lymphoid malignancies

Question 1

what is leukemia ?

Answer 1

leukemia is a malignant disease of hematopoetic tissue , characterized by the accumulation of white blood cells in the bone marrow, leukocytosis and infiltration of organs

Question 2

what are the risk factors of leukemia ?

Answer 2

oncogene mutations and tumor suppressor gene alterations
host factors
environmental factors

Question 3

what are some of the host factors ?

Answer 3

1.congenital chromosomal abnormalities
2. immunodeficiency
3. chronic bone marrow dysfunction

Question 4

what are some environmental risk factors of leukemia ?

Answer 4

exposure to ionizing radiation

Question 5

what are some viruses that may cause leukemia ?

Answer 5

HTLV-I has been associated with T cell lymphoma
HTLV-II has been associated with hairy cell leukemia
epstein barr virus has been linked to Burkitts’s lymphoma

Question 6

what are the histological subclassifications of Acute lymphocytic anemia ?

Answer 6

pre - B ( common type)
B- cell
T-cell
undifferentiated

Question 7

how is acute lymphocytic leukemia diagnosed ?

Answer 7

by examination of lymph nodes 
abdominal organomegaly 
in CBC blasts will appear 
by CSF or cranial nerve infiltration
cytogenetics

Question 8

what is the treatment for acute lymphocytic leukemia ?

Answer 8

if specific therapy is needed then 
therapy induction 
remission 
remission consolidation 
maintenance therapy 
if no specific therapy is required then just supportive therapy

Question 9

what does remission mean ?

Answer 9

no blasts cells in the peripheral blood

less then 5% immature cells in the Bone Marrow

Question 10

how is minimal residual disease detected ?

Answer 10

RT-PCR

Question 11

what is the most common type of chronic lymphocytic leukemia ?

Answer 11

b cell type

Question 12

what are the associated autoimmune diseases with CLL

Answer 12

autoimmune hemolytic anemia
ITP

immune thrombocytopenia

Question 13

what is the clinical presentation of CLL ?

Answer 13

lymphocytosis with or without lymphadenopathy
hepatosplenomegaly
recurrent infection
bone marrow failure

Question 14

what are the key factors deciding clinical course in CLL

Answer 14

age
response to induction chemotherapy
diagnosis late or early
biology of the disease itself (aggressivness)

Question 15

what is the management for early stage CLL ?

Answer 15

watch and wait

Question 16

what are the prognostic markers of CLL ?

Answer 16

deletion of 11q
IGHV mutation 
CD34 expression 
ZAP-70 expression 
17 p deletion

Question 17

what is the management plan for CLL ?

Answer 17

chemotherapy plus anti B cell monoclonal antibodies
B-cell receptor signalling inhibitors
routine vaccinations
immunoglobulin replacement

Question 18

what are lymphomas

Answer 18

primary malignant neoplasms of lymphoid cells

Question 19

what are the most common type of lymphomas

Answer 19

hodgkin lymphomas

Question 20

what is seen in the microscopy of hodgkin lymphomas?

Answer 20

reed Sternberg cells

Question 21

what are the classification of non hodgkin lymphomas?

Answer 21

b-cell and t-cell types

Question 22

what is the staging system used for lymphomas ?

Answer 22

ann arbor staging

Question 23

what are the stages in the ann arbor staging system ?

Answer 23

stage 1- involvement of one lymph node on one side of the body
stage 2- more than 2 lymph node regions on the same side of the diaphragm
stage 3- lymph node involvement on both sides of the diaphragm
stage 4- dissemination to one of the extra-nodal tissues or organs with or without nodal disease

Question 24

what are the modifying features in the ann arbour staging system ?

Answer 24

A- absence of B symptoms

B- fever, night sweats and weight loss

Question 25

what are the investigations for a suspected lymphoma ?

Answer 25

• CT scan of the neck, chest, abdomen and pelvis
• tissue biopsy/ examination of relevant body fluids
• bone marrow investigation

Question 26

what are the pre-treatment and supportive care considerations that must be taken ?

Answer 26

fertility
assessment of cardiac function
acute tumor lysis syndrome

Question 27

what to give for tumor lysis syndrome ?

Answer 27

rasburicase

Question 28

what is the treatment for hodgkin lymphoma ?

Answer 28

chemotherapy

Question 29

what clinical feature is moree associated with ALL ?

Answer 29

CNS symptoms

Question 30

what age group is associated with ALL ?

Answer 30

considered disease of the young

Question 31

what disease is associated with CLL ?

Answer 31

AIHA ITP