Leukemias and Lymphomas Flashcards
What is Leukemia
Cancer of the bone marrow, primarily WBC
Overgrowth of immature or abnormal cells leads to suppression of normal cells/cell growth
What blast cell is effected in Myeloid Leukemia?
Myeloid Progenitor cells
What blast cell is effected in Lymphoid Leukemia?
Lymphoid Progenitor cells
Acute leukemias are more common in what age cohort?
Children
Are chronic leukemias common in children?
No, more common in older adults
Is acute or chronic leukemia more likely to have an insideous onset?
Chronic
What is the goal of treatment in acute leukemias?
Goal is cure (chemo and bone marrow transplant)
What is the goal of treatment in chronic leukemias?
Goal is to slow disease progression, normalize cell counts (less curative)
What is the median age of diagnosis of acute myeloid leukemia?
68
Is acute myeloid leukemia an acute or chronic leukemia?
Acute, but more common in adults than kids
What is the presentation of acute myeloid leukemia?
Non-specific symptoms less than 3 months in duration
Fatigue most common presenting symptom
What is the pathognomonic histology finding for acute myeloid leukemia?
Auer Rods, crystalized cytoplasmic inclusion granules
Why is post-remission treatment important to consider in acute myeloid leukemia?
High chance for relapse, BMT is most effective and recommended for anyone less than 75 who has an HLA compatible donor
If diagnosed with acute myeloid leukemia and febrile what should be initiated?
Prompt broad-spectrum antibiotic therapy
What is the pathophysiology of chronic myeloid leukemia (CML)?
Not hereditary, secondary to chromosomal translocation of bcr-abl gene (Philadelphia chromosome)
How are most cases of CML identified?
Routine screening, typically asymptomatic
For patients without routine healthcare may be symptomatic and present with what type of symptoms in CDL?
Non-specific symptoms
Fatigue, weight loss, abdominal pain, blood clots, evidence of bleeding, bone pain
What are going to be the laboratory findings in someone with CDL?
Primary leukocytosis (WBC > 50,000)
Thromboycosis
+/- anemia (1/3rd of patients)
What is the definitive diagnosis for CML?
BM biopsy and genetic testing
What is the first line treatment for CML?
Tyrosine Kinase Inhibitors (TKIs)
Imatinib (Gleevec), Dasatinib, hilotinib, bosutinib
What is the most common malignancy in kids?
Acute Lymphoid Leukemia (ALL)
What is the derivative cell lines in ALL?
B and T-cells, T-cell has the worst prognosis
What conditions are at high risk for developing ALL?
Genetic condition, Trisomy 21 has a 20x increased risk
What are the three most common presenting symptoms of ALL?
Fever, Fatigue/lethargy, Bone pain
When is an anterior mediastinal mass found on x-ray?
Acute Lymphoid Leukemia (8-15% of cases)
What adjunctive tests should be done when diagnosing ALL?
Imaging to rule out mediastinal mass
CSF analysis to rule out lymphoblastic infiltration
Who is more likely to be diagnosed with Chronic Lymphocytic Leukemia (CLL)?
More common in caucasian, males with the median age of 70 years at time of diagnosis
What are the risk factors for Chronic Lymphocytic Leukemia?
Farmers
Hairdressers
HCV infection
Agent orange exposure (Vietnam Vets)
What are the common presenting symptoms for CLL?
Fatigue, lymphadenopathy most common
Other sx include: recurrent infections, fevers, weight loss, night sweats, symptoms from anemia
Is the platelet count usually normal or abnormal in the laboratory work-up of CLL?
Usually Normal
What is needed for a definitive diagnosis of CLL?
Bone marrow biopsy
What cell finding will be present on histology in CLL?
Smudge cells, ruptured CLL cells
If patient is asymptomatic or with co-morbidities what is the first line treatment in CLL?
Observation
If symptomatic, what is the treatment in CLL?
Bruton tyrosine kinase (BTK) inhibitors
What is the most common cell origin for Non-Hodgkin Lymphoma?
B-cells
What is the primary presenting symptom in Non-Hodgkin Lymphoma?
Lymphadenopathy
What are the B symptoms?
Fever
Night sweats (drenching)
Weight loss (>10% of body weight in less than 6 m.o.)
What is needed for the definitive diagnosis of Non-Hodgkin Lymphoma?
Lymph node biopsy
What is the mainstay treatment for Non-Hodgkin Lymphoma?
Chemotherapy (+ prednisone)
What are risk factors for Hodgkin Lymphoma?
Epstein Barr Virus (EBV)
HIV or AIDS
Positive family history
What is a unique presenting symptom to Hodgkin Lymphoma?
Pruritis with ETOH ingestion and bathing
What cells are found on lymph node biopsy in Hodgkin Lymphoma?
Reed-Sternberg cells (owl eye appearance, symmetric bilobed nucleus)
Many patients are asymptomatic with Multiple Myeloma, but some are symptomatic and will present with what symptoms?
Bone pain- often first symptom
Spinal cord compression
Pathologic fracture (femoral neck or vertebrae)
What will be the findings on MRI in Multiple Myeloma?
Lytic lesions, “moth eaten” or “punched out appearance”
What are the symptoms in the CRAB mnemonic for Multiple Myeloma?
HyperCalcemia
Renal insufficiency
Anemia
Bone lesions
What is a pathognomonic finding for Multiple Myeloma on urine protein electrophoresis (UPEP)?
Bence Jones proteins
What causes leukopenia?
Decreased production or increased destruction of WBC’s
Drugs (chemotherapy)
Infections (flu, TB, malaria)
Nutritional (B12 and folate deficiency)
Genetic
Hematologic diseases
SLE
Hypersplenism
