Week 3 - Heme/Onc

Question 1

What is hyperleukocytosis?

Answer 1

Peripheral WBC > 100,000/mm3

Question 2

What is the clinical presentation of hyperleukocytosis?

Answer 2

SOB/tachypnea/dyspnea
Blurred vision/papilledema
Ataxia
Mental status changes
Priapism

Question 3

How do you manage hyperleukocytosis?

Answer 3

IV hydration
Chemotherapy
Leukapheresis?

Question 4

What are the metabolic anomalies associated with tumor lysis syndrome?

Answer 4

Hyperuricemia (>8)
Hyperkalemia (>6)
Hyperphosphatemia (>6.5)
Hypocalcemia (<7)

Question 5

What is superior mediastinal syndrome?

Answer 5

When superior vena cava syndrome coexists w/ obstruction of trachea –> tracheal compression –> acute respiratory failure

Question 6

What is superior vena cava syndrome?

Answer 6

compression of the SVC –> poor or no venous return from heart and RUE

Question 7

What are 3 s/s of superior mediastinal syndrome?

Answer 7

cough, dyspnea, orthopnea hoarseness

Question 8

What is neutropenia?

Answer 8

When absolute neutrophil count (ANC) < 500

Question 9

What is absolute neutrophil count (ANC)?

Answer 9

WBC x (% segs + % bands) = WBC x (% neutrophils)

Question 10

What are 3 stem cell sources?

Answer 10

bone marrow
peripheral blood stem in cells
cord blood

Question 11

How do you manage hyperuricemia?

Answer 11

Allopurinol/Rasburicase

Hydration

Question 12

How do you manage GVHD?

Answer 12

Corticosteroids
Cyclosporine
Methotrexate
Tacrolimus

Question 13

What is the 3 (or 4) drug regimen used in induction chemotherapy?

Answer 13

Vincristine (weekly)
Corticosteroid (daily)
Asparaginase
Anthracycline (Daunorubicin)

Question 14

How is response to chemotherapy assessed?

Answer 14

Bone marrow exam - via quant PCR or flow cytometry

Question 15

How do you treat or prevent tumor lysis syndrome?

Answer 15

Allopurinol/Rasburicase
IV hydration
Hemodialysis may be necessary

Question 16

What are 3 goals of post-remission?

Answer 16

1. prevent leukemic growth
2. reduce residual tumor burden
3. prevent emergence of drug resistance in remaining leukemic cells

Question 17

What is part of maintenance therapy after chemo?

Answer 17

1. daily PO 6-MP
2. weekly methotrexate
3. periodic vincristine, prednisone, intrathceal therapy

Question 18

What immunizations should you NOT give during chemotherapy?

Answer 18

live vaccines (oral polio, rotavirus, nasal flu, varicella, MMR)

Question 19

What is lymphocytosis?

Answer 19

Absolute lymphocyte count (ALC) > 4000

Question 20

What is lymphocytopenia?

Answer 20

ALC < 1500

Question 21

What are the 3 main organs involved in aGVHD?

Answer 21

skin, liver, GI tract

Question 22

What is diagnostic clinical features of aGVHD?

Answer 22

maculopapular rash, increasing bilirubin levels, diarrhea (w/wo hematochezia)

Question 23

What are diagnostic findings of cGVHD?

Answer 23

lichen planus-like features of skin, oral mucosa, genitalia

GI - strictures/stenosis

lung - bronchiolitis obliterans

MSK - joint stiffness/contractures

Question 24

What are 2 ways to diagnose cGVHD?

Answer 24

1. presence of diagnostic clinical manifestation

2. presence of distinctive finding, confirmed by biopsy

Question 25

What are 3 biopsies you can perform to dx cGVHD?

Answer 25

skin, lung, GI biopsy