Malignancies 2 Flashcards
malignancies from the lymphoid line
b cell neoplasms: lymphoma, myeloma
t cell neoplasms
amyloidosis
most common type of lymphoid neoplasm
non hodgkin lymphoma –> diffuse large b cell lymphoma, indolent follicular lymphoma
most common cancer in children
acute lymphoblastic leukemia
clinical picture of lymphoid malignancies
lymphadenopathy
splenomegaly
constitutional symptoms: weight loss, night sweats, irritable
anemia, thrombocytopenia
infectious agents associated with lymphoid malignancies
ebv, htlv-1, hiv, hepatitis c virus, h. pylori, hhv 8
associated syndromes with all
trisomy 21
bloom syndrome
fanconi anemia
common causes of all
idiopathic!!
ionizing radiation
chemicals, drugs
clinical manifestations of all
lymphadenopathy and organomegaly
cns involvement
testicular seeding
special chemo technique used in all
intrathecal chemo
reason why males have to be treated longer for all
testicular seeding: chemo cannot penetrate testis
diagnosis for all
morphology cytochemical analysis (-) myeloperoxidase immunophenotyping flow cytometry, cytogenetics, fish markers
induction phase for all treatment
use heavy chemo to induce remission
consolidation and maintenance phase of all treatment
to prolong remission or achieve cure
if refractory: bone marrow transplant, tki
length of all treatment
2-3 years, longer for males
clinical presenting features of all
fever!! bleeding bone pain lymphadenopathy splenomegaly hepatosplenogmegaly!!
lab findings for all
leukocyte <10,000
hgb <7
platelet <20,000
lymphoblast L1 > L2 > L3
patho of chronic lymphocytic leukemia
proliferation of mature lymphocytes
characteristics of cll
no lymphoblasts
patients are in immunodeficient state
indolent course = can just observe
peripheral smear in cll
mature lymphocytes (chromatin does not show) scattered among lymphocytes are basket cells/smudge cells
staging of cll
table 7
t/f survival is long for cll patients with only lymphocytosis
true
treatment for cll
low risk: just observe
high risk, fit: transplantation or FCR chemo
high risk, frail: don’t be agressive
t/f patients with mutation in p53 of 17p have better diagnosis
false
hallmark of hodgkin’s lymphoma
reed sternberg cells with owl’s eye appearance
symptoms of lymphomas
bulky lymph nodes
b symptoms: fever, night sweats, weight loss
stage 1 lymphoma
single lymph node
stage 2 lymphoma
> 1 lymph node as long as it’s in one side of the diaphragm
stage 3 lymphoma
lymph nodes on both sides of diaphragm
stage 4 lymphoma
involves bone marrow, liver, or other extranodal sites
A vs B in lymphoma
A: no other symptoms
B: other symptoms
diagnostics of lymphomas
morphology, cytochemical, immunophenotyping, flow cytometry, imaging (ct form brain to pelvis, pet to see active LNs)
serum chemistry
treatment for diffuse large b cell lymphoma
RCHOP Rituximab Cyclophosphamide Hydroxydaunomycin Oncovin Prednisone
bulky tumor = + radiotherapy
early stage hodgkin lymphoma treatment
short course chemo
moderate dose radiation targeting of lns
nodular lymphocyte predominant hodgkin lymphoma treatment
radiation alone, good prognosis
advanced stage HL treatment
chemo is main, limited role for radiation
chemo drugs for HL
ABVD Adriamycin Bleomycin Vinblastine Dacarbazine
treatments to consider in HL
autologous stem cell transplant
immune checkpoint inhibitors
treatments for refractory HL
anti cd30 antibody: brentuximab vedotin
disorders involving plasma cells
myeloma
amyloidosis
waldenstrom’s macroglobulinemia
heavy chain disease
mature b-cell neoplasms = loss of control over igg production
symptoms of multiple myeloma
CRAB
Calcium is high due to increased bone resorption
Renal failure due to immunoglobulins deposited into kidney
Anemia
Bone pain due to bone resorption
diagnosis for multiple myeloma
clonal bone marrow cells >/= 10% plasma cells
+ CRAB symptoms
+ other markers like increase in serum free light-chain
smear of multiple myeloma cells
numerous myeloma cells
normal to have eccentric nucleus and perinuclear clearing
skeletal findings in multiple myeloma
lytic lesions due to increased osteoclast activity
electrophoresis results in multiple myeloma
keeps producing one specific type of protein
pathophysio of multiple myeloma
figure 12
high risk multiple myeloma patients
have deletion of 17p (tp53 gene)
treatment for multiple myeloma
chemo followed by autologous stem cell transplant
drug given to MM patients eligible for transplant
bortezomib (proteosome inhibitor)
- cleans up all cellular protein debris
steroids
immunomodulatory drugs: thalidomide, dexamethasone
t/f stem cells are harvested after induction in MM
true
treatment for MM patients not eligible for transplant
give bortezomib + melphalan
course of multiple myeloma
- many relapses
- still uncurable
