Leukemia, Lymphoma, MM Flashcards by Lauren F

What is a normal WBC count?

4,400-11,000

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What is the most common acute leukemia in adults?

AML

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What is the median age of AML

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Is it ever normal to have blast cells in the peripheral blood?

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If you have an accumulation of leukemia blasts, could it be AML/

Yes

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Can chemical exposure or chemo cause AML

Yes

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What can myelodysplastic syndrome progress to?

AML

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What are the genetic abnormalities associated with AML?

Trisomy 21

Fanconi

RUNX1

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How do you diagnose AML?

Do a bone marrow aspiration and biopsy and look for blast cells forming 20% or more

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What would you see on a peripheral smear of AML

Auer rods

Clumps of azurophilic granule material

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What other labs would be high in AML?

Uric acid

LDH

Calcium

Potassium

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Do Auer rods always indicate AML

No, can be seen in other myeloblast disorders

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What kind of labs do you see with tumor lysis syndrome?

High potassium

High phosphate

High uric acid

Low calcium

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Is tumor lysis syndrome an emergency?

YES

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What cancer is associated with the Bcr-Abl1 gene?

CML

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How does a Philadelphia chromosome come about?

Translocation of chromosomes 9 and 22

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What are the 3 phases of CML?

Chronic

Accelerated

Blast

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How do you treat CML?

Tyrosine kinase inhibitors

Monoclonal antibodies

Chemo

Allogenic stem cell transplant

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What are the complications of CML that are emergencies?

Tumor lysis syndrome

Hyperleukocytosis (WBC over 100,000)

Hyperviscosity syndrome

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Is it common to diagnose CML after a routine CBC?

Yes

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What is the peak incidence of ALL?

2-5 yrs old

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What are the signs and symptoms of ALL?

Fever

Fatigue

Pallor

Hepatosplenomegaly

Lymphadenopathy***

Testicular mass (painless and unilateral)

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What will you see on a peripheral blood smear of ALL

“Small, uniform blasts with scant cytoplasm and inconspicuous nucleoli”

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Which type of ALL is more common?

B precursor

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What kind of ALL is also known as Burkett cell leukemia

Mature B-cell ALL

So your 4 year old patient is being treated with chemo for her ALL and her mom wants to take her to Disneyland. Is that ok?

No. These kids are at high risk of opportunistic infection and its what ends up killing them 5% of the time

What is the treatment for ALL?

Chemo Monoclonal antibodies Tyrosine kinase inhibitors

Do most children with ALL that are treated with chemo make a complete recovery?

Yes 98%

What kind of leukemia: “Progressive accumulation of functionally incompetent B cell lymphocytes”

CLL

What is the most prevalent leukemia in western countries?

CLL

What is the median age of diagnosis for CLL

What is the most common finding at diagnosis of CLL

Organomegaly (lymphadenopathy, big spleen, big liver)

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

The skin “Leukemia cutis”

What are the 2 stages of CLL

Indolent Advanced

What are some of the diagnostic tests that can be used for CLL?

CBC with diff Flow cytometry Bone marrow aspirate Lymph node biopsy

Do you need to treat every patient in early CLL?

No, may observe

If you are going to treat your CLL patient, what are you going to do

Chemo Rituximab Radiation Splenectomy

What kind of B cells do you see with Hodgkin lymphoma?

Reed-Sternberg cells- multinucleated B cells

40-50% of Hodgkin lymphoma patients also have this virus:

What is Epstein Barr virus

What are the 6 main clinical features of Hodgkin Lymphoma

1. Painless lymphadenopathy (especially cervical nodes) 2. Mediastinal mass 3. Pain after drinking alcohol 4. B symptoms 5. Fatigue 6. Itchy, but no rash

Which Ann Arbor stage: 1 lymph node or lymphoid organ

Stage 1

What Ann Arbor stage: 2 or more groups of lymph nodes on the same side of the diaphragm

Stage II

What Ann Arbor stage: | Lymph nodes on both sides of the diaphragm

Stage III

What Ann Arbor stage: | Distant spread to bone marrow, liver, brain, spinal cord, or pleura

Stage IV

What do we use the Ann Arbor staging system for?

Staging of Hodgkin lymphoma

What kind of cells would you see in a lymph node biopsy that would confirm your diagnosis of Hodgkin lymphoma?

Reed-Sternberg cells | Multinucleated B cells/popcorn

Combination chemotherapy cures Hodgkin lymphoma almost all the time! What is the draw back to that?!

Complications such as more cancer or heart disease

When would we do a stem cell transplant for Hodgkin lymphoma

If it comes back or its not getting better with chemo

In non-Hodgkin lymphomas, are they usually B or T cell?

90% B

What are the associated conditions with non-Hodgkin lymphoma

HIV Autoimmune disease (SLE, RA, ) Inflammatory GI disease (Crohn’s, H Pylori)

What is the median age at diagnosis of nonhodgkin lymphoma

When might you see a mediatsinal mass?

Non-Hodgkin lymphoma T-Cell ALL Hodgkin lymphoma

What is a symptom of Burkitt lymphoma?

Abdominal fullness

How do we diagnose non-hodgkin lymphoma

Biopsy lymph nodes that are 2cm+ CT to find areas of involvement or a preferred biopsy site Bone marrow aspiration and biopsy

What is the Lugano classification used for?

Staging of primary nodal lymphomas

How do you treat non-hodgkin lymphoma that is indolent with 1-2 nodes involved?

Radiation alone

What is it: A malignancy of plasma cells

Multiple myeloma

Plasma cells normally make antibodies. What do they make in multiple myeloma?

Paraproteins (abnormal immunoglobulin fragments)

What will you see in the urine/plasma if you do protein electrophoresis on multiple myeloma?

M-spike

How could you determine which type of paraprotein is present in multiple myeloma?

Protein electrophoresis

What is the median age of dx for multiple myeloma

What are some of the symptoms of hyperviscosity syndrome?

Spontaneous bleeding from mucous membranes Retinopathy (visual disturbances) Neurological symptoms

What will you see on a peripheral blood smear in multiple myeloma?

Anemia Rouleaux formation- RBCs stack up like coins

What will you see in the urine in multiple myeloma? (Other than M-spike)

Bence-jones proteins

What will you see on x-rays in multiple myeloma?

Lytic lesions “punched out appearance” Generalized osteoporosis

What are these associated with: Bence jones proteins Roleaux formation M-spike Punched out lesions

Multiple myeloma

What does CRAB stand for

Calcium (>10.5) Renal insufficiency (creatinine over 2) Anemia (Hb <10) Bone lesions (Associated with multiple myeloma)

What are the treatments for multiple myeloma?

Vertebroplasty/kyphoplasty IV Bisphosphates to prevent loss of bone mass Combination chemo Autologous hematopoietic stem cell transplant

If you see compression fractures in a stem, what disease do they have

Multiple myeloma