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Hematology > Leukemias and Lymphomas > Flashcards

Leukemias and Lymphomas Flashcards

1
Q

What is Leukemia

A

Cancer of the bone marrow, primarily WBC

Overgrowth of immature or abnormal cells leads to suppression of normal cells/cell growth

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2
Q

What blast cell is effected in Myeloid Leukemia?

A

Myeloid Progenitor cells

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3
Q

What blast cell is effected in Lymphoid Leukemia?

A

Lymphoid Progenitor cells

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4
Q

Acute leukemias are more common in what age cohort?

A

Children

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5
Q

Are chronic leukemias common in children?

A

No, more common in older adults

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6
Q

Is acute or chronic leukemia more likely to have an insideous onset?

A

Chronic

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7
Q

What is the goal of treatment in acute leukemias?

A

Goal is cure (chemo and bone marrow transplant)

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8
Q

What is the goal of treatment in chronic leukemias?

A

Goal is to slow disease progression, normalize cell counts (less curative)

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9
Q

What is the median age of diagnosis of acute myeloid leukemia?

A

68

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10
Q

Is acute myeloid leukemia an acute or chronic leukemia?

A

Acute, but more common in adults than kids

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11
Q

What is the presentation of acute myeloid leukemia?

A

Non-specific symptoms less than 3 months in duration

Fatigue most common presenting symptom

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12
Q

What is the pathognomonic histology finding for acute myeloid leukemia?

A

Auer Rods, crystalized cytoplasmic inclusion granules

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13
Q

Why is post-remission treatment important to consider in acute myeloid leukemia?

A

High chance for relapse, BMT is most effective and recommended for anyone less than 75 who has an HLA compatible donor

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14
Q

If diagnosed with acute myeloid leukemia and febrile what should be initiated?

A

Prompt broad-spectrum antibiotic therapy

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15
Q

What is the pathophysiology of chronic myeloid leukemia (CML)?

A

Not hereditary, secondary to chromosomal translocation of bcr-abl gene (Philadelphia chromosome)

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16
Q

How are most cases of CML identified?

A

Routine screening, typically asymptomatic

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17
Q

For patients without routine healthcare may be symptomatic and present with what type of symptoms in CDL?

A

Non-specific symptoms

Fatigue, weight loss, abdominal pain, blood clots, evidence of bleeding, bone pain

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18
Q

What are going to be the laboratory findings in someone with CDL?

A

Primary leukocytosis (WBC > 50,000)
Thromboycosis
+/- anemia (1/3rd of patients)

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19
Q

What is the definitive diagnosis for CML?

A

BM biopsy and genetic testing

20
Q

What is the first line treatment for CML?

A

Tyrosine Kinase Inhibitors (TKIs)

Imatinib (Gleevec), Dasatinib, hilotinib, bosutinib

21
Q

What is the most common malignancy in kids?

A

Acute Lymphoid Leukemia (ALL)

22
Q

What is the derivative cell lines in ALL?

A

B and T-cells, T-cell has the worst prognosis

23
Q

What conditions are at high risk for developing ALL?

A

Genetic condition, Trisomy 21 has a 20x increased risk

24
Q

What are the three most common presenting symptoms of ALL?

A

Fever, Fatigue/lethargy, Bone pain

25
Q

When is an anterior mediastinal mass found on x-ray?

A

Acute Lymphoid Leukemia (8-15% of cases)

26
Q

What adjunctive tests should be done when diagnosing ALL?

A

Imaging to rule out mediastinal mass

CSF analysis to rule out lymphoblastic infiltration

27
Q

Who is more likely to be diagnosed with Chronic Lymphocytic Leukemia (CLL)?

A

More common in caucasian, males with the median age of 70 years at time of diagnosis

28
Q

What are the risk factors for Chronic Lymphocytic Leukemia?

A

Farmers
Hairdressers
HCV infection
Agent orange exposure (Vietnam Vets)

29
Q

What are the common presenting symptoms for CLL?

A

Fatigue, lymphadenopathy most common

Other sx include: recurrent infections, fevers, weight loss, night sweats, symptoms from anemia

30
Q

Is the platelet count usually normal or abnormal in the laboratory work-up of CLL?

A

Usually Normal

31
Q

What is needed for a definitive diagnosis of CLL?

A

Bone marrow biopsy

32
Q

What cell finding will be present on histology in CLL?

A

Smudge cells, ruptured CLL cells

33
Q

If patient is asymptomatic or with co-morbidities what is the first line treatment in CLL?

A

Observation

34
Q

If symptomatic, what is the treatment in CLL?

A

Bruton tyrosine kinase (BTK) inhibitors

35
Q

What is the most common cell origin for Non-Hodgkin Lymphoma?

A

B-cells

36
Q

What is the primary presenting symptom in Non-Hodgkin Lymphoma?

A

Lymphadenopathy

37
Q

What are the B symptoms?

A

Fever
Night sweats (drenching)
Weight loss (>10% of body weight in less than 6 m.o.)

38
Q

What is needed for the definitive diagnosis of Non-Hodgkin Lymphoma?

A

Lymph node biopsy

39
Q

What is the mainstay treatment for Non-Hodgkin Lymphoma?

A

Chemotherapy (+ prednisone)

40
Q

What are risk factors for Hodgkin Lymphoma?

A

Epstein Barr Virus (EBV)
HIV or AIDS
Positive family history

41
Q

What is a unique presenting symptom to Hodgkin Lymphoma?

A

Pruritis with ETOH ingestion and bathing

42
Q

What cells are found on lymph node biopsy in Hodgkin Lymphoma?

A

Reed-Sternberg cells (owl eye appearance, symmetric bilobed nucleus)

43
Q

Many patients are asymptomatic with Multiple Myeloma, but some are symptomatic and will present with what symptoms?

A

Bone pain- often first symptom
Spinal cord compression
Pathologic fracture (femoral neck or vertebrae)

44
Q

What will be the findings on MRI in Multiple Myeloma?

A

Lytic lesions, “moth eaten” or “punched out appearance”

45
Q

What are the symptoms in the CRAB mnemonic for Multiple Myeloma?

A

HyperCalcemia
Renal insufficiency
Anemia
Bone lesions

46
Q

What is a pathognomonic finding for Multiple Myeloma on urine protein electrophoresis (UPEP)?

A

Bence Jones proteins

47
Q

What causes leukopenia?

A

Decreased production or increased destruction of WBC’s

Drugs (chemotherapy)
Infections (flu, TB, malaria)
Nutritional (B12 and folate deficiency)
Genetic
Hematologic diseases
SLE
Hypersplenism

Hematology (9 decks)

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