymphoma?
- Stage 1: One node. Type A = no B symptoms. Type B = fever, night sweats, weight loss.
- Stage 2: >1 node, same side of diaphragm.
- Stage 3: >1 node, both sides of diaphragm.
- Stage 4: Both sides of diaphragm with spread to non-LN areas (e.g., liver, bone marrow).
What characterizes Non-Hodgkin lymphoma?
- Arises from B-cells (80%), T-cells (15-20%), or NK cells.
- Multiple peripheral nodes, noncontiguous spread, extranodal involvement common.
- Presents with drenching night sweats.
What is characteristic of Burkitt lymphoma?
Extremely aggressive, fastest-growing human tumor, associated with EBV.
