Leukaemias and Lymphomas Flashcards
What investigation can be used to identify normal progenitors and stem cells?
Immunophenotyping
What investigation can be used to identify mature lymphoid cells?
Immunophenotyping
What investigation can be used to identify mature non-lymphoid cells?
Morphology (i.e. blood count and film)
Leukaemias are tumours where?
The bone marrow
Lymphomas are tumours where?
The lymph nodes
Which is usually more clinically aggressive- acute or chronic leukaemias?
Acute
Acute leukaemias are caused by uncontrolled proliferation of what cells?
Partially developed white blood cells (blast cells)
Which type of acute leukaemia is more commonly seen in children?
Acute lymphoblastic leukaemia
Which type of acute leukaemia is more commonly seen in older individuals?
Acute myeloid leukaemia
In acute leukaemia, in what peripheral organs and tissues may blast cells, particularly lymphoblasts, settle in?
Liver, spleen, lymph nodes and thymus
What are the 3 main symptoms of acute leukaemias as a result of anaemia, thrombocytopenia and leukopenia?
Fatigue, easy bruising/bleeding, increased susceptibility to infections
What symptom may occur in individuals with acute leukaemia due to increased cell production in the bone marrow?
Pain and tenderness in the bones
What are the first line investigations for acute leukaemias?
Full blood count and peripheral blood film
A peripheral blood film showing the presence of lots of blast cells is suggestive of what diagnosis?
An acute leukaemia
What investigation is required to confirm acute leukaemia and what will it show?
Bone marrow biopsy showing > 20% blast cells
What is the first line treatment for both types of acute leukaemia?
Chemotherapy
What is the most common malignancy affecting children?
Acute lymphoblastic leukaemia
What age is the peak incidence of ALL?
2-3 years
Are boys or girls more likely to be affected by ALL?
Boys
What feature is present in up to 50% of new cases of ALL, which may represent infection or a constitutional symptom?
Fever
What investigation may be used to assess for CNS involvement of ALL?
Lumbar puncture
After induction and consolidation chemotherapy, how long is maintenance chemotherapy given for in those with ALL? What is the aim of this?
Up to 3 years, to reduce the risk of recurrence
What treatment may be offered to those with ALL who continue to relapse despite adequate treatment with chemotherapy?
Stem cell transplant
What is the 5-year survival rate of ALL in children?
80-90%
AML may occur as a primary disease or following a secondary transformation from what conditions?
Myeloproliferative disorders
Bony pain and lymphadenopathy are more likely to be features of which type of acute leukaemia?
ALL
Organomegaly, haemorrhage and DIC are more likely to be features of which type of acute leukaemia?
AML
The formation of mediastinal or abdominal masses is more likely to be a feature of which type of acute leukaemia?
AML
What type of anaemia is typically seen in acute leukaemias?
Normocytic anaemia
Auer rod cells on a peripheral blood film is suggestive of what diagnosis?
AML
Which type of bacteria can cause fulminant life-threatening sepsis in neutropenic patients?
Gram negative bacteria
What should be suspected if a neutropenic patient has a persisting fever and is unresponsive to antibiotics?
Fungal infection
Immature B cells known as smudge/smear cells are seen on a peripheral blood film of individuals with what condition?
Chronic lymphocytic leukaemia
What investigation can be used to make a definitive diagnosis of chronic myeloid leukaemia?
Genetic testing
The Philadelphia chromosome is present in more than 95% of patients with which condition?
CML
The Philadelphia chromosome describes a translocation between the long arms of which two chromosomes?
9 and 22
The BCR-ABL gene is the hallmark of what condition?
CML
At what age does chronic myeloid leukaemia typically present?
60-70 years
Chronic myeloid leukaemia can develop into what other malignancy?
Acute leukaemia, most commonly AML
What is the first line treatment for chronic myeloid leukaemia?
Imatinib
What type of drug is imatinib?
Tyrosine kinase inhibitor
Chronic lymphocytic leukaemia is caused by a monoclonal proliferation of well differentiated lymphocytes which are almost always which type of cell?
B cells
What is the most common form of leukaemia seen in adults?
CLL
Hypogammaglobulinaemia leading to recurrent infections is a potential complication of which leukaemia?
CLL
Chronic lymphocytic leukaemia may progress to what other malignancy?
High-grade non-Hodgkin’s lymphoma (Richter’s transformation)
Reed-Sternberg cells are pathognomonic of what condition?
Hodgkin’s lymphoma
When are the two peaks of Hodgkin’s lymphoma?
In the 3rd and 7th decades of life
Describe how a lymph node with lymphoma will feel?
Enlarged, painless, ‘rubbery’
Alcohol induced lymph node pain is seen in which condition?
Hodgkin’s lymphoma
What complications can mediastinal lymph node involvement of a lymphoma lead to?
Bronchial or SVC obstruction
What type of anaemia is seen in lymphoma?
Normocytic anaemia
What happens to LDH in Hodgkin’s lymphoma?
Increased
What is the investigation of choice for lymphoma?
Lymph node excision biopsy
What staging system is used for lymphomas?
Ann-Arbor system
What stage would a lymphoma be that is confined to a single lymph node?
Stage 1
What stage would a lymphoma be that involves two or more nodal areas on the same side of the diaphragm?
Stage 2
What stage would a lymphoma be that involves nodes on both sides of the diaphragm?
Stage 3
What stage would a lymphoma be that has spread beyond the lymph nodes to the liver or spleen?
Stage 4
Each stage of lymphoma can be further classified as A or B, what is meant by A?
No systemic features other than pruritus
Each stage of lymphoma can be further classified as A or B, what is meant by B?
System features such as weight loss, fever or night sweats
How are early stage Hodgkin’s lymphomas treated?
Radiotherapy +/- chemotherapy
How are late stage Hodgkin’s lymphomas treated?
Chemotherapy
What is the most common subtype of Hodgkin’s lymphoma?
Nodular sclerosing
Which subtype of Hodgkin’s lymphoma has the best prognosis?
Lymphocyte predominant
Which subtype of Hodgkin’s lymphoma has the worst prognosis?
Lymphocyte depleted
Gastric MALT lymphomas are caused by what?
H pylori infection
Do systemic symptoms typically occur earlier in Hodgkin’s or non-Hodgkin’s lymphoma?
Hodgkin’s
Is extranodal disease more common in Hodgkin’s or non-Hodgkin’s lymphoma?
Non-Hodgkin’s
Which type of non-Hodgkin’s lymphomas have a better prognosis- low-grade or high-grade?
Low-grade
Which type of non-Hodgkin’s lymphoma is more likely to be curable- low-grade or high-grade?
High-grade
What treatment may be used for localised low-grade non-Hodgkin’s lymphoma?
Radiotherapy
What treatment is used for high-grade non-Hodgkin’s lymphoma?
R-CHOP chemotherapy regimen
What type of lymphoma is Burkitt’s lymphoma?
High grade B cell non-Hodgkin’s lymphoma
The endemic (African) form of Burkitt’s lymphoma typically affects where?
The maxilla or mandible
The sporadic form of Burkitt’s lymphoma typically affects where?
The abdomen
The sporadic form of Burkitt’s lymphoma is mostly seen in individuals with what underlying condition?
HIV
Burkitt’s lymphoma is associated with the c-myc gene translocation, this is usually between which chromosomes?
8 and 14
What virus is strongly implicated in the development of Burkitt’s lymphoma?
EBV
Microscopy showing a ‘starry sky’ appearance is suggestive of what diagnosis?
Burkitt’s lymphoma
How is Burkitt’s lymphoma treated?
Chemotherapy
Itch without a rash is most likely to be associated with which type of lymphoma?
Hodgkin’s lymphoma
Is non-Hodgkin’s lymphoma more commonly B cell or T cell?
B cell
