Leukemia and Lymphoma Flashcards
Definition of febrile neutropenia
WCC<2 or neutrophils<1
Mx of febrile neutropenia (3)
low risk: ceftriaxone+blood cultures
medium: piptaz+gent+cultures
septic shock: vancomycin+meropenem+gent
RFs for ALL (2)
down’s
radiation
(does not run in families)
Features of ALL (4)
CNS involvement common
period before Dx consists of 2-4 wks of:
- lymphadenopathy
- anaemia, bleeding, infection
- orchidomegaly
Classification of ALL (3)
morphological: L1/2/3
surface antigens:
- B-cell precursor: most common
- B Cell (B-lymphoblastic)
- T cell (T-lymphoblastic)
chromosomal analysis:
-philadelphia=poor prognosis
Ix for ALL (8)
Raised WCC: lymphoblasts
CXR/CT: lymphadenopathy, lytic bone lesions and pneumonia
LP for CNS involvement:
-raised WCC w. blast forms
low platelets
normocytic anaemia
raised urate and LDH
marrow biopsy: 50-90% of nucleated cells are blasts
Common translocations:
- TEL-AML: 12-21
- philadelphia: 9-22
Mx of ALL (6)
supportive: bloods/platelets, fluids, allopurinol
insert SC port/hickman line for IV access
chemo:
- induction: 3 drug induction+intrathecal methotrexate to induce remission
- consolidation and CNS prophylaxis: cranial irradiation if known CNS disease
- maintenance: daily mercaptopurine+weekly intrathecal methotrexate+vincristine/steroids. 3 months of intrathecal drugs. co-trimoxazole prophylaxis
- imatinib if phil. +ve
Poor prognostic factors for ALL (4)
male
philadelphia Cr
CNS involvement
<1yr/>10yrs
Assoc. of AML (6)
Fanconi anaemia
Down’s
Edward’s
Li-Fraumeni
NF1
Osler-Weber-Rendu
RFs for AML (6)
chromosomal abnormalities-Down’s
radiation/chemicals (benzene)
chemotherapy
myelodysplastic syndromes
myeloproliferative syndromes
CML
Features and presentation of acute promyelocytic anaemia (APML) (4)
pml-RARA fusion protein
DIC most common
gum hypertrophy
hepatosplenomegaly
Ix for AML
marrow biopsy: auer rods
Rx of AML (2)
all-trans-retinoic-acid (ATRA) for APML: poorer prognosis than AML
allogenic marrow transplant improves survival; may be offered if suitable donor found
Presentation of lymphoma (4)
lymphadenopathy
mediastinal mass: SVC obs
Long Hx
B Sx rare
Peak incidence and characteristic features of HL (2)
young and elderly
characterised by Reed-Sternberg cells
RFs for HL (5)
sibling affected
EBV
SLE
transplantation
obesity
Presentation of HL (3)
painless, enlarged lymph nodes: may fluctuate in size. alcohol may bring pain
B-Sx
Guillan-Barre
Ix for HL (2)
LN biopsy (not FNA):
- nodular sclerosing: most common
- lymphocyte predominant: best prognosis
- lymphocyte depleted: worst prognosis
- mixed cellularity
Bloods:
- FBC
- ESR
- raised LDH
- raised urate and Ca
Staging of HL (4)
I: confined to single LN
II: two or more LNs on same side of diaphragm
III: two or more LNs on opposite sides of diaphragm
IV: extra-nodal spread
for each stage:
-A/B depending on B-Sx
Mx and prognosis of HL (3)
RT+short course chemo
for relapses:
-high dose chemo+autologous SC transplant
prognosis better than NHL
RFs for NHL (4)
chronic immune stimulation:
- HIV
- H-pylori
- transplantation
- HTLV-1
environmental carcinogens
congenital
radiation
Presentation of NHL (5)
75% w. nodal disease
25% w. extra-nodal disease:
- skin involvement e.g. sezary syndrome
- oropharynx
- gut: gastric MALT(h. pylori), non-MALT gastric lymphomas, small bowel.
B Sx more rare than in HL
Ix for NHL (5)
Bloods: FBC, LFT, U+Es, LDH (raised LDH=poor prognosis)
LN/marrow biopsy for classification
XR/CT chest/abdo/pelvis for staging
cytology of any effusions
LP if CNS signs
Classification of NHL (2)
low/high grade
Features of low-grade NHL (4)
Follicular (18:14; B cell)
marginal zone lymphoma/MALT
lymphocytic lymphoma
lymphoplasmocytoid lymphoma (Waldenstrom’s)
Features of high-grade NHL (4)
Diffuse large B cell: most common
lymphoblastic lymphoma
Burkitt’s: (8:14, IgH-Myc) assoc. w. EBV
T cell lymphomas
Rx and criteria for Rx of low-grade NHL (5)
Rx if:
- LNs causing blockage/pain
- marrow failure
- B Sx
localised radiotherapy can cure stage I/II
Chemo
Rx of high-grad NHL
R-CHOP
