W3: Leukaemias, Lymphomas and Myelomas Flashcards
define leukaemia
cancer of wbcs
define lymphoma
cancer of lymphoid tissue
define myeloma
cancer of clonal plasma cells in BM (B cells)
4 main types of leukaemia
Acute myeloid leukaemia (AML)
Acute lymphoblastic leukaemia (ALL)
Chronic myeloid leukaemia (CML)
Chronic lymphoid leukaemia (CLL)
2 types of lymphoma
Hodgkin’s
Non-Hodgkin’s
2 cell cycle abnormalities that cause cancer + where do they occur
mutations in proto-oncogenes
mutations in tumour suppressor genes
occurs in BM or peripheral lymphoid tissue
*mutation in single gene
incidence vs prevalence
i = rate of new cases in given time period/ % of pop at risk of dev
p = no. of people already w condition
known causes of leukaemia
- previous chemotherapy w alkylating agents
- radiation exposure
- benzene/ formaldehyde exposure
- genetic conditions (down’s syndrome)
- myelodysplasia (pre-leukaemia)
dysplasia vs myelodysplasia
d = abnormal dev
md = abnormal dev of myeloid cells (pre-leukaemia)
define acute myeloid leukaemia
> 20% myeloblast cells (immature wbcs) in blood/ BM
affects myeloid line (granulocytes + monocytes)
define acute lymphoid leukaemia
> 20% lymphoblast cells (immature wbcs) in blood/ BM
affects lymphoid line
define chronic myeloid leukaemia
chronic = incr no. of mature cells than blast cells
affects myeloids (granulocytes + monocytes)
define chronic lymphoid leukaemia
chronic = incr no. of mature cells than blast cells
affects lymphocytes
AML: median age
60yrs
AML: signs + symptoms + why
- Acute, often critically ill
- Malaise, fever, sweats (high E use of uncontrolled prolif - hot + sweaty)
- Symptoms of anaemia (BM too crowded so no space + nutrients to make rbcs)
- Neutropenia - infections
- Thrombocytopenia - bleeding / DIC
what type of anaemia can be seen in AML + why
normocytic normochromic bc nothing wrong w prod of rbcs just not enough space to make them
testing to distinguish btwn myeloid leuk vs lymphoid leuk
m = myeloperoxidase (MPO) pos (enzyme found in granulocytes)
prognosis of AML
chemo leads to complete remission in 80-90% younger patients
cure rate lower ~45%
older patients - 5yr survival rate ~15%
cure rate rare
define “in remission”
cancer repressed to <5% blast cells
chemotherapy side effects
chemo = cytotoxic drugs = toxic to all rapidly dividing cells (healthy or not)
side effects:
- hair loss (bc hair follicles divide fast)
- nausea + vomiting (bc mucus mem gut lining cant divide)
- decr in sperm prod -> infertility
ALL: peak age, % of childhood leukaemias, ratio caused by B to T cells, categories
0-4 yrs
80%
85:15
L1-L3
ALL signs + symptoms
- Starts abruptly
- Bone + joint pain
- Symptoms of BM failure (anaemia, infection, haemorrhage)
- Generalised lymphadenopathy (enlarged lymph nodes in multiple places)
Hepatosplenomegaly (liver + spleen reactivated to prod wbcs) - Testicular involvement
- CNS manifestations
define sanctuary site
places in body where chemo struggles to reach
ALL blood test
leukocytosis/ leukopenia/ normal wbc count
normo, normo anaemia
neutropenia
thrombocytopenia
wbcs MPO neg
ALL prognosis
children curable w chemo + CNS prophylaxis
adult cured less freq - stem cell transpalnt
35% 5y survival adults
CML common age range
65-85 yrs
CML associated w presence of which chromosome
Philadelphia
CML S+S
fatigue, weight loss, sweaty
splenomegaly
hepatomegaly (sensation of fullness)
gout, bruising
leukostasis (clumping of leukocytes)
CML blood test
leukocytosis, neutrocytosis
incr basophils
normo normo anaemia
thrombocytosis most freq
incr lactate dehydrogenase (LDH)
CML prognosis
50% 5y survival
indolent (slothful), followed by period of acceleration + final generally fatal leukemic phase
stem cell transplant - can cause mortality
tyrosine kinase inhibitor - imatinib as initial therapy
CLL age
50+ , peak at 90+
CLL S+S
asymptomatic
symmetrical + painless enlargement of lymph nodes
symptoms of anaemia
weight loss
indolent
CLL blood test
lymphocytosis
wbcs appear as small + round lymphocytes
smear cells (fragile lymphocytes burst during processing)
immunotyping - shows as almost always B cells (bc CD19+ on surface)
normo normo anaemia
thrombocytopenia
CLL prognosis
initially indolent
chemo not needed immediately
705 5y survival
often die of other causes
becomes more aggressive in advanced stages
lymphoma is
cancer of lymphoid tissues
e.g
spleen, lymph nodes, tonsils, adenoids, thymus
lymphoma effects
swollen lymphod tisses fileld w B or T cells
% ratio of hodgkins vs non-hodgkins lymphoema + which cells + how distinguished
40% H (B lymphs)
60% non-H (T or B lymphs)
biopsy node + stain lymphs
CD15 marker of Reed-Sternburg cells (in hodgkins)
hodgkins lymphoma
Malignant B-cells accumulate in lymph nodes
malignant cells = minority of tumour
inflammatory cells = majority
2 peak ages of hodgkins
15-35
over 50
hodgkins S+S
asymmetrical + painless lymphadenopathy (swollen lymph nodes)
splenomegaly
fever, night sweats, wt loss, pruritus (itching), fatigue in minority
hodgkins blood test
normo normo anaemia
eosinophilia
neutrophilia
normal/ incr platelet count
advanced disease - lymphopenia, thrombocytopenia
hodgkins prognosis
80% 10y survival
largely determined by stage of disease
chemo -> high cure rates
risk of 2ndary malignancy as late side effect of treatment
non-hodgkins age
85-89
non-hodgkins S+S
asymmetrical painless lymphadenopathy
Less fever, night sweats + wt loss than w Hodgkin’s
Sore throat
Symptoms of anaemia/ thrombocytopenia/ neutropenia w infections
Acute abdominal symptoms due to spleen/ liver enlargement + involvement of GI tract
non-hodgkins blood tests
normo normo anaemia - maybe autoimmune haemolytic anaemia
in advanved diseas w marrow involvement - neutropenia, thrombocytopenia
lymph node biopsy
cytogenics (chromosome mapping)
non-hodgkins prognosis
55% 10y survival
indolent
chemo effective
cure elusive
aggressive NHL cured w chemo + ruiximab
stem cell transplant
multiple myeloma (MM)
cancer of clonal plasma cells in BM (B cells)
MM detected by
Ab secreting B cells that secrete paraprotein (aka M protein) (detectable in serum/ urine)
MM age + race most effected
85-89
african americans
MM S+S
bone pain, fractures
anaemia symptoms
thrombocytopenia
leukopenia
renal failure, hypercalcaemia
amyloidosis (deposition of abnormally folded proteins)
MM blood tests
incr plasma cells in BM
presence of paraprotein
normo normo OR macro anaemia
pancytopenia
hypercalcemia
normo
