leukemia

Question 1

AML characteristics

Answer 1

most common leukemia in older adults

most idiopathic, trisomy 21, or therapy-induced, myelodysplastic syndrome

DX: bmbx w 20% blasts

symptom onset < 3 months

Question 2

heme malignancy symptomatology

Answer 2

fatigue, anorexia, weight loss, fever, bruising/bleeding

Question 3

AML labs

Answer 3

anemia, reduced reticulocyte count
leukocytosis/leukopenia
thrombocytopenia, odd shapes

Question 4

AML exam findings

Answer 4

fever
splenomegaly
hepatomegaly
lymphadenopathy

Question 5

general supportive care

Answer 5

central venous access

transfusions (hgb >7, plt >10 unless bleeding then 20)

acute infection monitoring - filgrasim 24 hr after chemo

prophylaxis - antiviral (acyclovir), anti fungal (fluconazole), PJP (bactrim)

Question 6

AML treatment

Answer 6

induction - 7+3 regimen = cytarabine and daunorubicin

evaluate for response w BMBx (<5% blasts)

SCT for <60 yrs

continued chemotherapy to prevent relapse in select patients

Question 7

ALL characteristics

Answer 7

greatest risk in first 5 years of life

unknown cause, some genetic risks

DX: BMBX, peripheral blood smear, LP

Question 8

ALL symptomatology

Answer 8

B symptoms - fever, chills, night sweats, weight loss

fatigue, easy bruising

Question 9

ALL labs

Answer 9

pancytopenia

Question 10

ALL treatment

Answer 10

pediatric-inspired regimens

induction, consolidation, maintenance phases

intense inpatient regimen for 3 months

SCT

4+years of therapy probable

Question 11

CML characteristics

Answer 11

mean age at diagnosis 55-65
RF: radiation

Philadelphia chromosome 90% cases

Question 12

CML symptomatology

Answer 12

fatigue, anemia, splenomegaly

weight loss if high cell burden

hyperviscocity events - MI, CVA, visual changes, dyspnea, confusion

blast phase - fever, weight loss, bone/joint pain, bleeding and thrombotic events, infections

Question 13

CML physical exam

Answer 13

hepatomegaly
splenomegaly
lymphadenopathy
infection?
petechiae/purpura?

Question 14

CML labs

Answer 14

leukocytosis w left shift
thrombocytosis
thrombocytopenia (rare)
anemia

Question 15

CML diagnosis

Answer 15

BMBx- hyper cellular with myeloid hyperplasia & high myeloid-to-erythroid ratio

blasts <5%

Question 16

CML treatment

Answer 16

BCR-ABL1 tyrosine kinase inhibitors
BCR-ABL1 oncoprotein synthesis inhibitor

SCT - 2nd/3rd line

Question 17

CLL characteristic

Answer 17

cancer of older adults

proliferation of mature B lymphocytes

can be very stable, many do not require treatment at time of dx

prognosis - IGHV

Question 18

CLL diagnosis

Answer 18

most incidental on CBC

flow cytometry

no BMBx!!!!

Question 19

CLL treatment

Answer 19

watchful waiting
criteria for starting treatment: bone marrow failure, splenomegaly, hepatomegaly, constitutional symptoms

chemo - FCR (fludarabine, cyclophosphamide, rituximab)

SCT only curative (but not many candidates)