Week 3 - Heme/Onc Flashcards
What is hyperleukocytosis?
Peripheral WBC > 100,000/mm3
What is the clinical presentation of hyperleukocytosis?
SOB/tachypnea/dyspnea Blurred vision/papilledema Ataxia Mental status changes Priapism
How do you manage hyperleukocytosis?
IV hydration
Chemotherapy
Leukapheresis?
What are the metabolic anomalies associated with tumor lysis syndrome?
Hyperuricemia (>8)
Hyperkalemia (>6)
Hyperphosphatemia (>6.5)
Hypocalcemia (<7)
What is superior mediastinal syndrome?
When superior vena cava syndrome coexists w/ obstruction of trachea –> tracheal compression –> acute respiratory failure
What is superior vena cava syndrome?
compression of the SVC –> poor or no venous return from heart and RUE
What are 3 s/s of superior mediastinal syndrome?
cough, dyspnea, orthopnea hoarseness
What is neutropenia?
When absolute neutrophil count (ANC) < 500
What is absolute neutrophil count (ANC)?
WBC x (% segs + % bands) = WBC x (% neutrophils)
What are 3 stem cell sources?
bone marrow
peripheral blood stem in cells
cord blood
How do you manage hyperuricemia?
Allopurinol/Rasburicase
Hydration
How do you manage GVHD?
Corticosteroids
Cyclosporine
Methotrexate
Tacrolimus
What is the 3 (or 4) drug regimen used in induction chemotherapy?
Vincristine (weekly)
Corticosteroid (daily)
Asparaginase
Anthracycline (Daunorubicin)
How is response to chemotherapy assessed?
Bone marrow exam - via quant PCR or flow cytometry
How do you treat or prevent tumor lysis syndrome?
Allopurinol/Rasburicase
IV hydration
Hemodialysis may be necessary
What are 3 goals of post-remission?
- prevent leukemic growth
- reduce residual tumor burden
- prevent emergence of drug resistance in remaining leukemic cells
What is part of maintenance therapy after chemo?
- daily PO 6-MP
- weekly methotrexate
- periodic vincristine, prednisone, intrathceal therapy
What immunizations should you NOT give during chemotherapy?
live vaccines (oral polio, rotavirus, nasal flu, varicella, MMR)
What is lymphocytosis?
Absolute lymphocyte count (ALC) > 4000
What is lymphocytopenia?
ALC < 1500
What are the 3 main organs involved in aGVHD?
skin, liver, GI tract
What is diagnostic clinical features of aGVHD?
maculopapular rash, increasing bilirubin levels, diarrhea (w/wo hematochezia)
What are diagnostic findings of cGVHD?
lichen planus-like features of skin, oral mucosa, genitalia
GI - strictures/stenosis
lung - bronchiolitis obliterans
MSK - joint stiffness/contractures
What are 2 ways to diagnose cGVHD?
- presence of diagnostic clinical manifestation
2. presence of distinctive finding, confirmed by biopsy
What are 3 biopsies you can perform to dx cGVHD?
skin, lung, GI biopsy
