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Leukemia/Lymphoma/Multiple Myeloma Flashcards

1
Q

Leukocytosis

A

WBC greater than 10,000

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2
Q

Acute Myeloid Leukemia Epidemiology

A

Most common ACUTE leukemia in adults. White, males 65yo.

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3
Q

Acute Myeloid Leukemia Definition

A

accumulation of luekemic blasts in blood and bone marrow. With reduced production of normal cells (neutrophils, erythrocytes, platelets)

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4
Q

Acute Myeloid Leukemia Associations

A

Chemical exposure, some genetics, Myelodysplastic syndrome.

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5
Q

Acute Myeloid Leukemia Presentation

A

Anemia: angina, dyspnea with exertion, fatigue, pallor.
Neutropenia: delayed healing, enterocolitis, fever, infection, oral lesions, perianal abscesses, pneumonia, sinusitis.
Thrombocytopenia: bleeding, conjunctival hemorrhages, eccymoses, epistaxis, gingival bleeding, petechiae.

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6
Q

Acute Myeloid Leukemia prognosis

A

Good in younger patients. Poor if developed from myelodysplastic syndrome.

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7
Q

Acute Myeloid Leukemia CBC

A

elevated/decreased WBC, cytopenias, blasts

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8
Q

Acute Myeloid Leukemia peripheral smear

A

Auer Rods: elongated needles in neutrophils, clumps of azurophilic granule material.

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9
Q

Acute Myeloid Leukemia metabolic panel

A

elevated creatine and liver function tests. altered electrolytes. Elevated uric acid and LDH.

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10
Q

Acute Myeloid Leukemia bone marrow biopsy

A

Blasts greater than 20%.

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11
Q

Acute Myeloid Leukemia treatment

A

Induction: chemo
consolidation: stem cell transplant

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12
Q

Myelodysplastic syndrome Definition

A

ineffective hematopoiesis with cytopenia. Can progress to AML.

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13
Q

Myelodysplastic syndrome epidemiology

A

males, 60 years old. chemical exposure can be treatment related (chemo 4-6 years later).

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14
Q

Myelodysplastic syndrome treatment

A

hematopoietic growth factors, immunomodulatory agents, hypomethylating agents, immunosuppressants

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15
Q

Tumor Lysis syndrome Definition

A

Oncological emergency. Massive tumor cell lysis causes release of cellular contents (K, Pi, nucleic acids etc.)

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16
Q

Tumor Lysis syndrome causes

A

Initiation of cytotoxic treatment and can occur spontaneously.

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17
Q

Tumor Lysis syndrome treatment

A

Prevention! fluids, diuresis, monitoring. Xanthine oxidase inhibitors, monitor cardiac function, seizure precautions, dialysis, treat the hyperkalemia and phosphatemia.

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18
Q

Chronic Myelogenous Leukemia Epidemiology

A

Males around 50yo. Risk factors are ionizing radiation and benzene.

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19
Q

Chronic Myelogenous Leukemia definition

A

Clonal malignancy of B-lymphocytes. Due to transposition of 9 and 22 on the philadelphia chromosome.

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20
Q

Chronic Myelogenous Leukemia presentation

A

fatigue, malaise, abdominal fullness, splenomegaly, B symptoms (fever, weight loss and night sweats).

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21
Q

Chronic Myelogenous Leukemia Chronic Phase

A

Lasts 5-6 years 80% are diagnosed here. WBC is greater than 10,000. High chance of remission if caught here.

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22
Q

Chronic Myelogenous Leukemia Accelerated Phase

A

Anemia, fatigue, malaise, flu-like symproms. 10-19% of blasts.

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23
Q

Chronic Myelogenous Leukemia Blast Crisis Phase

A

20% or more are blasts. Fever extramedullary blasts and splenomegaly.

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24
Q

Chronic Myelogenous Leukemia diagnosis

A

bone marrow biopsy shows philadelphia chromosome.

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25
Q

Chronic Myelogenous Leukemia treatment

A

Tyrosine Kinase inhibitors like Gleevac(imantinib) or an allogenic stem cell transplant=curative.

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26
Q

Chronic Myelogenous Leukemia Complications

A

Tumor lysis syndrome, hyperluekocytosis, Hyperviscosity.

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27
Q

Hyperluekocytosis

A

WBC greater than 100,000. Medical emergency. Decreased perfusion to the tissues. Can require leukapheresis.

28
Q

Hyperviscosity Syndrome

A

spontaneous bleeding, visual distrubances, neuro symptoms, HA, vertigo, seizures, coma. Treat with leukapheresis or plasma exchange.

29
Q

Acute Lymphocytic Leukemia Epidemiology

A

Most common cancer in children and teens. 60% are under 20. Caucasian and certain genetic conditions (down syndrome).

30
Q

Acute Lymphocytic Leukemia symptoms

A

fever, fatigue, lethargy, pallor, petechiae, ecchymosis, bone pain. In the elderly dyspnea, angina, dizziness.

31
Q

Acute Lymphocytic Leukemia Signs

A

LAD, thymic mass, testicular mass, limp, arthralgia

32
Q

Acute Lymphocytic Leukemia Periperal smear

A

Lymphoblasts

33
Q

Acute Lymphocytic Leukemia CBC

34
Q

Acute Lymphocytic Leukemia LDH

35
Q

Acute Lymphocytic Leukemia bone marrow biopsy

A

morphology, immunotype, cytogenics

36
Q

Acute Lymphocytic Leukemia precursor B cell type

A

80% express this CD10 type and it is favorable prognosis.

37
Q

Acute Lymphocytic Leukemia T cell type

A

More serious. Common in males. Hyperleukocytosis, mediastinal masses and intramedullary disease. Worse prognosis.

38
Q

Acute Lymphocytic Leukemia Mature B cell type

A

Burkitt lymphoma. More common in males. Extramedullary disease and CNS leukemia. Favorable prognosis with intensive chemo.

39
Q

Acute Lymphocytic Leukemia treatment

A

Induction chemotherapy. Monoclonal antibodies and tyrosine kinase inhibitors.

40
Q

Chronic Lymphocytic Leukemia epidemiology

A

Most prevalent leukemia in adults. Males, 72yo. Highest inheritability of any malignancy.

41
Q

Chronic Lymphocytic Leukemia Definition

A

accumulation of incompetent lymphocytes in the blood, marrow and lymph nodes.

42
Q

Chronic Lymphocytic Leukemia Presentation

A

Bone marrow failure: anemia, thrombocytopenia, neutropenia.

Organomegaly: LAD, spleno/hepatomegaly.

43
Q

Chronic Lymphocytic Leukemia Indolent stage

A

Can be asymptomatic or have fatigue malaise. Lyphocytosis is usually an incidental finding.

44
Q

Chronic Lymphocytic Leukemia Advanced stage

A

anemia, B symptoms, atypical infections. Death is usually due to an infection, bleeding or cachexia.

45
Q

Chronic Lymphocytic Leukemia Diagnosis

A

CBC, bone marrow biopsy, Lymph node biopsy to look for incompetent lymphocytes.

46
Q

Chronic Lymphocytic Leukemia treatment

A

chemo, immunotherapy ( retiximab and other mabs), radiation, splenectomy.

47
Q

Hodgkins Lymphoma definition

A

Cancer of the lymphocytes

48
Q

Hodgkins lymphoma presentation

A

Painless LAD (cervical and supraclavicular) pruritis, B symproms, alcohol induced pain of lymph nodes. Enlarged spleen and liver

49
Q

Hodgkins lymphoma epidemiology

A

15-34yo. Often with EBV, HIV and smoking, obesity.

50
Q

Hodgkins lymphoma prognosis

A

Worsens with advanced stages and prescence of B symptoms.

51
Q

Hodgkins lymphoma Diagnosis

A

Reed-sternburg cells in the lymph node/bone marrow biopsy. Multinucleated, arrested development of B cells. “pop corn” cells.
Then stage with a CT

52
Q

Hodgkins lymphoma treatment

A

Combo chemotherapy (often curative)
Combined with radiation in bulky disease
Stem cell transplant if needed

53
Q

Non-Hodgkins Lymphoma Epidemiology

A

66yo often associated with HIV, EBV, HCV, HBV etc. CLL can transition into Non-Hodgkins Lymphoma.

54
Q

Non-Hodgkins Lymphoma Presentation

A

Painless, persistent LAB with B symptoms.

55
Q

Aggressive Lymphomas

A

rapidly growing, B symptoms, elevated LDH and uric acid.

56
Q

Indolent Lymphomas

A

LAD, hepato/splenomegaly, cytopenia.

57
Q

Non-Hodgkins Lymphoma diagnosis

A

Biopsy of lymph nodes, stage with CT bone marrow biopsy if develop cytopenias.

58
Q

Non-Hodgkins Lymphoma treatment

A

Indolent: radiation alone
Aggressive: chemo, immuno and transplant.

59
Q

Multiple myeloma definition

A

Malignancy of plasma cells. Replace the bone marrow, destroy the bone and form tumors. Instead of immunoglobulins the plasma cells release paraproteins (hyperviscosity and renal failure).

60
Q

Multiple myeloma epidemiology

A

65, african americans.

61
Q

Multiple myeloma symptoms

A

fatigue, back pain, bone pain, infections, renal failure, bleeding, neuro changes.

62
Q

Multiple myeloma signs

A

pancytopenia, osteoporosis, hypercalcemia, pathologic fractures, plasmacytomas, spinal cord compression.

63
Q

Multiple myeloma diagnosis

A

Protein electrophoresis (blood or urine) show paraproteins with an M spike. Will also have bence jones protein in the urine.

64
Q

Multiple myeloma xrays

A

lytic lesions, osteoporosis

65
Q

Multiple myeloma CRAB

A

Calcium greater than 10.5
Renal insufficiency (cre less than 2)
Anemia
Bone lesions

66
Q

Multiple myeloma treatment

A

combo chemo, vertebroplasty, IV bisphosphates, marrow transplant.

Clinical Medicine (7 decks)

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