Leukemia, Lymphoma, & Multiple Myeloma Flashcards
Abnormally low neutrophils is called:
Neutropenia
Reduction in mature blood cells is called:
Cytopenia
Pancytopenia is a deficiency of:
All three cellular components (RBCs, WBCs, Platelets)
Normal WBC count
4,400-11,000/mcL
< 4.5K WBC
Leukopenia
WBC >10K
LEUKOCYTOSIS
_________ is cancer of the body’s blood forming tissues
Leukemia
Effects Bone Marrow and Lymphatic System
High numbers of WBCs
• Immature cells
•Fast growth
Types: • Acute Myeloid Leukemia (AML) • Chronic Myeloid Leukemia (CML) • Acute lymphoblastic Leukemia (ALL) • Chronic lymphocytic Leukemia (CLL)
Most common acute leukemia in adults is:
Acute Myeloid Leukemia (AML)
Relatively rate even though most common leukemia
Median age ~65 years Incidence increases with: • Age • M:F ratio ~5:3 • Caucasians
Acute Myeloid Leukemia is characterized by an accumulation of ________________.
Leukemia blasts
Peripheral blood is ALWAYS abnormal —> biopsy
Reduced production of normal cells (neutrophils, erythrocytes, platelets)
AML Associations
Environmental Factors:
***Chemical exposure, radiation, tobacco, chemotherapy
Genetic abnormalities:
Trisomy 21, Fanconi’s anemia, Familial RUNX1 mutations
Malignant hematologists diseases
***Myelodysplastic syndrome (MDS), Myeloproliferative disorders
Clinical presentation of AML
ANEMIA:
• shortness of breath
• dyspnea on exertion
• weakness/fatigue
NEUTROPENIA:
• Infection and fever related to infection
THROMBOCYTOPENIA:
• Bleeding (conjunctival hemorrhages, gingival bleeding, epistaxis, petechiae, menorrhagia, ecchymosis)
OPHTHALMIC CHANGES
• Hemorrhages or white plaques
AML Diagnostic tests
***Bone marrow aspiration and biopsy
Blasts form ≥20% of cellularity
<20% blasts in BM with cytogenetic abnormalities
CBC with diff —> cytopenia and blasts ≥ 20%
AUER RODS on peripheral smear
Elevated Creatinine and LFTs and altered electrolytes
Elevated Uric Acid and Lactate Dehydrogenase (LDH) (both from high cell turnover)
Absolute Neutrophil Count (ANC)
Normal = 2500-7500 (calculated as WBC x % neutrophils)
Neutrophilia (>10K) could be reactive (stress, trauma), proliferation (cancer), demargination (stress, infection), from meds (corticosteroids), from poison
Neutropenia could be from chemo, radiation, blood CA, overwhelming infection or meds (PCN)
If ANC is abnormal, RECHECK
What are AUER RODS?
Clumps of azurophilic granule material
Form elongated needles in leukemia blasts
**Pathognomonic of myeoblasts —> AML
AML treatment
Induction = chemotherapy (heavy), with goal to eradicate most leukemic cells
Consolidation = stem cell transplant, with goal to destroy remaining leukemic cells
Maintenance = lower dose chemo, supportive measures
Targeted therapies for certain mutations
AML prognosis
Favorable if: • < 60 years old • Good performance status • No comorbities (ie DM, CAD) • No Hx of exposures to cytotoxic agents or radiation
Unfavorable if:
• Age > 60
• Hx of exposure
• Hx of myelodysplasia
Myelodysplastic Syndrome (MDS)
Cytopenia (low # blood cells) Ineffective hematopoiesis May be asymptomatic More common in those >60 (increased incidence in men, smokers, benzene exposure) May progress to AML
Can be treatment related (chemotherapy, radiation therapy)
• Peak incidence 4-6 years after treatment
MDS Treatment
Hematopoietic growth factors help blood cells grow/mature
Immunomodulatory agents can alter or regulate immune function
Hypomethylating agents inhibit DNA methylation
Immunosuppressive therapy
Goals to Tx: Minimize cytopenias, maintain quality of life, delay onset of AML transformation
Tumor Lysis Syndrome
ONCOLOGIC EMERGENCY! Associated with high mortality
Massive tumor cell lysis —> release of cell contents (Potassium, phosphate, nucleic acids)
Causes:
• Initiation of cytotoxic therapy (usually within 12-24 hours of start of chemo) - possible at at treatment but esp. at first
• Spontaneously with some tumor types (high proliferation rate, large tumor burden, high sensitivity to cytotoxic therapy)
The four blood manifestations of tumor lysis syndrome:
Hyperkalemia (inc. potassium)
Hyperphosphatemia (inc. phosphate)
Hypocalcemia (dec. calcium)
Hyperuricemia (inc uric acid)
Tumor Lysis Syndrome may result in …
Renal failure —> hemodialysis
ECG changes (arrhythmia)
Seizure
Tetany
Treatment of Tumor Lysis Syndrome
PREVENTION! Fluids, dieresis Frequent monitoring during therapy (Creatinine, Potassium, Phosphorus, Uric Acid, Calcium) Meds to lower Uric Acid Monitor cardiac function Seizure precautions Treat hyperkalemia and hyperphosphatemia Preserve renal function (dialysis)
Chronic Myeloid Leukemia
AKA Chronic Myelogenous Leukemia
Uncontrolled production of mature and maturing granulocytes (neutophils and some basophils, eosinophils)
Abnormal gene called BCR-ABL1 fusion gene resulting from the translocation of chromosomes 9 & 22 (Philadelphia Chromosome)
15-20% of leukemia’s in adults (rare)
Slight male predominance
Median age at presentation ~50 years
Risk factor: Ionizing radiation
CML signs and symptoms
20-50% are asymptomatic (first suspected on routine blood tests - WBC > 100K, Platelets >600K)
Fatigue (34%) Malaise (3%) Abdominal fullness (15%) *Splenomegaly (48-76%) Bleeding episodes (21%) Pain over lower sternum (expanding bone marrow) B symptoms • Fever • Weight loss 20% • Drenching night sweats 15%
The three phases of CML are:
Chronic
• 85% of pats diagnosed here (often asymptomatic)
• LEUKOCYTOSIS WBC >100K
• <10% blood or BM blast cells
• Chance for remission is high if to started in this phase
Accelerated
• 10-19% blood or BM cells are blasts
• Progressively impaired neutrophil diff
• Leukocyte counts more difficult to control
• Sx - Anemia, fatigue, malaise, flu-like Sx
Blast Crisis
• Resembles acute leukemia
• 20% or more of blood or BM cells are blasts
• Sx - fatigue, fever, extramedullary blasts, splenomegaly
