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Phase 3 > Leukaemia and Lymphoma > Flashcards

Leukaemia and Lymphoma Flashcards

1
Q

What leukaemia typically affects children?

A

ALL

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2
Q

What leukaemia typically affects adults?

A

AML

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3
Q

What does a diagnosis of Acute leukaemia have to have?

A

> 20% blast cells.

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4
Q

What are the typical symptoms of ALL?

A

Child limping with bone pain.

Anemic.

Purpuric rash - defective platelet function

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5
Q

What is the mutation in M3 AML, and what is significance of this?

A

translocation of 15;17.

high risk of DIC as many of the cells developed contain large amounts of granulytic cells.

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6
Q

What is the most common type of leukaemia?

A

CLL

- 95% are B cell origin

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7
Q

What age group is usually affected by CLL?

A

> 60years

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8
Q

What is a very aggressive type of CLL, and why?

A

chromosome 17p deletions.

deletion of p53

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9
Q

What would typically be seen on a lab test of CLL?

A

Lymphocytosis - high white blood cells

Smear Cells - leukocytes destroyed during process

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10
Q

What surface markers are often seen on B-cell CLL?

A

CD5
CD19
CD20
CD23

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11
Q

what are some complications of CLL?

A

Autoimmune Haemolytic anaemias

Autoimmune thrombocytopenia

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12
Q

What is the genetic abnormalities in CML?

A

Philadelphia gene

translocation of chromosome 9:22

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13
Q

What mutation typically leads to Myeloproliferative disorder?

and what is the risk of this?

A

JAK2

May develop into AML

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14
Q

What are the two broad types of lymphoma?

A

Hodgkins - 20%

Non- Hodgkins - 80%

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15
Q

Name the high grade NHLs:

A

Burkitt’s

Diffuse Large B-Cell

Mantle Cell

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16
Q

Name the low grade NHLs:

A

Small Lymphocytic

Follicular

Marginal Zone

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17
Q

What are the sub-catergories of classical Hodgkins lymphoma?

A

Nodular Sclerosing

Mixed Cellularity

Lymphocyte depleted

Lymphocyte dominant

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18
Q

What is the name of the cell seen in hodgkins lymphoma?

A

Reed -Sternberg Cells

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19
Q

What are some important protein expression of Reed-Sternberg cells:

A

CD30 - strong antigen towards other lymphocytes

Cd15

**don’t express CD45

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20
Q

What are the monoclonal antibodies produced in multiple myeloma?

A

Paraproteins

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21
Q

What are the protein build ups seen in multiple myeloma and what are they?

A

Bence- Jones Proteins

  • kappa and lamda (light chains)
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22
Q

Whats the most common genetic defect in Multiple myeloma?

A

translocation of 13q14

IgH gene affected

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23
Q

What are the symptoms of multiple myeloma?

A

C - hypercalcaemia

R- Renal impairment (bence -Jones proteins)

A - Anaemia

B - Bone pain

*CRAB

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24
Q

What immunological studies are done for multiple Myeloma?

A

Serum Free Light Chain Quantity

25
Q

What features are seen on x-ray for multiple myeloma?

A

Osteolytic erosions

  • due to the substances released from cancer cells.
26
Q

What is the diagnostic criteria of multiple myeloma?

A

> 10% plasma cells in bone marrow

+

CRAB symptoms

or

Bio-markers of malignancy

27
Q

What cells are involved in follicular lymphoma?

A

Centrocytes

Centroblasts

28
Q

What is the genetic cause of follicular lymphoma?

A

Heavy chain promoter region on chromosome 14 joining BCL.

leads to BCL2 Protein production

*this an anti-apoptotic protein

29
Q

What are the common genetic abnormalities of Diffuse Large B cell lymphoma?

A

BCL6 - promotes proliferation in germinal centres

BCL2 - 18:14

MYC gene: Warburg metabolism - promotes rapid cellular growth

30
Q

Whats an important protein expression on Diffuse large B cell lymphoma that allows it to be a target for Rituximab?

31
Q

What are the three types of Burkitt Lymphoma?

A

Endemic - Eptein Barr Virus

Sporadic - genetic mutation

Immunodeficiency -HIV

32
Q

What cells are involved in Burkitts lymphoma?

A

Centroblasts

33
Q

What is the common genetic defect in Burkitts lymphoma?

A

MYC gene activation

t(8:14) - MYC with IgH gene.

34
Q

What is a unique feature of Burkitts lymphoma in presentation?

A

Sarcoma of the mandible and maxillary region.

Ileocecal junction infiltration

35
Q

What is a major difference between hodgkins and non-hodgkins lymphoma in terms of spread?

A

Hodgkins has no extra-nodal involvement.

It spreads one node to the next.

36
Q

Where are lymphadenopathies most likely to occur in hodgkins lymphoma?

A

Mediastinal area

Cervical

37
Q

What is the bone marrow transplant where the patients own stem cells are used?

A

Autologous

38
Q

What is the bone marrow transplant when another persons stem cells are used?

39
Q

What is the chemotherapy regimen for Hodgkins lymphoma?

A

ABVD

A - Doxorubicin

B - Bleomycin

V - Vinblastine

D - Dacarbazine

40
Q

What is the chemotherapy regimen for non-Hodgkins lymphoma?

A

R - CHOP

R - Rituximab

C - Cyclophosphamide

H - Hydrooxy - Doxorubicin

O - Vincristine

P - Prednisolone

41
Q

How does the EBV cause Burkits lymphoma?

A

All B cells have a receptor for EBV - which promotes rapid proliferation of the B cells. - with increased B cell proliferation there is increased risk of mutations - which occurs eventually leading to translocation.

**note that this is why glandular fever is called infectious mononucleous as there is loads of B cells.

42
Q

What leukaemia can be treated with Vitamin A? and how does this work?

A

Acute Promyleotic Leukaemia - translocation of 15;17.

Vitamin A promotes maturation of the B cells - thus rendering them unable to divide.

43
Q

What leukeamia can be seen with Auer rods?

A

Acute promyleotic leukaemia

44
Q

Which type of lymphoma when excised will produce a “stary sky appearance”

A

Burkitt’s lymphoma

  • black sky - cancerous B cells
  • stars - activated macrophages
45
Q

What’s the common translocation of Diffuse Large cell lymphoma?

A

3;4 - BCL6

14;18 - BCL2

46
Q

Whats the management for AML?

A

Intensive Chemo +/- Stem cell transplant
- <60 years old. 1st time

Low dose chemo
- Relapse

Supportive management only

**young people tend to be entered into trials

47
Q

What kind of chemotherapy is used for AML?

A

Anthracycline

Cytarabine

48
Q

What are the typically translocations of ALL?

A

12;21

9;22 (ABL BCR) - poor prognostic

4;11 - poor prognostic

49
Q

When a bone marrow sample is sent, what is carried out?

A

Cell nature is distinguished

  • Immunocytochemistry
  • using antibodies

Cytogenetics
- Looking at the mutation present

50
Q

Outwith bone marrow disorders - what else may cause pancytopenia?

A

Hypersplenism

Peripheral consumption of blood cells

51
Q

What is the treatment for Acute leukaemia:

A

In young it is aggressive chemotherapy which intends to cure.

In elderly who could not stand the intense chemotherapy then they are given:

  • RBCs
  • Plasma transfusions
  • Antibiotics

Only in severe cases are Bone Marrow/ Stem cell transplants carried out

Those on clinical trials tend to do better as well
- which is mainly done for children

52
Q

What favourable circumstance may occur in Graft versus host disease?

A

Since in GVHD it is the graft targeting the host - it may destroy the leukemia cells as well - called Graft vs leukemia

53
Q

What is the chemotherapy for Acute Leukemia?

A

Prednisolone

cyclophosphamide

anthracycline

asparaginase

Vincristine

Etoposide

Cytarabine

54
Q

In addition to Chemotherapy - what other treatments may be given?

A

Fresh Frozen Plasma
- clotting factors

Platelets

Blood transfusion

Antibiotics

Growth factors

55
Q

What mutation can lead to aggressive chronic leukemia?

A

17 chromosome deletion leading to p53 defect

56
Q

What are the two common mutations for CLL?

57
Q

Whats the drug used for CML?

A

Imatinib - ATP substitute `

58
Q

What are the two common mutations seen in AML?

A

M2: 8;21

M3 15;17

Phase 3 (50 decks)

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