leukemia and lymphoma Flashcards

1
Q

prevalence of acute in leukemia in children vs adults

A

30% of childhood cancers

2.3% of adult cancers

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2
Q

define leukemia

A

neoplastic disease, abnormal proliferation of WBCs

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3
Q

name the 4 types of leukemia (that we need to know)

A

acute lymphoblastic leukemia
chronic lymphoblastic leukemia
acute myelogenous leukemia
chronic myelogenour leukemia

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4
Q

difference between acute and chronic leukemia

A

acute is associated with proliferation of immature precursors in blood and marrow, chronic is associated with mature precursors

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5
Q

which genetic conditions predispose you to leukemia

A

down syndrome, neurofibromatosis, BMF syndromes

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6
Q

what environmental/iatrogenic factors predispose you to leukemia?

A

ionizing radiation, occupational exposure (benzene), prior radiation therapy, prior malignancy

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7
Q

in acute leukemia, what is the outcome of malignancy in immature precursors/ early hematopoietic precursors?

A

cell progeny does not differentiate/mature but proliferates uncontrollably. These “blasts” overtake the bone marrow, peripheral blood stream, lymph nodes

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8
Q

what is a typical WBC count with leukemia

A

varies widely
50% have normal-mild elevation
25% very high
25% decreased

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9
Q

what does a bone marrow biopsy show in leukemia

A
hypercellular marrow
marrow fibrosis (AML)
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10
Q

when do you order a lumbar puncture?

A

with ALL always

if there are neurologic symptoms in a patient with AML

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11
Q

what disease presents with a mediastinal mass? (50%)

A

T-cell ALL

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12
Q

What is the characteristic histology finding with AML?

A

Auer rods (found in 30% of patients)

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13
Q

How long is induction with AML

A

10 days

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14
Q

What is the most common form of cancer in children

A

acute lymphoblastic leukemia (ALL)

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15
Q

associates symptoms common with ALL

A

splenomegaly, lymphadenopathy, bone pain

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16
Q

How long is induction with ALL

A

4 weeks

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17
Q

what is the management of ALL after induction?

A
post-remission consolidation for 6-8 weeks
maintenance doses daily or weekly for 2-3 years
CNS prophylaxis (intrathecal chemo)
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18
Q

What disease is associated with the Philadelphia Chromosome

A

Characteristic finding of CML, but also seen in ALL- means worse prognosis- lower remission rates

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19
Q

major sequelae of leukemia

A

subsequent cancers

20
Q

complications associated with chemo

A

osteopenia, endcrine abnormalities, poor cardiac function

21
Q

how does treatment of children with ALL differ from adults?

A

intensive multi-agent induction
less intensive maintenance
bone marrow transplant in 5%

22
Q

treatment of children with AML?

A

6 months inpatients treatment- intensive and toxic

bone marrow transplant in 30%

23
Q

Chronic lymphocytic leukemia (CLL) epidemiology

A

most common adult leukemia (western world)
male to female 2:1
median age of onset 72

24
Q

CLL definition

A

proliferation of mature B cells, accumulation of long-lived mature lymphocytes, hypogammaglobulinemia

25
Q

CLL clinical presentation

A
often asymptomatic- incidental finding
fatigue
appetite loss
lymphadenopathy
hepatosplenomegaly
26
Q

CLL immunologic abnormalities

A

auto-immune hemolytic anemia
auto-immune thrombocytopenic purpura
monoclonal spike
hypogammaglobulinemia

27
Q

how do you Dx CLL?

A

Flow cytometry

28
Q

CLL staging

A
Rai Stage
Stage 0 Lymphocytosis only
Stage I Lymphadenopathy
Stage II Splenomegaly
Stage III Anemia
Stage IV Thrombocytopenia
29
Q

CLL staging- ABC

A

Binet Stage
A: <3 areas of lymphadenopathy. No anemia/ thrombocytopenia
B: 3 or more involved LN areas. No anemia/ thrombocytopenia
C: Hemoglobin <10 g/dl or <100,000 platelets

30
Q

Treatment of CLL

A

usually none, only if progressive/severe symptoms

31
Q

Define CML

A

proliferative hematopoeitic stem cells

32
Q

characteristic abnormalities

A

Philadelphia chromosome

BCR-ABL tyrosine kinase

33
Q

epi of CML

A

median age 45-65
slightly male
increase risk with age

34
Q

3 phases of CML

A

chronic
accelerated
blastic crisis

35
Q

presentation of CML

A
often asymptomatic
fatigue
anorexia
abdominal fullness
splenomegaly
36
Q

CML CBC findings

A

leukocytosis
thrombocytosis
anemia
basophilia

37
Q

lymphoma symptoms

A

painless lymphadenopathy
constitutional symptoms
extranodal involvement

38
Q

hodgkin lymphoma epi

A

bimodal- 15-34 years and >60
male
associated with viral infections

39
Q

key finding to suggest hodgkin lymphoma

A

painless, mobile, rubbery lymph nodes
worse/painful with alcohol
B symptoms
Reed Sternberg Cells

40
Q

how to Dx hodgkin lymphoma

A

biopsy- see Reed Sternberg cell

41
Q

treatment of hodgkin lymphoma

A

radiotherapy and chemotherapy, length depends on stage

42
Q

complications of hodgkin lymphoma treatment

A

immunologic deficit
thyroid dysfunction
cardiac dysfunction
secondary malignancies

43
Q

non-hodgkin lymphoma epi

A

increasing prevalence- unknown why
common in AIDS patients
average age at Dx- 42
risk groups- occupational exposure to hazardous material, viral exposure, low veggie/high red meat diet
drink a little wine to protect yourselves ladies

44
Q

clinical presentation of non-hodgkin lymphoma

A

lymph node involvement
splenomegaly
B symptoms

45
Q

non-hodgkin lymphoma staging

A

Stage I
– Involvement of single lymph node (LN) region
Stage II
– >2 LN regions on same side of diaphragm
Stage III
– LNs on both sides of diaphragm
Stage IV
– Multifocal involvement of >1 extra-lymphatic sites (e.g., liver, bone marrow, lung)

46
Q

non-hodgkin treatment

A

chemotherapy +/- radiation depending on staging

prognosis variable depending on staging