Malignant Hematology - Lymphoid Disorders

Question 1

What does the peripheral blood smear of patients with chronic lymphoid leukemia demonstrate?

Answer 1

Excess, small, mature lymphocytes & smudge cells.

Question 2

How do you diagnose chronic lymphoid leukemia?

Answer 2

Peripheral blood flow cytometry
Peripheral blood B-cell lymphocyte count > 5

DO NOT need bone marrow biopsy

Question 3

What is a Richters transformation?

Answer 3

Sudden increase in lymph node side - suggests aggressive lymphoma (DLBCL)

Question 4

What are the complications of chronic lymphoid leukemia (4)?

Answer 4

(1) Lymphadenopathy & Splenomegaly
(2) Cytopenias - Marrow Crowding
(3) Cytopenias - ITP & AIHA
(4) Richters transformation

Question 5

What are the indications to treat chronic lymphoid leukemia (6)?

Answer 5

(1) Asymptomatic: Watch & Wait
(2) Indications for Tx
- Lymphadenopathy > 10cm or symptomatic
- Splenomegaly > 6cm below costal margin or symptomatic
- Progressive cytopenias (Hb or Plt < 100)
- AIHA/ITP with poor steroid response
- Extranodal involvement (skin, lung, kidney, spine)
- Significant constitutional symptoms

Question 6

What is the treatment choice for CLL?

Answer 6

Ibrutinib

Question 7

What are the side effects of ibrutinib?

Answer 7

Bleeding

Atrial Fibrillation

Question 8

Which type of lymphoma are SLE and RA associated with?

Answer 8

Non-Hodgkins

Question 9

What is needed for staging of lymphoma?

Answer 9

(1) PET-CT neck/chest/abdo/pelvis
(2) BMBx with aspirate
(3) +/- LP

Question 10

What is the Ann-Arbor stages for lymphoma?

Answer 10

Stage 1: Single lymph node region
Stage II: Lymph node regions on the same side of the diaphragm
Stage III: Lymph node regions on both side of the diaphragm
Stage IV: One or more extralymphatic organs involved (including the bone arrow)
A: No sympoms; B: B-symptoms, E: Contiguous extranodal site; S Splenic involvement.

Question 11

Which type of lymphoma has Reed-Sternberg cells?

Answer 11

Hodgkin Lymphoma

Question 12

How do you treat Hodkin lymphoma?

Answer 12

ABVD +/- Radiation

A - Adrimycin
B - Bleomycin
C - Vinblastine
D - Dacarbazine

Question 13

What are two types of non-hodgkins lymphoma?

Answer 13

Indolent: Follicular, marginal zone

Aggressive: Diffuse Large B Cell, Burkitt

Question 14

How do you treat diffuse large B cell lymphoma?

Answer 14

R-CHOP

R - Rituximab
C - Cyclophosphamide
H - Doxorubicin/Adriamycin
O - Vincristine (Oncovin)
P - Prednisone