Leukemia and Lymphoma Flashcards
What is the median age at diagnosis for AML
68
How does AML present
Nonspecific symptoms that have been around for 3 months or less
-weight loss
-fever
-cough
-bone pain
-bruising / easy bleeding
What is the workup for AML
Variable WBC count (>20% blasts)
Low neutrophil count
What is the workup for AML
Variable WBC count (>20% blasts)
Low neutrophil count
Thrombocytopenia
*decreased reticulocyte count
What will be present on histology reports in AML
Auer rods
What are supportive measures for AML
Platelet transfusions
PRBCs
Prophylaxis with neutropenia
Prompt abx if febrile
What lab value is determinant of remission
blasts <5%
What are some antibiotics you could use for someone with AML who has a fever
Imipenem
Meropenem
Pipercillin/tazobactam
Which gender is more prone to developing CML
Males
What is the average age of diagnosis for someone with CML
65y/o
*rare under age 40
What is the pathophys of CML
Bar-abl (philadelphia chromosome) results in hyperactive Tyrosine
*Interferes with JAK/STAT pathway to produce resistance to apoptosis
What are some lab findings of CML
Leukocytosis
Thrombocytosis
What gives a definitive dx of CML
Bone marrow bx
genetic testing
What is the first line treatment of CML
Tyrosine Kinase Inhibitor
What is curative treatment of CML
Bone marrow transplant
What are signs that CML is progressing
Leukocytosis is resistant to treatment
Worsening anemia
Fever
Increased number of blasts / basophils
What is the most common malignancy in kids
ALL
What causes ALL
T or B cell mutations
Which cell line mutation has a worse prognosis
T cell mutation
Which children have an increased risk of developing ALL
Children with Down syndrome
What is the presentation of ALL
Fever
Fatigue/lethargy
Bone pain
Weight loss
Fever
Bruising / easy bleeding
What is the most common finding of ALL
Pallor
petechiae
ecchymosis
What laboratory findings will be found with ALL
Leukocytes (normal or elevated)
Most patients will have blasts
Elevated eosinophils
neutropenia
thrombocytopenia
How do you get a definitive diagnosis for ALL
Bone marrow biopsy
What is considered a cute in ALL
10 or more years in remission
What is CLL
malignancy of B lymphocytes
What are risk factors for CLL
Agent orange (vietname vets)
Hairdressers
Farmers
hx of HCV infection
What are some symptoms with CLL
Fatigue
lymphadenopathy (non painful)
What are some laboratory findings of CLL
Sustained lymphocytosis >20,000
CD19 & CD5 on flow cytometry
*platelet count usually normal
What occurs in stage 1 of CLL
Presence of lymphadenopathy
What stage CLL does Spleno- hepatomegaly occur in
Stage 2
What occurs in stage 3 of CLL
Presence of anemia
What stage of CLL does the presence of thrombocytopenia occur in
Stage 4
What is the first line treatment for CLL
observation
What is the first line treatment if the patient is symptomatic
Bruton tyrosine kinase inhibitors
What is the median age of diagnosis for non-hodgkin lymphoma
76
What do oncogenes allow for
Promote unchecked cell proliferation
What does the tumor suppressor gene do
Stop cell proliferation
What occurs in burrito lymphoma
Unchecked proliferation of B-cell proliferation
What occurs in follicular lymphoma
Inhibition of Apoptosis
How does Non-hodgkin lymphoma present
Lymphadenopathy (painless)
B symptoms
What are B symptoms in Hodgkin lymphoma
Fever
Night sweats (drenching)
Weight loss (>10% in 6 months)
how do you get a definitive diagnosis of non-hodgkin lymphoma
Lymph node biopsy
How do you do staging with non-hodgkin lymphoma
PET/CT
Bone marrow bx
+/- LP
What is the mainstay treatment of non-hodgkin lymphoma
Chemotherapy
When can radiation therapy be used in non-hodgkin lymphoma
Stage 1 or 2 disease
When are bone marrow transplants used in non-hodgkin lymphoma
Reserved for relapse that remain positive to chemotherapy
What is the median age of diagnosis for Hodgkin lymphoma
39-40
What is the average age range for Hodgkin lymphoma
20-34
Which gender is at higher risk for developing Hodgkin lymphoma
Males
What are the risk factors for Hodgkin lymphoma
Epstein Barr virus
HIV
Aids
What is the presence of Hodgkin lymphoma
Similar to non-hodgkin lymphoma
-arisus from single lymph node
-contiguous spread
-hemotogenous spread
*generalized pruritic with ETOH ingestion and bathing
What will be seen on a lymph node biopsy for Hodgkin lymphoma
Reed-sternberg cell on biopsy
-owl eye appearance
-Symmetric, bilobed nucleus
What is the most common primary bone malignancy
Multiple myeloma
Which ethnicity is at higher risk of developing multiple myeloma
African American
What type of cell makes up multiple myeloma
Plasma cell tumor
What is often the first symptom of multiple myeloma
Bone pain
What will be seen on laboratory workup of multiple myeloma
Anemia (rouleau formation)
Hypercalcemia
Proteinuria (bence jones protein)
What signs allow for diagnosis of multiple myeloma
Presence of paraproteins
Moth eaten appearance on imaging
CRAB symptoms
What is the gold standard for multiple myeloma diagnosis
Biopsy
“fried egg appearance”
What are CRAB symptoms
HyperCalcemia
Renal insufficiency
Anemia
Bone lesions
How does Leukopenia generally present
Infections
What are some causes of neutropenia
Drugs (chemo)
Infection
Nutritional
Genetic
Hematologic disease
Hypersplenism
Autoimmune diseases
What ANC is indicative of infection risk
ANC< 1,000
What are some causes of lymphopenia
Acute stressful illness (MI, sepsis)
Glucocorticoids
Lymphoma
Radiation
Bone marrow failure
What are causes of monocytopenia
Acute stressful illness
Aplastic anemia
Leukemia
Immunosuppressants
What are causes of eosinopenia
Glucocorticoids
