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onco term test 2 Flashcards

1
Q

which acute leukemia is most common in adults

A

acute myeloid leukemia

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2
Q

what are the chemical agents linked to acute myeloid leukemia

A

benzene
petroleum products
chloramphenicol

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2
Q

which leukemia is most common in pediatrics

A

acute lymphoid leukemia

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3
Q

what are the chemical agents / medical drugs linked to acute myeloid leukemia

A

alkylating agents (chlorabucil)
topoisomerase II inhibitors (anthracyclines, mitoxantrone, epipodophyllotixins)

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4
Q

what viruses or immunologic disorders are linked to acute lymphoid leukemia

A
  • human T cell lymphocyctic virus HTLV - 1
  • EBV in mature B cells
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5
Q

what lifestyle habits are linked to acute myeloid lymphoma

A

obesity, tobacco

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6
Q

what genetic disorders are linked to acute myeloid lymphoma

A

down syndrome (trisomy 21)
defective DNA repair (fanconi anemia, bloom syndrome, ataxia)
Kotsmann syndome

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7
Q

what genetic disorders are linked to acute lymohoid leukemia

A

down syndrome, bloom syndome, klinefelter syndrome, fanconi, ataxia, neurofibromatosis

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8
Q

where does acute myeloid leukemia progress

A

gum infiltration, chloromas

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9
Q

where does acute lymphoid leukemia progress

A

CNS , LN, Liver or spleen

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10
Q

which leukemia is abrupt with rapid progression

A

acute lymoid leukemia

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11
Q

what are the symptoms of leukemia (general)

A

infection, bleeding anemia,
neutropenia (fever)
thrombocytopenia
hypoxemia, retinal hemorrhage, confusion

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12
Q

what are the CNS symptoms of Leukemia

A

headache, confusion, cranial nerve palsy

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13
Q

what are acute myeloid leukemia specific symptoms

A
  • coagulation disorder, marrow failure, organ infiltration
  • gum hypertrophy and skin irritation
    tumor lysis syndrome
    DIC: hemorrhage, thrombosis
    extramedullary sarcoma
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14
Q

what are acute lymphoid leukemia specific symptoms

A

symptoms related to marrow failure
- bone pain
mediastinal mass with cough and SVC syndrome in T precursor
- lymphadenopathy
splenomegaly and hepatomegaly

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15
Q

which cells does acute myeloid leukemia start in

A

myeloid progenitor cells
- neutrophils
- eosinophils
- basophils
- monocytes
- platelets
- RBCs
cells responsible for fighting infection

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16
Q

what are the 4 categories of acute myeloid leukemia subtypes

A
  1. recurrent with genetic abnormalities
  2. myelodysplasia related changes
  3. therapy related myeloid neoplasm
  4. not otherwise specified
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17
Q

what are the histopathologies for acute lymphoid leukemia

A

B precursor (75%)
T precursor (25%)
B and T cells responsible for creating antibodies

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18
Q

what are the diagnostic procedures for leukemia

A

CBC and peripheral blood smear
kidney, liver, coagulation tests
uric acid
bone marrow aspirate, blast count
CXR, EKG, echocardiogram
HLA testing
infectious screen
gene expression profilling

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19
Q

what are the staging procedures for acute myeloid AND acute lymphoid leukemia

A

labs
imaging
HLA testing for genetic match for BMT
flow cytometry
ECG pre chemo

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20
Q

what are the staging procedures specific to acute lymphoid leukemia

A

CT chest, abdo, pelvis
testicular examination and lumbar puncture to evaluate extramedullary disease
immunophenotyping of PB and/or BM

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21
Q

which leukemia has a worse prognosis

A

acute myeloid leukemia

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22
Q

what are the prognostic factors for acute myeloid leukemia

A

age > 60
WBC > 100, 000 uL at presentation
not achieving complete remission after induction therapy
poor performance status and co morbidities
unfavourable cytogenetic and molecular markers
cytogenetic abnormalities at diagnosis are the most prominent of prognosis in patients with AML

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23
Q

what are the prognostic factors for acute lymphoid leukemia

A

age > 35
WBC > 30,000 uL for B precursor at diagnosis and >100, 000 for T precursor
hypodiploidy (<44 chromosomes)
Philadelphia chromosome
gene mutation
achieving CR > 4 weeks post induction
detection of residual leukemic clone

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24
explain the treatment for acute myeloid leukemia
induction + consolidation induction : 3 days of anthracycline and 7 days of IV continuous infusion of cytarabine consolidation: high dose cytarabine, every 12 hours on days 1, 3 , 5
25
explain the treatment for acute lymphoid leukemia
induction , consolidation, maintenance, CNS prophylaxis (dana faber protocol) induction: 2x cycles, each over 4 weeks including vincristinem dexacort, daunorubicin and L asparaginase in the first cycle, and cytarabine and cyclophosphamidine in second cycle of intensification consolidation: 5 cycles of chemo (decrease tumour burden and prevent relapse) maintenence: daily mercaptopurine (MP) weekly methotextrate and vincristine and predisone every 3 months
26
what is the goal of induction in leukemia
achieve remission : get rid of blood and marrow visible of leukemic blast cells (4-6 weeks)
27
what is the goal of consolidation
reduce number of leukemic cells remaning, begins when patient goes into complete remission (CR) 4-6 months
28
what is maintenance in leukemia
chemo given over an extended period to remain remission typically 2 years
29
what is a stem cell transplant and what does it involve
- high dose chemo + total body irradiation followed by stem cell infusion to rescue bone marrow
30
when is an allotransplant used
mainly used to ensure not transplanting cancer cells inadventently
31
what is the role of radiation in curative cases
TBI withchemo and stem cell transplant -
32
what is the role of radiation in PALLIATIVE cases
granulocytic sarcomas, splenomegaly, bone pain
33
when is cranial and spinal rads used
CNS prophylaxis and treatment
34
when is prophylactic radiation used (with intrathecal chemotherapy)
high risk cases
35
when is cranial spinal RT used
gross disease +/- brain and meninges OR palliation in brain deposits
35
what is chloroma
tumour deposits od leukemia
36
what dose is used for chloroma
5-6 Gy
37
dose for splenomegaly
1-5Gy / 4-10 fx
38
what is the dose for bone pain
single 5-6 Gy
39
what are acute side effects of TBI
nausea vomitting fatigue skin and hair salivary glands mucosa pancytopenia, enteritis, veno occuluive disease, pulmonary
39
what are the types of TBI regimes
hypofractionated non myeloablative (most common)
39
late effects of TBH
cataracts, pulmonary, infections, endocrine (sex, thyroid, fertility) , renal, secondary malignancies
40
what are late side effects in children (TBI)
- growth and development (hormonal, skeletal, delayed puberty) CNS and other organ injury (ex kidney)
41
what are the viruses related to chronic lymphoid leukemia
hepatitis B or C, and HIV status
42
what genetic disorders are related to chronic lymphoid leukemia
recriprocal translocation (9:22) philadelphia chromosome BCR - ABL (immediate cause)
43
which leukemia has a familial predesposition of 10%
chronic lymphoid leukemia
44
what are the 3 phases of of chronic myeloid leukemia
chronic, accelerated and blastic
45
how is the chronic phase characterized
abnormal number of mature granulocytes dye to uncontrolled proliferation
46
how is the accelerated phase characterized
splenomegaly high WBC bleeding, anemia fatigue weight loss non specific bone pain sweating abdominal discomfort early satiety
47
how long does the chronic and accelerated phase last
3-5 years 6 months
48
if chronic lymphoid leukemia is left untreated what can it progress into
aggressive lymphoma
49
what are forms of autoimmune phenomena
coombs positive autoimmune haemolytic anaemia idiopathic thrombocytopenia
50
what are symptoms of accelerated phase
night sweats fever weight loss bone pain increased basophils and blasts
51
what is the change into an aggressive lymphoma called
richter transformation
52
what is chronic myelogenous characterized by
accumulation of neoplastic, functionally incompetent B lymphocytes in the blood, BM, LNs, spleen, or other organs
53
what sit eh staging system for chronic lymphoid leukemia
RAI staging - 0-4 : location of sites affected and blood results Binet staging - A-C based on enlarged areas, Hb levels and platelet levels
54
what are the phases / stages (WHO) of chronic myelogenous leukemia
chronic accellerated blastic crisis
55
what are the diagnostic procedures for chronic myelogenous leukemia
CBC, BM examination (cytogenetic analysis, molecular analysis) chemistry tests (serum LDH, uric acid, serum B12) Sokal and Hasford prognostic scores
56
what are the diagnostic procedures for chronic lymphoid leukemia
CBC, pheripheral film LDH flow cytometry, lymphocyte surface markers BM testing imaging virology - hepatitus B , C HIV
57
what are the staging procedures for chronic myelogenous leukemia
Criteria for AP - Blasts 10–19% in PB or BM - PB basophils ≥20% - Persistent thrombocytopenia (<100 × 10 9 /L) unrelated to therapy or persistent thrombocytosis (>1000 × 10 9 /L) unresponsive to therapy - Increased spleen size and increased WBC count unresponsive to therapy - Cytogenetic evidence of clonal evolution Criteria for BC - Blasts ≥20% in PB or BM - Extramedullary blast proliferation (chloroma) - Large foci or clusters of blasts in BM biopsy - PET-CT - CT - CBC
58
what are the staging procedures for chronic lymphoid leukemia
CT/US CBC Rai staging binet staging system
59
what is the treatment of choice for chronic myelogenous leukemia
targeted therapy
60
what are the generations for targeted therapy for chronic myelogenous leukemia
1st: imatinib 2nd: nilotinib and dasatinib 3rd: bosutinib and ponatinib
61
what is the goal of targeted therapy in CML
target molecular defect
62
what are side effects of targeted therapy
cytopenia nausea rush fluid retention hepatic toxicity
63
when is ALLO STC used
BC status or progress to AP while on therapy or failed 2nd generation TKI or unavailable to receive ponatinib
64
what race in myeloma has twice the risk compared to caucasians
african americans
65
where is the highest and lowest prevalence of myeloma
high: north america, europe, australia low: asia, africa
66
what medical drugs are linked to myeloma
immunosuppressive agents chemo drugs long term
67
what viruses are linked to myeloma
HIV and hepatitus C increase myeloma risk autoimmune disease (lupus, rheumatoid)
68
what lifestyle factors are linked to myeloma
tobacco alcohol animal fats obesity
69
what are the 3 progressions of myeloma
asymptomatic phase symptomatic phase (Active ) advanced refractory disease
70
what are the features of symptomatic myeloma
CRAB calcium evaluation renal dynfuction anemia bone disease
71

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