leukemia and lymphoma Flashcards
prevalence of acute in leukemia in children vs adults
30% of childhood cancers
2.3% of adult cancers
define leukemia
neoplastic disease, abnormal proliferation of WBCs
name the 4 types of leukemia (that we need to know)
acute lymphoblastic leukemia
chronic lymphoblastic leukemia
acute myelogenous leukemia
chronic myelogenour leukemia
difference between acute and chronic leukemia
acute is associated with proliferation of immature precursors in blood and marrow, chronic is associated with mature precursors
which genetic conditions predispose you to leukemia
down syndrome, neurofibromatosis, BMF syndromes
what environmental/iatrogenic factors predispose you to leukemia?
ionizing radiation, occupational exposure (benzene), prior radiation therapy, prior malignancy
in acute leukemia, what is the outcome of malignancy in immature precursors/ early hematopoietic precursors?
cell progeny does not differentiate/mature but proliferates uncontrollably. These “blasts” overtake the bone marrow, peripheral blood stream, lymph nodes
what is a typical WBC count with leukemia
varies widely
50% have normal-mild elevation
25% very high
25% decreased
what does a bone marrow biopsy show in leukemia
hypercellular marrow marrow fibrosis (AML)
when do you order a lumbar puncture?
with ALL always
if there are neurologic symptoms in a patient with AML
what disease presents with a mediastinal mass? (50%)
T-cell ALL
What is the characteristic histology finding with AML?
Auer rods (found in 30% of patients)
How long is induction with AML
10 days
What is the most common form of cancer in children
acute lymphoblastic leukemia (ALL)
associates symptoms common with ALL
splenomegaly, lymphadenopathy, bone pain
How long is induction with ALL
4 weeks
what is the management of ALL after induction?
post-remission consolidation for 6-8 weeks maintenance doses daily or weekly for 2-3 years CNS prophylaxis (intrathecal chemo)
What disease is associated with the Philadelphia Chromosome
Characteristic finding of CML, but also seen in ALL- means worse prognosis- lower remission rates
major sequelae of leukemia
subsequent cancers
complications associated with chemo
osteopenia, endcrine abnormalities, poor cardiac function
how does treatment of children with ALL differ from adults?
intensive multi-agent induction
less intensive maintenance
bone marrow transplant in 5%
treatment of children with AML?
6 months inpatients treatment- intensive and toxic
bone marrow transplant in 30%
Chronic lymphocytic leukemia (CLL) epidemiology
most common adult leukemia (western world)
male to female 2:1
median age of onset 72
CLL definition
proliferation of mature B cells, accumulation of long-lived mature lymphocytes, hypogammaglobulinemia
CLL clinical presentation
often asymptomatic- incidental finding fatigue appetite loss lymphadenopathy hepatosplenomegaly
CLL immunologic abnormalities
auto-immune hemolytic anemia
auto-immune thrombocytopenic purpura
monoclonal spike
hypogammaglobulinemia
how do you Dx CLL?
Flow cytometry
CLL staging
Rai Stage Stage 0 Lymphocytosis only Stage I Lymphadenopathy Stage II Splenomegaly Stage III Anemia Stage IV Thrombocytopenia
CLL staging- ABC
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
Treatment of CLL
usually none, only if progressive/severe symptoms
Define CML
proliferative hematopoeitic stem cells
characteristic abnormalities
Philadelphia chromosome
BCR-ABL tyrosine kinase
epi of CML
median age 45-65
slightly male
increase risk with age
3 phases of CML
chronic
accelerated
blastic crisis
presentation of CML
often asymptomatic fatigue anorexia abdominal fullness splenomegaly
CML CBC findings
leukocytosis
thrombocytosis
anemia
basophilia
lymphoma symptoms
painless lymphadenopathy
constitutional symptoms
extranodal involvement
hodgkin lymphoma epi
bimodal- 15-34 years and >60
male
associated with viral infections
key finding to suggest hodgkin lymphoma
painless, mobile, rubbery lymph nodes
worse/painful with alcohol
B symptoms
Reed Sternberg Cells
how to Dx hodgkin lymphoma
biopsy- see Reed Sternberg cell
treatment of hodgkin lymphoma
radiotherapy and chemotherapy, length depends on stage
complications of hodgkin lymphoma treatment
immunologic deficit
thyroid dysfunction
cardiac dysfunction
secondary malignancies
non-hodgkin lymphoma epi
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
clinical presentation of non-hodgkin lymphoma
lymph node involvement
splenomegaly
B symptoms
non-hodgkin lymphoma staging
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)
non-hodgkin treatment
chemotherapy +/- radiation depending on staging
prognosis variable depending on staging
