Leukemias and Lymphomas Flashcards
1
Q
Labs required for diagnosis of leukemia ?
A
peripheral blood smear + bone marrow biopsy
2
Q
type of leukemia by age ? (roughly)
newborn-14
A
ALL
3
Q
type of leukemia by age ? (roughly)
40-60
A
AML or CML
4
Q
type of leukemia by age ? (roughly)
>60
A
CLL
5
Q
what is the percentage of blasts in the acute leukemia ?
A
> 20%
6
Q
What are the lymphomas ?
A
Solid tumors of the the immune system
7
Q
Is normal cell division/ proliferation is poly/mono clonal ?
A
Polyclonal
8
Q
Definition of Leukemia ?
A
White blood cell malignancy originating in the bone marrow and going to the blood
9
Q
What are the blast cell types we can have in Leukemia?
A
Myeloid blasts
Monoblasts
Lymphoblasts
10
Q
Important histologic characteristic of AML ?
A
Auer rods
peroxidase positive
11
Q
Acute leukemia morphology of the cells ?
A
Large, immature cells (blasts)
12
Q
Lymphadenopathy in acute leukemias is painfull or painless?
A
Painless
in infections it’s painfull
13
Q
What type of anemia we usually see in Acute leukemias?
A
Normocytic, can be also Macrocytic
Macro because of the Folic acid deficiency, because of high cell turn ov
14
Q
What is the platelets count in acute leukemias ?
A
Low, <100,000
Normal is 150,000-400,000
15
Q
Blasts percentage in Acute leukemias in a bone marrow biopsy?
A
blasts >20%
16
Q
cell morphology we see in Chornic leukemias?
A
Small, mature cells, but non functioning
17
Q
How do we consider Myelodysplasia in hematology ?
A
Pre-leukemic
18
Q
What causes Sideroblastic anemia ?
A
Defect in Protoporphyrin
protoporphyrin—>Heme—->Hemoglobin
19
Q
How do you define Myelodysplasia ?
A
Problem in maturation of the bone marrow, especially in the myeloid lineage
20
Q
Do we have cytopenia in Myeloproliferative disorders?
A
No
21
Q
Do we have cytopenia in Myelodysplastic disorders?
A
Yes
22
Q
ALL stands for
A
Acute Lymphoblastic Leukemia
23
Q
CLL stands for
A
Chronic Lymphocytic Leukemia
24
Q
Important findings on Immunohistochemistry of ALL ?
A
positive for: TdT and PAS
25
Some studies suggest that giving ________________ to the pregnant mother, can decrease the incidence of ALL in the newborn
Folic Acid
| "Give me Folic, don't be such an alcoholic"
26
What are the main phases in the ttt of ALL ?
1.Remission-Induction phase
2.Consolidation*---->maintenance
3.Prophylaxis for CNS and testes
| *Consolidation is needed because relapse occurs in 100% of the cases
27
AML stands for
Acute Myelogenous Leukemia
28
Which **subtype of AML** we see **gingival hyperplasia/gum infiltration** ?
**M5**
29
What subtype of **AML** is the **most common**?
M2
| Myeloblastic with maturation t (8:21), good prognosis
30
What is the **translocation** of **M3** subtype of **AML** ?
t (15;17)
| Good prognosis
31
AML-M3 also known as
Acute promyelocytic anemia
32
**AML-M5** also known as
**Monocytic**
has gum infiltration
| **"Mouth"** has **5** letters
33
AML-M3 is strongly associated with
DIC
| DIC has 3 letters
34
How can we treat AML-M3 ?
Vitamin A
35
What can we see on the **smear of AML-M3** ?
Numerous auer rods
36
Common complication of AML M3 ?
DIC
| Occures at diagnosis, or shortly after chemo
37
What is one of the main problems of giving a patient chemotherapy?
Bone marrow suppression
38
What is the advantage of giving **Vitamin A** to a **AML-M3 patient** ?
No bone marrow suppression
39
How does **Vitamin A** cure AML-M3 ?
By **inducing maturation** of primitive promyelocytes into mature Neutrophils
| then the Neutrophils undergo apoptosis
40
What type of cancer can be treated with antibiotics?
**MALTomas** caused by H. pylori can be treated with antibiotics aimed at eradicating H. pylori.
41
What is the fusion gene we see in t(15:17) ?
**PML-RAR-α**
42
What is the consequence of fusion gene of **PML-RAR-α** ?
| two things
1. Arrest of differentiation
2. Abnormal retinoic acid metabolism
| That is why Vitamin A helps (vitamin A A.K.A *retinoic acid*)
43
What is the best **initial therapy** for AML-M3 ?
Retinoic acid
| Later we can proceed to Arsenic
44
What is the translocation of CML ?
**t(9:22)**
45
What is the **initial step** in the pathophysiology of **CML** ?
**Reciprocal translocation** between***chromosome 9*** and ***chromosome 22***
46
What is the result of **BCR-ABL gene** ?
inhibits physiologic apoptosis and increases mitotic rate
47
what is the prognosis for **ALL** patients with **philadelphia chromosome**?
Bad prognosis
48
what is the prognosis for ***CML*** patients with ***philadelphia chromosome***?
Good prognosis
| note the difference in prognosis with **ALL**
49
TTT for CML ?
TKI
| Imatinib
50
Is the *Philadelphia chromosome* **specific** for **CML** ?
**No**
| It's present also in **ALL**
## Footnote
but it is **sensitive**, **100%** of patients have it
51
What does **LAP** stands for ?
**Leukocyte alkaline phosphatase**
| An enzyme found in mature leukocytes.
## Footnote
A high LAP score is associated with an increased number of mature white blood cells (e.g., from leukemoid reaction or myeloproliferative disorders); a low LAP score is associated with an increased number of immature white blood cells (e.g., from CML).
52
A **high LAP** score is associated with ?
An **increased number of mature white blood cells**
| (e.g., from leukemoid reaction or myeloproliferative disorders)
53
A low LAP score is associated with
An **increased number of *immature* white blood cells**
| (e.g., from CML).
54
Labs of Platelets in CML ?
**Thrombocytosis** (especially in the *accelerated* and the *blast* phase)
55
What type of leukemic cells can we see in CML ?
Evidance of maturation, *"All stages of development"*
| Different from AML, where we had lots of blasts, and no maturation
56
**Results** in a definitive diagnosis by **bone marrow biopsy** for **CML** ?
1. **Hypercellular** with myeloid hyperplasia
2. **blasts** **<10%**
57
What can be a side effect of using **ATRA** for **AML-M3** patients?
## Footnote
All trans retinoic acid
Differentiation syndrome
58
What are the **main characteristics** of **Differentiation syndrome**?
1. **Fever**
2. **Volume overload**
59
How do we treat differentiation syndrome ?
1. Stop ATRA
2. High dose Dexamethasone
| *When doctors don't have a clue, they will give steroids to you*
60
What labs do we see in *Blast Crisis* in **CML** ?
-Blasts >20%
-Basophilia
61
Two phases of treatment we see in each type of Acute leukemia ?
1. Induction phase
2. Consolidation phase
62
What is the **induction phase** of **AML** treatment ?
High dose chemotherapy
| Suppress all cell lines--> px becomes susceptible to infections
63
**When** can we pass to the **consolidation phase** when treating **AML** ?
When cell counts normalize
64
What is the **definition** of **CLL** ?
**Lymphoproliferative disorder**
65
In **CLL** we have accumulation of ?
Lymphocytes
66
Describe the **morphology** and **functionality** of lymphocytes in CLL
-Morphologically mature
-Functionaly incompetent
67
What is **CLL** with a **solid lymph nodal mass** ?
SLL
| Starts as *leukemia* and becomes *lymphoma*
68
Peripheral smear of **CLL** we will see
Smudge cells
69
Do we need bone marrow biopsy for the dx of CLL ?
No
70
**CLL** on Flow cytometry, what do we see ?
CD-5 +
CD-23 +
71
What is the result for a **CLL** patient on **Coomb's test** ?
Positive
| **Direct coombs test** !!!!
72
Is leukamoid reaction malignant or benign?
Benign
73
Which leukemia is mostly associated with leukostasis?
AML
74
definition of leukostasis ?
It is characterized by an **extremely elevated blast cell count** and symptoms of **decreased tissue perfusion**.
75
What are the most common symptoms of Leukostasis?
**Dyspnea** and **hypoxia**
76
How does leukostasis affects the blood ?
**Increases it's viscosity**
77
Count of WBC in Leukostasis?
> 100,000
78
What is the function of Kinases ?
Adding Phosphate group
79
What is the function of phosphorylated proteins?
They aid in signal transduction
| "like on-off switch of the cell"
80
Humor meaning ?
Fluid
81
What does "Phlebotomy" means?
**Phlebo**- Vein
**Tomy**- To cut
| in greek
82
Anatomy meaning ?
Ana- up
tomy- Cut
## Footnote
To cut up
83
"Onkos" meaning
Masses
| Roman
84
What are the B-cell indolent lymphomas? (Mnemonic)
Marginal zone lymphoma
Waldenstorm lymphoma
Hairy cell leukemia
Follicular lymphoma
״מזל שוולדנסטורם נהיה שעיר בכלל השתלת הפוליקל״
85
What is the translocation of Marginal zone lymphoma?
t(11;18)
86
What is the translocation of **follicular lymphoma**?
t(14;18)
87
What are the **aggressive** B-cell lymphoms? (mnemonic)
"If you are **aggressive** you are **DMB**"
DLBCL
Mantle cell lymphoma
Burkitt lymphoma
88
What is the translocation in **mantle cell lymphoma** ?
t(11;14)
89
what is the translocation of **burkitt lymphoma**?
t(8;14)
90
What are the etiologies for Non-hodgkin lymphomas?
**CIA-E**
Chromosomal translocations
Infections
Autoimmune diseases
Environmental factors
91
Indolent T-cell lymphoma
Mycosis fungoides
92
Aggressive T-cell lymphoma?
Sezary syndrome
93
B symptoms include ?
Weight loss
Fever
Night sweats
94
Most important clinical feature for Non-hodgkin lymphoma?
Painless lymphadenopathy associated with fatigue and weakness
95
Important clinical feature for **high grade** NHL ?
B symptoms
96
Important clinical feature for **Low grade** NHL ?
Hepatosplenomegaly
97
What is the most common tx regimen for NHL ?
CHOP-R
**C**yclophosphamide
**H**ydroxidaunorubicin
**O**ncovin
**P**rednisolone
**r**ituximab
98
What is the only way to confirm lymphoma? and which one do we prefer?
A biopsy is the only way to confirm a person has NHL.
Excisional or incisional biopsy:
This is the preferred and most common type of biopsy if lymphoma is suspected, because it almost always provides enough of a sample to diagnose the exact type of NHL.
99
What is the prognosis for NHL ?
Worse than that of HL
100
What is the pathognomic sign for HL ?
Reed-sternberg cells
101
important features of reed-sternberg cells?
Owl-eye/binuclear-bilobed nuclei
CD 15/30 positive
102
DD for HL ?
CD 20 - positive in mononucleosis
103
what are the **classical HL** rated from worst prognosis to best ?
depleted mixer תקע nod ונהיה עשיר rich
Lymphocyte depleted
Mixed cellularity
Nodular sclerosing
Lymphocyte rich
104
What is the most common subtype of HL ?
Nodular sclerosing
105
What are the Non-classical HL ?
Nodular lymphocyte predominant HL
106
What are the characteristics of Nodular lymphocyte predominant HL? (non classical HL)
Pop-corn cells
cd20+
cd45+
cd79a+
**NEGATIVE: CD15 and CD30**
107
What is the imaging used for HL ?
PET, with the lugano classification
108
Diagnosis for HL is made with
Medical history and clinical features
and confirmed with lymph node biopsy
109
what is the most widely used chemo approach in HL ?
***ABVD***
**A**driamycin
**B**leomycin
**V**inblastine
**D**acarbazine
110
progression in HL ?
Slow
111
progression in NHL ?
Fast
112
Area mainly affected in HL ?
Cervical, Axillary, Chest
113
Area mainly affected in NHL ?
Throughout the body
114
from what cells NHL originates?
B/T
115
from what cells HL originates?
B cells
116
What is a pathognomic sign of CLL ?
Smudge cells
