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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
What features are seen on x-ray for multiple myeloma?
Osteolytic erosions - due to the substances released from cancer cells.
26
What is the diagnostic criteria of multiple myeloma?
>10% plasma cells in bone marrow + CRAB symptoms or Bio-markers of malignancy
27
What cells are involved in follicular lymphoma?
Centrocytes Centroblasts
28
What is the genetic cause of follicular lymphoma?
Heavy chain promoter region on chromosome 14 joining BCL. leads to BCL2 Protein production *this an anti-apoptotic protein
29
What are the common genetic abnormalities of Diffuse Large B cell lymphoma?
BCL6 - promotes proliferation in germinal centres BCL2 - 18:14 MYC gene: Warburg metabolism - promotes rapid cellular growth
30
Whats an important protein expression on Diffuse large B cell lymphoma that allows it to be a target for Rituximab?
CD20
31
What are the three types of Burkitt Lymphoma?
Endemic - Eptein Barr Virus Sporadic - genetic mutation Immunodeficiency -HIV
32
What cells are involved in Burkitts lymphoma?
Centroblasts
33
What is the common genetic defect in Burkitts lymphoma?
MYC gene activation t(8:14) - MYC with IgH gene.
34
What is a unique feature of Burkitts lymphoma in presentation?
Sarcoma of the mandible and maxillary region. Ileocecal junction infiltration
35
What is a major difference between hodgkins and non-hodgkins lymphoma in terms of spread?
Hodgkins has no extra-nodal involvement. It spreads one node to the next.
36
Where are lymphadenopathies most likely to occur in hodgkins lymphoma?
Mediastinal area Cervical
37
What is the bone marrow transplant where the patients own stem cells are used?
Autologous
38
What is the bone marrow transplant when another persons stem cells are used?
Allogenic
39
What is the chemotherapy regimen for Hodgkins lymphoma?
ABVD A - Doxorubicin B - Bleomycin V - Vinblastine D - Dacarbazine
40
What is the chemotherapy regimen for non-Hodgkins lymphoma?
R - CHOP R - Rituximab C - Cyclophosphamide H - Hydrooxy - Doxorubicin O - Vincristine P - Prednisolone
41
How does the EBV cause Burkits lymphoma?
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
What leukaemia can be treated with Vitamin A? and how does this work?
Acute Promyleotic Leukaemia - translocation of 15;17. Vitamin A promotes maturation of the B cells - thus rendering them unable to divide.
43
What leukeamia can be seen with Auer rods?
Acute promyleotic leukaemia
44
Which type of lymphoma when excised will produce a "stary sky appearance"
Burkitt's lymphoma * black sky - cancerous B cells * stars - activated macrophages
45
What's the common translocation of Diffuse Large cell lymphoma?
3;4 - BCL6 14;18 - BCL2
46
Whats the management for AML?
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
What kind of chemotherapy is used for AML?
Anthracycline Cytarabine
48
What are the typically translocations of ALL?
12;21 9;22 (ABL BCR) - poor prognostic 4;11 - poor prognostic
49
When a bone marrow sample is sent, what is carried out?
Cell nature is distinguished - Immunocytochemistry - using antibodies Cytogenetics - Looking at the mutation present
50
Outwith bone marrow disorders - what else may cause pancytopenia?
Hypersplenism Peripheral consumption of blood cells
51
What is the treatment for Acute leukaemia:
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
What favourable circumstance may occur in Graft versus host disease?
Since in GVHD it is the graft targeting the host - it may destroy the leukemia cells as well - called Graft vs leukemia
53
What is the chemotherapy for Acute Leukemia?
Prednisolone cyclophosphamide anthracycline asparaginase Vincristine Etoposide Cytarabine
54
In addition to Chemotherapy - what other treatments may be given?
Fresh Frozen Plasma - clotting factors Platelets Blood transfusion Antibiotics Growth factors
55
What mutation can lead to aggressive chronic leukemia?
17 chromosome deletion leading to p53 defect
56
What are the two common mutations for CLL?
p53 11;22
57
Whats the drug used for CML?
Imatinib - ATP substitute `
58
What are the two common mutations seen in AML?
M2: 8;21 M3 15;17

Phase 3 (50 decks)

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