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X Clin Med Final > Leukemia, Lymphoma and Multiple Myeloma > Flashcards

Leukemia, Lymphoma and Multiple Myeloma Flashcards

1
Q

What are the functions of neutrophils?

A

Target bacteria and fungi

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2
Q

What are the functions of eosinophils?

A

Target larger parasites and modulate allergic inflammatory responses

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3
Q

What are the functions of basophils?

A

Release histamines for inflammatory responses

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4
Q

What is cytopenia?

A

Reduction in mature blood cells

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5
Q

What is pancytopenia?

A

Deficiency in all 3 cellular components

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6
Q

Difference between leukopenia and leukocytosis

A

Leukopenia is a decrease in WBCs below 4.5 K/mcL

Leukocytosis is an increase in WBCs above 10K

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7
Q

What is leukemia?

A

Cancer of the blood forming tissues (bone marrow and lymphatic system) with high numbers of WBCs

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8
Q

What is the most common acute leukemia in adults?

A

Acute myeloid leukemia

More in males (median age 65) and Caucasians

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9
Q

What is acute myeloid leukemia?

A

Accumulation of leukemic blasts in the bone marrow and peripheral blood (always abnormal if here) and reduced production of normal cells

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10
Q

What environmental factors can lead to AML?

A

Chemicals, radiation, smoking, chemotherapy drugs

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11
Q

What genetic abnormalities will make you consider AML?

A

Trisomy 21, Fanconis anemia (bone marrow failure), familial RUNX1 mutations (activates genes that control development of blood cells)

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12
Q

What complications of pancytopenia are seen in the presentation of AML?

A

Anemia, neutropenia, thrombocytopenia (bleeding), ophthalmic changes (hemorrhage or white plaques)

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13
Q

What will you see on a bone marrow aspiration and biopsy in AML?

A

Blast forms over 20% of cells (might be less if there are cytogenetic abnormalities tho)
*used for diagnosis!

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14
Q

What are some diagnostic tests for AML?

A

CBC with dif (cytopenia and blasts over 20%)
Auer rods on peripheral smear
Metabolic panel (elevated creatinine and liver function tests, altered electrolytes- increased Ca and K)
Elevated uric acid and LDH (due to tumor burden and high cell turnover)

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15
Q

What is the normal value of absolute neutrophil count?

A

2500-7500 (multiply WBC count by % neutrophils)

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16
Q

What is neutrophilia defined as?

A

ANC over 10,000

Due to stress/trauma, cancer, demargination, meds (corticosteroids), poison

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17
Q

When would you see neutropenia?

A

Chemo, radiation, blood related cancer, overwhelming infection, meds (PCN, ibuprofen)

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18
Q

What are auer rods?

A

Clumps of azurophilic granule material that forms elongated needles in leukemic blasts
*pathognomonic of myeloblasts
Can be seen in others than AML too

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19
Q

What tx do you do for AML?

A

Induction is chemotherapy to eradicate most leukemic cells and then consolidation to destroy the remaining ones (stem cell transplant)
Then maintenance

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20
Q

When is the prognosis for AML unfavorable?

A

Over 60, history of exposure and history of myelodysplasia

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21
Q

What is myelodysplastic syndrome?

A

Cytopenia (reduced number of blood cells) due to ineffective hematopoiesis
May progress to AML

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22
Q

What kinds of tx are used for myelodysplastic syndrome?

A

Hematopoietic growth factors to help blood cells grow and mature
Immunomodulatory agents to regulate immune function
Hypomethylating agents
Immunosuppressive therapy

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23
Q

What are the goals of tx for myelodysplastic syndrome?

A

Minimized cytopenias, maintain quality of life and delay onset of leukemic transformations

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24
Q

What is tumor lysis syndrome?

A

When there is massive tumor cell lysis and it releases potassim, phosphate, nucleic acids etc

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25
Q

Causes of tumor lysis syndrome

A

Initiation of cytotoxic therapy (12-24 hrs after) for lymphomas or acute lymphoblastic leukemia
Spontaneous

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26
Q

What are the manifestations of tumor lysis syndrome?

A

Hyperkalemia, hyperphosphatemia, hypocalcemia, hyperuricemia

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27
Q

What can tumor lysis syndrome lead to?

A

Renal failure, ECG changes, seizures, tetany

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28
Q

What is the tx for tumor lysis syndrome?

A

Prevention mostly (basically stop anything it can become)
Fluids, diuresis
Frequent monitoring of blood levels
Meds to treat manifestations

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29
Q

What is chronic myeloid leukemia?

A

Uncontrolled production of mature and maturing granulocytes (mostly neutrophils) due to the abnormal BCR-ABL1 fusion gene from 9 and 22

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30
Q

What is the risk factor of CML?

A

Ionizing radiation

Slight males, median age 50

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31
Q

Common signs/symptoms of CML?

A

A lot are asymptomatic (20-50%) and only seen on routin blood tests
Fatigue, splenomegaly, bleeding episodes, B sxs (fever, weight loss, night sweats)

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32
Q

What are the 3 phases of CML?

A

Chronic, accelerated, blast

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33
Q

What is the chronic phase of CML?

A

Most are diagnosed here with better prognosis and asymptomatic
WBC>100,00
<10% blood or BM are blast cells

34
Q

What is the accelerated phase of CML?

A

10-19% blood or BM cells are blasts
Progressively impaired neutrophil differentiation
See flu-like sxs

35
Q

What is blast crisis phase of CML?

A

Resembles AML with 20% of blood/BM cells being blasts

Fatigue, fever, extramedullary blasts, splenomegaly

36
Q

What does tx of CML depend on?

A

The stage at diagnosis

37
Q

What kinds of tx are there for CML?

A

Tyrosine kinase inhibitors, monoclonal antibodies, chemotherapy, allogenic stem cell transplant (possible cure)

38
Q

What are complications of CML?

A

Tumor lysis syndrome, hyperleukocytosis or hyperviscosity syndrome

39
Q

What is hyperleukocytosis?

A

WBC > 100,000/mcl
Medical emergency that may need leukapheresis
Decreased tissue perfusion

40
Q

What are sxs of hyperviscosity syndrome?

A

Spontaneous bleeding from mucous membranes, visual disturbances, neurologic sxs, HA, vertigo, seizures, coma
CML and multiple myeloma

41
Q

How do you treat hyperviscosity syndrome?

A

Leukapheresis or plasma exchange

42
Q

What is the most common cancer in children and teens?

A

Acute lymphoblastic leukemia
Peak incidence 2-5 yrs old
More males (whites and hispanics)

43
Q

What genetic conditions do you see acute lymphoblastic leukemia with?

A

Down syndrome, neurofibromatosis type 1, bloom syndrome

44
Q

Most common clinical features of ALL

A

Fever, fatigue, bruising, pallor, hepatosplenomegaly, LAD

testicular mass is rare

45
Q

What lab findings might you see in ALL?

A

Lymphoblasts on peripheral blood smear and BM
Cytopenias (neutropenia, anemia, thrombocytopenia)
Elevated LDH

46
Q

What types of tx can be used in ALL?

A

Chemotherapy, monoclonal antibodies, oral tyrosine kinase inhibitors
Complete response in 98% of kids with chemo

47
Q

When is there an 85% 5 year prognosis for ALL?

A

Younger than 35, favorable cytogenetics, absence of CNS disease at dx and B cell vs T cell phenotype

48
Q

What do you use the bone marrow biopsy to see in ALL?

A

Shape
Immunophenotype (70-80% b cell and 15-17% t cell)
Cytogenetics/ chromosomal abnormalities

49
Q

What is chronic lymphocytic leukemia?

A

Chronic lymphoid neoplasm with a progressive accumulation of functionally incompetent B cell lymphocytes

50
Q

When is CLL most common?

A

70 yrs, males and caucasians

51
Q

What is the most common finding at dx of CLL?

A

Organomegaly (LAD, spleno, hepato)

52
Q

What is the most common non-lymphoid organ affected by CLL?

A

Skin (leukemia cutis)

53
Q

What is the indolent stage of CLL?

A

Usually asymptomatic
Lymphocytosis on peripheral blood and BM
B sxs

54
Q

What is the advanced stage disease in CLL?

A

Rapidly progressive and terminal
Anemia, b sxs
Atypical infections
Death secondary to infection, bleeding, cachexia

55
Q

What tests help you diagnosis CLL?

A

CBC with diff (B lymphocytes >5000 microL)
Flow cytometry of peripheral blood (clonality of B lymphocytes)
Bone marrow aspirate and biopsy (lymphocytes >30%)
Lymph node biopsy (infiltrate with mature, small lymphocytes)

56
Q

When do you see a significantly shorter survival rate for CLL?

A

When lymphocyte doubling time is less than 12 mos

57
Q

How you treat asymptomatic and early stage 1 CLL?

A

Observe

58
Q

What are options of tx for pts with symptoms of CLL?

A

Chemotherapy, immunotherapy (monoclonal antibodies), radiation, splenectomy

59
Q

What are lymphomas?

A

Cancers that begin in the lymphocytes

60
Q

Where are lymphocytes?

A

Lymph nodes, spleen, thymus, bone marrow, tonsils, adenoids

61
Q

Risk factors of Hodgkins lymphoma

A

Socioeconomic status, immunosuppression, autoimmune disorders, family hx (genetic susceptibility or common environmental exposure)

62
Q

What is Hodgkins lymphoma characterized by?

A

Enlargement of lymph nodes, spleen, liver

Reed-Sternberg cells (multinucleated B cells)- popcorn cells

63
Q

What is a very common etiology of Hodgkins lymphoma?

A

EBV (40-50%)

64
Q

When is hodgkins lymphoma most common?

A

15-34, peak in 20s and after 50
Rare under 5
Slight male

65
Q

What are some clinical features of Hodgkins lymphoma?

A

Painless LAD (cervical most common), mediastinal mass, sever pain response after alcohol, B symptoms, fatigue, pruritus but no rash

66
Q

Ann Arbor staging of Hodgkins lymphoma

A

I: 1 lymph node area of lymphoid organ
II: 2+ groups of lymph nodes on same side of diaphragm
III: lymph nodes on both sides of diaphragm
IV: distant spread
X: bulky disease or mediastinal mass

67
Q

What can chemo and radiation as tx for lymphoma lead to?

A

Another cancer or heart disease

68
Q

Treatment for Hodgkins lymphoma

A

Combo chemo (curative most cases)
Often combine with radiation (bulky disease or relapse)
Stem cell transplant if more severe

69
Q

What are considerations of hodgkins lymphoma?

A

Secondary malignancy, CAD, pulm dysfunction, infertility, hypothyroidism, diabetes, psychosocial issues

70
Q

What diseases are associated with non-hodgkin lymphoma?

A

HIV, autoimmune diseases, inflammatory GI disease

Age: 66

71
Q

What are clinical features of NHL?

A

Painless, persistent LAD
Mediastinal mass
Extralymphatic sites (GI, skin, bone, BM, adm)
B sxs in high grade disease

72
Q

What are the b symptoms?

A

Fever, weight loss, night sweats

73
Q

When is NHL considered aggressive?

A

Rapidly growing mass
B sxs
Elevated LDH and uric acid
1/3 curable with chemo

74
Q

What are indolent NHL?

A

LAD, hepatomegaly, splenomegaly, cytopenias

75
Q

What diagnostic tests can you do for NHL?

A 
Biopsy (lymph nodes over 2 cm best)
CT or PET/CT to see areas of involvement
Bone marrow aspiration and biopsy
Cerebral spinal fluid, pleural/peritoneal fluid
Splenectomy
76
Q

How do you treat indolent NHL with 1-2 nodes?

A

Radiation only

77
Q

How do you treat aggressive or high grade NHL?

A

Chemo, immunotherapy, autologous stem cell transplant

78
Q

What is multiple myeloma?

A

Malignancy of plasma cells that proliferate in the bone marrow, can form tumors and secrete paraproteins (abnormal Ig fragments)

79
Q

What does protein electrophoresis do for multiple myeloma?

A

Blood or urine
Shows paraproteins as different bands
Provides an early indication of malignant condition
Can see an m-spike

80
Q

Common clinical presentation of multiple myeloma

A

Fatigue, bone pain, weight loss, weakness, back pain

81
Q

What diagnostic studies are used for multiple myeloma?

A

Anemia-rouleaux formation (RBCs stacked like coins)
Hallmark: monoclonal spike on protein electrophoresis
Bence-jones proteins in urine
Xrays of axial skeleton that show lytic lesions and osteoporosis
CRAB (calcium >10.5, renal insufficiency, anemia, bone lesions)

82
Q

Txs for multiple myeloma

A 
REFER
Combo chemo
Vertebroplasty or balloon kyphoplasty
IV bisphosphonates (prevent loss of bone mass)
Autologous hemopoeitic cell transplant

X Clin Med Final (5 decks)

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