Leukemia and Lymphoma Flashcards
Leukopenia is a WBC count less than…
< 4.5k
leukocytosis is a WBC count…
> 11K
This leukemia:
is the most common acute leukemia in adults
Average age is 65 yo
rare and rarely fatal,
acute myeloid leukemia (AML)
A 65 yo patient w/ a hx of benzene exposure complains of anemic sxs, neutropenic sxs (fever), bleeding, and ophthalmic changes.
What do you suspect based off this hx?
AML
For a pt. you suspect of AML, what should you expect to see on CBC with Diff and in the peripheral smear
+ pancytopenia
+ 20% blasts
+ Auer Rods on peripheral smear
For a pt. you suspect of AML, what would a CMP show? What two other labs might help with a dx?
elevated creatinine, liver fxn, increased potassium, calcium
elevated Uric Acid and elevated LDH
Can auer rods be seen in disorders other than AML?
Yes, they are pathognomonic only of myeloblasts
You suspect a patient has AML.
Labs indicate the following:
+ pancytopenia
+ elevated LDH, Uric Acid
+ elevated calcium and potassium
+ Auer Rods
What test do you want ot order to confirm you dx?
bone marrow aspiration and biopsy showing 20% blasts
Induction tx for AML includes what?
chemotherapy for 6 mo
consolidation therapy for AML includes what?
stem cell transplant
What is a common progression to AML?
Myelodysplastic syndromes
This disease is characterized by abnormal cell maturation, and ineffective blood cell production leading to pancytopenia.
it is commonly asymptomatic and found incidentally on CBC
Cure is via bone marrow transplant
It can progress to AML?
myelodysplastic syndrome
This disease occurs 12-24 hours after cytotoxic therapy
is associated with high mortality
and occurs when massive tumor cells lyse to release contents (K, PO3, nucleic acid)
tumor lysis syndrome
What should you expect to see on labs in tumor lysis syndrome?
hyperkalemia, hyperphosphatemia, hypocalcemia, hyperuricemia
how do you treat TLS?
prevention, monitor cardiac fx
This leukemia is associated with the BCR-ABL1 fusion gene, the philadelphia chromosome and tyrosine kinase activation…
chronic myeloid leukemia (CML)
A 50 yo male pt. presents c the following after routine blood work. Pt. appears asymptomatic:
- hx of ionizing radiation
- profound leukocytosis (WBC > 100k)
- B sxs
- Splenomegaly
- fatigue
What do you suspect?
CML
When a patient c CML is in blast crisis, what would be present?
20% blast cells
fatigue, fever, extramedullary blasts, splenomegally
How do you diagnose a pt. you suspect of CML?
identification of philadelphia chromosome or BCR-ABL gene
CML can be treated with…
Tyrosine Kinase Inhibitors
Monoclonal Abs
Chemo
Allogenic Stem Cell Transplant
Complications of CML include…
tumor lysis syndrome
hyperleukocytosis
hyperviscosity syndrome
Tx with leukapheresis/plasma exchange
A 2 year old male patient of caucasian descent c NF1 presents c. the following…
Hx:
+ Fever, Fatigue, Pallor, Bone pain
+ hx genetic disorders
PE:
+hepatosplenomegaly, nontender LAD
Labs:
+ Neutropenia, anemia, thrombocytopenia
+ elevated LDH
Peripheral smear:
+ 20% lymphoblasts
What do you suspect, and what test do you want to Dx?
suspect ALL
Get bone marrow biopsy
70-80% of childhood ALL is what subtype?
precursor B-Cell ALL
Precursor B-Cell ALL has a favorable or unfavorable prognosis?
favorale
80% of this type of ALL express CD10
Precursor B-Cell ALL
What type of ALL has the following features…
Hyperleukocytosis at Dx
Older age
mediastinal mass
intramedullary disease
T-Cell ALL
This type of ALL is also called burkitt cell lymphoma
it presents with CNS sx and bulky extramedullary disease
Mature B-Cell ALL
Standard treatment for ALL is…
2 year course of chemotherapy
This type of leukemia has the following characteristics…
Median age of 70 yo, only adults
+ B cell lymphocytosis
organomegaly
Skin changes (leukemia cutis, macules, papules, etc)
may be treated with observation if early stage 1
CLL
A pt. presents c the following:
Painless cervical LAD
Mediastinal mass on CXR
Pain after EtOH
B Sxs
Fatigue
Pruritus s rash
This presentation is concerning for what?
hodgkins lymphoma
A patient is positive for the following:
supraclavicular LAD
splenomegaly
hepatomegaly
Reed-Sternberg cells.
This is concerning for what?
Hodgkins lymphoma
You are concerned a pt. may have hodgkins lymphoma. What can confirm the diagnosis? What do you need to stage the disease?
Dx via lymph node biopsy showing + Reed Sternberg cells
Get CT/PET to stage
Describe the treatment options for HL.
Chemo, very effective
Radiation in bulky disease
stem cell transplant for relapse or persistent disease
A patient c. HL presents with bilateral cervical LAD, bulky disease, distant spread.
How should this affect prognosis?
worse prognosis
90% of non-hodgkin lymphoma is derived from…
B lymphocytes
A pt. presents c. the following on H&P:
- Diffuse, painless, persistent LAD
- Mediastinal mass
- B sxs
- Extra lymphatic sites like bone marrow.
This is concerning for what?
NHL
Diffuse large B cell lymphoma
burkitt lymphoma
adult t cell leukemia-lymphoma
precursor B and T lymphoblastic leukemia/lymphoma
These conditions are associated with what…
aggressive NHL
B Sxs
Elevated LDH, Uric Acid
Dx for NHL is done via…
lymph node biopsy
CT/PET
Bone Marrow aspiration
A patient with slow growing indolent NHL is treated with…
radiation alone
Aggressive, intermediate or high grade NHL is treated with…
chemo + immunotherapy + autologous stem cell transplant
this disease is a malignancy of plasma cells.
multiple myeloma
when performing protein electrophoresis on a patient suspicious for multiple myeloma, what you expect ot find?
paraproteins, M-Spike
A patient presents c. the following on H & P:
Fatigue, back pain, weakness, parasthesia in LE, incontinence, weight loss.
What is this concerning for?
multiple myeloma
A pt. presents with the following lab findings:
M-Spike on protein electrophoresis
+ bence-jones proteins in urine
+ lytic lesions and osteoporosis on X-Ray
This is concerning for what?
multiple myeloma
CRAB stands for what? It is concerning for what disease?
Calcium > 10.5
Renal Insufficiency
Anemia
Bone Lesions
concerning for multiple myeloma
Tx of multiple myeloma…
hem/onc
combination chemo
Iv bisphosphonates to prevent bone loss
autologous hemopoietic cell transplant
Pt. presents with
bone pain in spine and ribs
recurrent infections
hypercalcemia
anemia
kidney failure.
What does this concern for?
Multiple myeloma.
Bones BREAK in multiple myeloma
(Bone pain, Recurrent infx, Elevated calcium, Anemia, Kidney failure)
