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BDS2 - diseases of the blood > Leukaemia and Lymphoma > Flashcards

Leukaemia and Lymphoma Flashcards

1
Q

what are the 2 cell types

A

> myeloid stem cell

> lymphoid stem cell

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2
Q

what are the 3 types of lymphoid stem cells

A

> pre-B stem cell
= B cells

> thymocyte
= T cells

> NK cells

(these are lymphocytes)

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3
Q

what are the 3 types of of myeloid stem cells

A

> BFU-E

> CFU-Meg

> CFU-GM

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4
Q

what do BFU-E cells divide into

A

CFU-E then become red cells (erythrocytes)

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5
Q

what do CFU-Meg cells become

A

> megakaryoblast

> platelets (megakaryocytes)

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6
Q

what are the different cells CFU-GM divides into

A

> neutrophils

> basophils

> eosinophils

> monocytes

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7
Q

what does over production of the end cell types develop into

A

malignancies

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8
Q

when can haematological cells turn neoplastic

A

at a number of stages

the earlier in the cell line it occurs the more potentially aggressive the malignancy

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9
Q

how do haematological malginancy occur

A

> DNA mutation (usually translocation - part of DNA strand gets artificially added on to the wrong part of the DNA chain when replicating and it ends up in wrong place)

> switches off a tumour suppressor gene or switches on an oncogene

> clonal proliferation
(one cell changes and this one become immortalised, tends to be more than one cell type in a tumour, ones which are hard to kill comes back)

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10
Q

what are characteristics of cancer cells

A

> uncontrolled proliferaton
loss of apoptosis
loss of normal function / products

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11
Q

what are the 2 classes of leukaemia and lymphoma

A

acute

chronic

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12
Q

give an example of acute lymphoid leukaemia

A

acute lymphoblastic leukaemia

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13
Q

give an example of acute myeloid leukaemia

A

acute myeloid leukaemia

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14
Q

name chronic lymphoid leukaemia / lymphomas

A

> chronic lymphocytic leukaemia
hodgkin lymphoma
non-hodgkin lymphoma
multiple myeloma

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15
Q

name chronic myeloid leukaemia / lymphoma

A

> chronic myeloid leukaemia

> myeloproliferative disorders

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16
Q

how is chronic lymphocytic leukaemia found

A

by accident
usually through a blood test but testing for something else
find lots of white blood cells present but no symptoms
changes to acute in a period of months = problem

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17
Q

what is hodgkin lymphoma

A

lots of white cells in lymph node

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18
Q

what is multiple myeloma

A

malignancy of basal cells

tendency to dissolve away bones (bones become hallowed out and break)

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19
Q

what do lymphocytic, lymphoblastic and myeloid describe

A

describe the point in the cell lines or cell type at fault

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20
Q

what do leukemic cells look like

A

they still look like the cells they are meant to be before malginancy

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21
Q

what do lymphoblastic cells look like

A

cant tell what type of cell it is meant to be

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22
Q

what does blast mean

A

immature cell

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23
Q

what is leukaemia

A

describes a group of cancer of the bone marrow which prevent normal manufacture of the blood and therefore result in
> anaemia
> infection (neutropenia)
> bleeding (thrombocytopenia)

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24
Q

what is the pathogenesis of leukaemia

A

> clonal proliferation
replacement of marrow
increasing marginalisation of productive normal marrow leading to marrow failure and organ infiltration

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25
Q

how do patients with leukaemia present

A

tiredness

spontaneous bleeding

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26
Q

what are the clinical presentations of leukaemia

A

> anaemia
problems carrying oxygen

> neutropenia
problems with infection

> thrombocytopenia
problems with bleeding

> lymphadenopathy
extra number of wbc
occupies bone marrow and spreads outside
whole cell lumps in lymph nodes and soft tissues
may not be palpable

> splenomegaly / hepatomegaly
swollen abdomen

> bone pain (children)
bone marrow trying to expand within the bone cavity itself

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27
Q

what are the symptoms of anaemia in a clinical presentation

A 
progressive 
> breathlessness
> tiredness
> easily fatigued
> chest pain / angina
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28
Q

what are the signs of anaemia in a clinical presentation

A 
> pallor
> signs of cardiac failure
- ankle swelling
- breathlessness
> nail changes
- brittle nails
- koilonychia
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29
Q

how does neutropenia appear clinically

A 
> infections associated with portals of entry
- mouth
- throat
§ tonsillitis 
§ pharyngitis 
- chest
§ bronchitis 
§ pneumonia
- skin
§ impetigo
§ cellulitis
- perianal 
§ thrush
§ abscesses

> reactivation of latent infections
(infection returns when immune system is suppressed)

> increased severity, frequency and can rapidly lead to systemic infection
(immune response reduces)

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30
Q

what is a major problem with tuberculosis

A

you never really get rid of the infection
whether treated or not
it remains in the body waiting for an opportunity to arise again
if immune system is suppressed the infection will return

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31
Q

what are the symptoms of a neutropenia infection

A

> recurrent infection

> unusual severity of infection

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32
Q

what are the signs of a neutropenia infection

A 
> unusual patterns of infection and rapid spread
> will respond to treatment but recur
> signs of systemic involvement
- fever
- rigors
- chills
> investigations
- unusual pathogens (usually bacterial)
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33
Q

what are the symptoms of bleeding at clinical presentation

A

> bruises easily or spontaneously
minor cuts fail to clot
gingival bleeding or nose bleeds (no gingivitis)
menorrhagia

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34
Q

what are the signs of bleeding at clinical presentation

A

> bruising
petechiae
BOP
bleeding / bruising following procedures

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35
Q

what is A.L.L.

A

acute lymphoblastic leukaemia

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36
Q

what cells does acute lymphoblastic leukaemia occur in

A

b cells / t cells

high up the differentiation process

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37
Q

what is the peak age group for acute lymphoblastic leukaemia to occur

A

around the age of 4
largely seen in children
can occur in adults too

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38
Q

when does acute lymphoblastic leukaemia develop over

A

days or weeks

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39
Q

what is the catabolic state of acute lymphoblastic leukaemia

A

> fever
sweats
malaise

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40
Q

what is common in acute lymphoblastic leukaemia

A

lymphadenopathy common

tissue infiltration common

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41
Q

who is the prognosis best for in acute lymphoblastic leukaemia

A

younger female patients

girls 2-12 do best

42
Q

how successful is treatment for acute lymphoblastic leukaemia in children

A

over 80% cured, almost 90%

very successful

43
Q

what is A.M.L

A

acute myeloid leukaemia

44
Q

when is acute myeloid leukaemia most common

A

most common in elderly
can occur at any age
not common in children

45
Q

what is the clinical presentation of acute myeloid leukaemia

A

similar to A.L.L.

46
Q

what is the prognosis for acute myeloid leukaemia

A

30-40% of over 60 y/os cured

10% cure for over 70 y/os (this is improving)

47
Q

what is C.L.L.

A

chronic lymphocytic (lymphoid) leukaemia

48
Q

what sort of disease is chronic lymphocytic leukaemia

A

b cell clonal lymphoproliferative disease

49
Q

what age is chronic lymphocytic leukaemia likely

A

older adults

peak age is over 70s

50
Q

how does chronic lymphocytic leukaemia occur / be discovered

A

occurs gradually over many years, slow progression
found by accident
no symptoms (asymptomatic)
patient unaware
usually discovered in routine blood tests

51
Q

which gender is more affect by chronic lymphocytic leukaemia

A

males : females

2:1

52
Q

is treatment needed for chronic lymphocytic leukaemia

A

may not need treatment
an aggressive form like occasional blast transformation may need treatment
treatment = monoclonal antibodies can take out specific cells and be removed from the blood

53
Q

what is chronic myeloid leukaemia

A

increase in neutrophils and their precursors

54
Q

what chromosome do patients have with chronic myeloid leukaemia and why

A

95% of patients have philadelphia chromosome
cell replication gone wrong
chromosome been moved into another chromosome and changes the transcription

55
Q

what is the peak age for chronic myeloid leukaemia

A

50-70s

can occur any age

56
Q

are males or females more likely to get chronic myeloid leukaemia

A

slight male preponderance

57
Q

what are the clinical presentations of chronic myeloid leukaemia

A 
fatigue 
weight loss
sweating 
anaemia 
bleeding 
splenomegaly
58
Q

what is lymphoma

A

generally solid lumps
normal number of white blood cells
abnormal collection of cells usually in lymph nodes
solid tumour but some cells in blood

59
Q

what are the 2 types of lymphoma

A

> hodgkin lymphoma

> non-hodgkin lymphoma

60
Q

which is more common hodgkin lymphoma or non hodgkin lymphoma

A

non hodgkin lymphoma is more common than hodgkin lymphoma (6:1)

61
Q

what does staging require

A

requires imaging
> CT
> PET / CT
> MRI

62
Q

what are the different categories of staging

A

> number of nodes involved and site
extra nodal involvement
systemic symptoms

63
Q

what is staging important in

A

predicting prognosis and deciding treatment

64
Q

define stage I

A

single lymph node region

65
Q

define stage II

A

two or more sites, same side of diaphragm

66
Q

define stage III

A

two or more sites on both sides of diaphragm

67
Q

define stage IV

A

diffuse involvement of extralymphatic site and / or nodal disease

68
Q

when is the peak incidence of hodgkin lymphoma

A

age 15-40 years

69
Q

are males or females more likely to develop hodgkin lymphoma

A

males > females

2:1

70
Q

name clinical presentations of hodgkins lymphoma

A 
> painless lymphadenopathy
- typically cervical
- fluctuate in size
- pain with alcohol notable
> fever
> night sweats
> weight loss
> itching
> infection
71
Q

what is the cure prognosis for stage I and II of hodgkins lymphoma

A

over 90%

72
Q

what is the cure prognosis for stage III and IV in hodgkins lymphoma

A

50-70%

older people do less well

73
Q

what are the types of non-hodgkin lymphoma

A

b cell type = 85%

t cell type = 15%

74
Q

what age is likely to develop non-hodgkin lymphoma

A

any age

more indolent in elderly

75
Q

what is the aetiology of non-hodgkin lymphoma

A

> microbial factors strongly implicated

  • EBC
  • HTLV-1
  • H.pylori

> autoimmune disease

  • sjogren’s syndrome
  • rheumatoid arthritis

> immunosuppression

  • AIDS
  • post-transplant
76
Q

what does H.pylori cause

A

stomach ulcers
strong connection between this and gastric lymphoma
infected element that is keeping the immune process going is causing the tumour
take away the infected element and the tumour shrinks

77
Q

why is a post-transplant patient at risk of non-hodgkins lymphoma

A

more vulnerable
prognosis is worse
more potential for treatment

78
Q

how does non-hodgkins lymphoma present

A

> lymphadenopathy

  • often widely disseminated
  • may be invisible

> extra-nodal disease more common
- oropharyngeal involvement
(waldeyer’s ring - noisy breathing and sore throat)

> symptoms of marrow failure

> constitutional symptoms less common

79
Q

what is the prognosis of non-hodgkins lymphoma

A

over 50% will relapse after treatment
aggressive disease, poor prognosis untreated but notably often responds better to treatmetn
indolent disease
hard to cure

80
Q

what is multiple myeloma

A

malignant proliferation of plasma cells
> plasma cells make lots of antibodies
> based on light chain and heavy chain combinations

81
Q

what are the features of multiple myeloma

A

> monoclonal paraprotein in blood and urine
lytic bone lesions - bone and fracture
excess plasma cells in bone marrow - marrow failure

82
Q

what is the mean age of diagnosis and which gender is more commonly affected by multiple myeloma

A

70 years

Males > females

83
Q

what is associated with multiple myeloma

A 
> infection
> bone pain
> renal failure
> amyloidosis
containable not treatable
can stop the effects it has on the body
84
Q

what are the treatments of haematological malignancies

A

> chemotherapy
radiotherapy
monoclonal antibodies
haemopoietic stem cell transplantation

85
Q

what sort of problem arises with bone marrow transplant

A

inflammatory problem

graft v host disease

86
Q

what is a safer way to have a bone marrow transplant

A

use patient’s own stem cells and clean them to remove the bad cells and place the good cells back in the patient again
this is less risky
wont reject own bone

87
Q

what concepts are associated with the treatment of haematological malignancies

A

> induction
= intense chemo, blast the bad cells out

> remission
= no cancer cells remaining

> maintenance and consolidation
= tries to ensure the cancer doesnt come back

> relapse
= not all cancer cells are removed, can only be removed if the cells can be accessed

these are predictable phases

88
Q

what is included in supportive therapy

A

> nutrition
psychological and social support
prevention and treatment of infection
managing symptoms of therapy side effects
correcting marked blood component deficits
pain control

89
Q

what does chemotherapy target

A

cells with high turnover rate

90
Q

what is the problem with chemotherapy

A

kill cells in other tissues that you need
responsible for many unwanted effects in normal high turnover tissues
causes ulcers cause no new cells come through to replace the old cells when they are killed

91
Q

what are the side effects of chemotherapy

A 
hair loss
nausea
vomiting
tiredness
these are improving
92
Q

what is a long term risk of chemotherapy in surviving patients

A

oncogenesis

93
Q

what does radiotherapy do

A

cytotoxic effect of ionising radiation
> beam directed from outside the body
> adjacent healthy tissue also irradiated
> effect of this minimised using complex spatial positioning, targeting and doing technique

94
Q

what risk does radiotherapy treatment carry

A

> risk of inducing late cancers

> damage to stem cell DNA

95
Q

What are monoclonal antibodies specific to

A

specific cancer cell antigens

96
Q

what do monoclonal antibody drug names end in

A

-mab

eg inflixmab

97
Q

where does the cells for a haemopoietic stem cell transplant come from

A 
a relative (sibling / close genetic match)
a stranger who has been matched
98
Q

what does allogenic transplant mean

A

stem cells are collected from a matching donor and transplanted into the patient to suppress the disease and restore the patient’s immune system

99
Q

what do autologous transplant mean

A

cells come from the patient

100
Q

what does haemopoietic stem cell transplant require

A

total body irradiation
eradicate malignant cells and host marrow = clean sheet
get rid of patents bone marrow
cant make any cells = chance of death is very high

101
Q

what are the risks associated with haemopoietic stem cell transplant

A

> life threatening infection
graft versus host disease
graft failure and total marrow failure
bone marrow failure = mortality

BDS2 - diseases of the blood (5 decks)

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