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Blood Disorders > Leukaemia And Lymphoma > Flashcards

Leukaemia And Lymphoma Flashcards

1
Q

What cells are all blood cells derived from

A

Multipotential haemopoitetic stem cells

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2
Q

What 2 cells do mutlipotential haemopoietic stem cells differenitate into

A

Common myeloid progenitor

Common lymphoid progenitor

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3
Q

What cells does myeloid progenitor cells give

A

Granulocytes

Red blood cells

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4
Q

What cells do lymphoid progenitor cells give rise to

A

Natural killer cells

Lymphocytes; t and b

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5
Q

What does leukemia arise from

A

Haemopoitetic stemm cells

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6
Q

What happens to the bone marrow when normal haemopoeisis is impaired

A

The bone marrow produces abnromal blood cells which leads to bone marrow failure

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7
Q

What happens when the bone marrow fails

A

You become:
anaemic
Prone to bleeding and bruising
Suspectible to infection

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8
Q

What are the 4 types of leukemia

A

Acute myeloid leukemia
Acute lymphoid leukemia
Chronic myeloid leukemia
Chronic lymphoid leukemia

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9
Q

What is the difference between chronic and acute leukemia

A

Acute leukemia involve the transformation of immature haemopoetic cells
Chronic leukemia invlve the cells that done further differentiation i.e are more mature cells

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10
Q

In chronic leukemia what can the accumulaton of cells lead to

A

Splenomegaly
Hepatomegaly
Lymphadenopathy

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11
Q

What is lymphoma

A

Cancer of the lymphoid tissue

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12
Q

What are the 2 main categories of lymphoma

A

Non hodgkin

Hodgkin lymphoma

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13
Q

What is lymphoma characterised by

A

Proliferation and accumulation of mature lymphocytes in lymphoid tissue resulting in lymphadenopathy and or hepatosplenomegaly

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14
Q

What are the b symptoms in lymphoma

A 
Night sweats
Intense prutitus
Unexplained fever
Unintentional weight loss
Fatigue and generalised weakness
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15
Q

What investigations should you carry out in suspected blood cancer

A

FBC
UE, lft, CRP and calcium
Coagulation profile (PT,APTT, fibrinogen)
Blood culture and screening for infection
Blood film
Peripheral blood immunophenotyping
Diagnoistic bone marrow aspirate and trephine biopsy

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16
Q

If you suspect lymphom what investigations should you carry out

A

LDH
Lymph node biopsy and history
CT imaging and PET scan

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17
Q

What is acute promyelocytic leukemia

A

A subset of acute myeloid leukaemia

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18
Q

For myleoid progenitor cells to give rise to granulocytes what does it need to differnitate to

A

Myeloblast

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19
Q

What do myeloblast cells differnitate into to give neutrophils

A 
Promyelocyte
Myelocyte
Metamyelocyte
Band cell
Neutrophil
20
Q

In acute prmyelocyte leukemia what happens to the differentiation

A

There is a block to promyelocyte so no further differentiation occurs and you seen no neutrophils on the blood film

21
Q

What is the distinct molecular abnormality that underpins acute promyelocytic leukemia

A

Recipricol translocation between chromosome 15 and 17

22
Q

When recipricol translocation occur which gene forms

A

PML-RARA on chromosome 15 and RARA-PML on chromosome 17

23
Q

When PML-RARA gene is translated what protein does it form

A

PML-RARA protein

24
Q

What is the role of PML-RARA protein

A

Block the promyelocyte differentiation

25
Q

What is the treatment of acute promyelocytic leukemia

A

Vitamin a derivate i.e all trans retinoic acid given with arsenic trioxide (ATRA)

26
Q

What are the other treatment for other types of acute myeloid leukemia

A

Chemotherapy
Monoclonal antibody
Allogenic stem cell transplantation

27
Q

What is chronic myeloid leukemia due to

A

Recipricol translocation of chromsome 9 and 22 that foms BCR-ABL gene

28
Q

What is the specific treatment of chronic myeloid leukemia

A

Tyrosine kinase inhibitor to stop the fusion of bcr and abl gene e.g imatinib

29
Q

What is a problem of using imaitib

A

The patient can develop imatinib resistance

30
Q

How do we solve imatinib resistance

A

Using 2 and 3rd generation tyrosine kinase inhibitors

31
Q

What are the features of CML on a blood film

A

Few rbc and platelets
Many white blood cells
Eosinophil precursors

32
Q

What is chronic lymphocytic leukemia characterised by

A

Accumulation of mature b lymphocytes

33
Q

What is the pathobiology of chronic lymphocytic leukemia

A

B cell receptors drive CLL proliferation and CLL cells express BCL-2 (anti-apoptotic protein) which makes them resistant to apoptosis

34
Q

What is the treatment of CLL

A 
Chemotherapy
Monoclononal antibodies e.g rituximab
Chemoimmunotherapy
BCR signalling inhibitors e.g ibrutinib
BCL2 inhibitor e.g venetoclax
35
Q

What are the symptoms of hodgkin lymphoma

A

B symptoms
Lymphadenopathy
Mediastinal lymph node mass

36
Q

What is the treatment of Hodgkin’s lymphoma

A

Chemotherapy and radiotherapy
Monoclonal antibody e.g brentuximab
Immune checkpint PD1 inhibitor
Autologous stem cell transplatantion

37
Q

What is a feature of hodgkins lymphoma and histology

A

Sternbers cell (owle eye cells)

38
Q

In hodgkin lymphoma what is the role of PD1

A
  1. EBV Infection or JAK/STAT activation mediate the expression of PDL1 on the cell surface of reenberg cells
  2. PDL1 interacts with PD1 receptors on t cells which causes on inhibitory signal to prevent t cells from destroying it
39
Q

What is the action of PD1 inhibitors in the treatment of hodgkin lymphoma

A
  1. PD1 inhibitors block the interaction of PDL1 on the reenberg cell
  2. This promotes t cell killing
40
Q

What receptor does sternbeg cell express on the surface

A

Cd30

41
Q

What is the mechanism of action of brenutixumab

A

Binds to CD30 and become internalised into the sternberg cell
The antibody i.e brunitixumab releases toxin to kill the cell

42
Q

What is a common type of non-hodgkin lymphoma

A

Large b cell lymphoma

43
Q

What does immunohistochemistry for b cell lymphoma show

A

Positive cd20
Negative cd3
Overepxressed bcl6

44
Q

What is the treatment of large b cell lymphoma

A

Cd20 monoclonal antibodt e.g retuximab

CAR T cell therapy

45
Q

What is CAR T cell therapy

A

You collect t cell from the patient
T cell is engineered with an artificial t cell receptor that recognise cd19 on lymphoma cells
CAR T cell exert cytotoxic activity by interacting with C19 and killing the lymphoma

Blood Disorders (9 decks)

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