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Hematalogy Lecture > Unit 2: Lymphocytic Leukemias > Flashcards

Unit 2: Lymphocytic Leukemias Flashcards

1
Q

Occurs when massive proliferation of blast cells overwhelm the bone
marrow and begin filtrating into the peripheral blood

A

Acute Leukemia

  • Cause unknown in most cases, but can be linked to genetics along
    with drug and environmental causes
  • Currently believed to rise from multiple genetic mutations
    influencing the stem cells
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2
Q

General ALL:

Normo- normo- anemia, neutropenia, & thrombocytopenia due to
bone marrow __________.

A

overcrowding

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3
Q

General ALL:

Many ______________ observed in majority of patients, but not all! –
variable morphologic presentation, depending upon subtype.

A

lymphoblasts

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4
Q

General ALL:

increased #s smudge cells! ( > ____ / 100 WBCs)

A

12

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5
Q

General ALL:

  • Splenomegaly and hepatomegaly possible
  • Bone pain from infiltration
  • Lymphoblasts can be observed in ____
A

CSF

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6
Q

ALL accounts for ___% of childhood leukemias.

-peak incidence is between
____ years of age
-rare in adults and have a poor prognosis

A

75

2-5

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7
Q

ALL can be classified as __-ALL or __-ALL

A

B, T

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8
Q

What is the most common lymphoblast size?

A
  • Small size is most common with distinct nucleoli
  • Large type is 2-3 times larger than lymphocyte with distinct nucleoli.
    (May be confused with myeloblasts)
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9
Q

Mature B-ALL Immunophenotype?

A

movement of cytoplasmic CD22 to Surface (sCD 22)

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10
Q

CD10 – _______ (most common)

A

CALLA

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11
Q

Majority of T-ALL have mutations involving the
________ gene, which alters T cell development.

A

NOTCH1

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12
Q

What genetics findings relate to the worst prognosis?

A

B-ALL with the t(9;22); BCR-ABL1 mutation
(Philadelphia chromosome-positive ALL)

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13
Q

Which translocation has an excellent prognosis in children?

A

B-ALL with t(12;21);ETV6-RINX1

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14
Q

________________ is common in B-ALLs with good prognosis in children, bad for adults.

A

Hyperdiploidy

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15
Q

Hypodiploidy is rare with bad prognosis in…

A

both adults and children

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16
Q

What is the prognosis for T-cell ALL?

A

poor

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17
Q

T-cell ALL is more common in….

A

adult and late teen males

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18
Q

T-cell ALL is frequently seen with ___________ mass in teenaged boys.

A

mediastinal mass (thymomegaly)

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19
Q

How is T-cell ALL treated?

A

very aggressive chemo

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20
Q

T-cell ALL will be positive for what cell markers?

A

CD2, (CD3, CD4,)* CD5, & CD8

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21
Q

T-cell All is acid phosphatase ___________.

A

positive

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22
Q

Treatment options for ALLs?

A
  • Chemotherapy administered directly into CSF
  • Methotrexate, vincristine, daunorubicin
  • Monoclonal antibodies (anti-CD20) are assuming a role in lead
    therapy
  • Imatinib, used to treat chronic leukemias
  • BMT or SCT last line of treatment (but can be curative in some pt.
    populations)
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23
Q

Three Chronic Lymphoproliferative
Leukemias

A
    1. Chronic Lymphocytic Leukemia (CLL)
    1. Prolymphocytic Leukemia (PLL)
    1. Hairy Cell Leukemia (HCL)
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24
Q

CLL/SLL onset =

A

insidious, asymptomatic.

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25
Q

CLL/SLL:

How is it usually diagnosed?

A

Typically, diagnosis made during exam for other
problems (fatigue, weight loss, lymphadenopathy,
&/or splenomegaly)!

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26
Q

True or false?

CLL/SLL rarely transforms into acute form.

A

true

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27
Q

CLL/SLL:

Even with therapy, median survival is ____years.

28
Q

CLL/SLL is more common in…

A

older patients and males

29
Q

What is the most common leukemia in elderly patients?

30
Q

CLL/SLL

Many ________ cells in peripheral blood due to marked cytoplasmic fragility (also seen in ALLs.)***

31
Q

CLL/SLL Lab Findings:

Report smudge cells as # per ____ WBCs diffed

32
Q

CLL/SLL Lab Findings:

To ↓ # smudge cells & make diff easier, add…

A

2 drops 7% B.B.
albumin to 0.5 mL whole anticoagulated blood before making smear (always make a note of this!)***

33
Q

CLL/SLL Lab Findings:

Bone marrow PAS + for what substance?

34
Q

CLL/SLL Lab Findings:

95% cases are B-cell; CD ___________

A

5, 19(know this, for all B-cell), 20, & 23 +

35
Q

CLL/SLL Lab Findings:

5% cases are T-cell; CD ____________

A

2, 3, 4, 5, 6, 8 +

36
Q

Most common leukemia/lymphoma in Western Hemisphere.

A

Chronic Lymphocytic Leukemia (CLL) and Small
Lymphocytic Lymphoma (SLL)

37
Q
  • Malignant, monoclonal proliferation of small lymphoid cells
  • Mature-looking, but functionally immature, B cells.
A

Chronic Lymphocytic Leukemia (CLL) and Small
Lymphocytic Lymphoma (SLL)

38
Q

CLL/SLL dont respond to Ag. why?

A

cells are too immature

39
Q

CLL/SLL positive for CD…

A

CD5, CD19, CD20, CD23, IgM and IgD+ B-cells

40
Q

CLL/SLL diagnosis based on…

A

Monoclonal B-lymphs > 5,000/uL

(normal range for ALC in adults = 1,000-4,000/uL.)

41
Q

SLL involves lymph nodes and ________ infiltration

42
Q

How do lymphs usually appear with CLL/SLL?

A

mature and mostly normal

  • Rarely, look immature & abnormal.
  • Course chromatin and scant cytoplasm
  • Appear “hypermature” (some have “soccer-ball
    appearance”!)
43
Q

Prognosis for CLL?

A

based upon genetic mutations

44
Q

Treatment for CLL?

A
  • Chemotherapy & leukopheresis (to reduce peripheral blood “burden”).
  • Due to indolent course, use the so-called “watchful waiting” approach.
  • BMT as last resort.
45
Q

Rare, mature lymphoid leukemia (both B- and T-cell
involvement)

A

Prolymphocytic Leukemia (PLL)

46
Q

Lymph node involvement is mostly seen with __-cell PLL

47
Q

Prolymphocytic Leukemia (PLL):

Diagnosis requires_____% prolymphocytes

48
Q

PLL:

Immature-looking, but functionally intermediate maturity, prolymphocyte ___ cells in peripheral blood.

49
Q

PLL:

Large ______, moderately coarse chromatin, 1-2 large nucleoli, agranular & lightly basophilic cytoplasm.

50
Q

“punched out” nucleolus is characteristic finding

A

Prolymphocytic Leukemia (PLL)

51
Q

Prolymphocytic Leukemia (PLL) is most common in…

A

men in their 60’s

52
Q

Prognosis for PLL?

A

Very poor prognosis, mean survival ~ 3 years w/ B-cell

53
Q
  • Absolute lymphocytosis in peripheral blood
  • ALC = 25,000 - 1,000,000/uL!
  • Cells will look more mature than lymphoblasts, but yet more immature than a regular “resting lymph”.
A

Prolymphocytic Leukemia (PLL)

54
Q

Prolymphocytic Leukemia (PLL) is CD…

A

CD20, CD19, CD22, and FMC7

55
Q

Clinical symptoms with PLL?

A
  • Acute onset of common symptoms
  • Also gross splenomegaly with sweats, & fevers, & weight loss
  • Presence of sweats & fevers make it important to rule out HIV!
56
Q

Hairy Cell Leukemia (HCL)

  • Malignant, monoclonal proliferation
  • Atypical-looking, but functionally intermediate to fully mature, ___-cells in with “hairy” cytoplasmic projections
57
Q

“Harry cells” are usually found in…

A

bone marrow or spleen,
sometimes found in peripheral blood, rare in lymph nodes.

58
Q

Large lymphs with big nuclei (round, oval, or
indented), pale blue cytoplasm with unique, hair-like surface projections.

A

Hairy Cell Leukemia (HCL)

59
Q

Hairy Cell Leukemia (HCL) is more common in…

A

middle-aged men

Overall Rare; accounts for only 2% of all leukemias.

60
Q

Hairy Cell Leukemia (HCL):

  • Characteristic pancytopenia & “__________” on bone marrow aspiration.
61
Q

What cells are TRAP positive?***

A

Harry cells.

  • Cells contain unusual isoenzyme of acid phosphatase that is not inhibited by tartaric acid: Tartrate-Resistant
    Acid Phosphatase.

-Other lymphoid cells are TRAP neg.

62
Q

Hairy Cell Leukemia (HCL) is PAS, SBB, and MPO _________.

63
Q

HCL is positive for CD…

A

CD19, CD20, CD22, CD25, and CD103

64
Q

Clinical symptoms of HCL?

A
  • Malaise & fatigue
  • Hugely enlarged spleen (in 90% patients).
65
Q

Treatment for HCL?

A
  • Considered completely incurable in the past
  • Now, however, it’s relatively easy to control with chemo. & splenectomy
  • Good remission rates possible.

Hematalogy Lecture (35 decks)

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