Week 3 Lecture 6 - Neoplastic Disorders of the Bone Marrow: Continued

Question 1

Dual Haematopoietic Neoplasia and Sequential Haematopoietic Neoplasia (DSHN)

Answer 1

Uncommonly cases of two haematopoietic neoplasms in the same patient are reported
May occur concurrently or sequentially
May be difficult to determine if two neoplasms evident at first presentation
Sequential haematological assessments can distinguish formation of second haematological neoplasm
Therapy for one haematopoietic neoplasm may result in a second haematopoietic neoplasm

Question 2

Therapy Related Haematopoietic Neoplasms

Answer 2

Designates leukaemias developing in persons who previously received anti-cancer therapy
Especially if therapy included drugs such as alkylators, DNA- intercalators, topoisomerase-2- inhibitors, purines and/or ionising radiation
Sometimes specific genes such as AML1, EVI1, NRAS, MLL are mutated in cases of therapy-related leukemia

Question 3

What does the BCR-ABL1 Fusion Gene Represent?

Answer 3

Chronic Myeloid Leukaemia

Question 4

Haematopoietic Neoplasia & Non-Neoplastic (‘Other’) Haematological Disease (OHD)

Answer 4

Many possible combinations of disorders
- e.g. neoplasm and infectious agent
Haematopoietic neoplasm may predispose to infectious agent
- neoplasm may compromise immune response
- therapy may compromise immune response
- recrudescence of latent infections
Complicated effect on:
- bone marrow/haematopoiesis
- peripheral blood composition
Effect of therapy
- cytotoxic chemotherapy
- haematological growth factors (exogenous)

Question 5

Chronic Lymphocytic Leukaemia Findings

Answer 5

Very high lymphocytes
CD5+/CD19+/CD23+/CD20dim/κdim

Question 6

Non-Haematological Neoplastic Disorders of the Bone Marrow - Metastatic Neoplasia

Answer 6

Often encountered
The primary site may not be detectable
Trephine biopsy is essential for suspected metastatic neoplasms
May require multiple biopsies
May still not detect all metastatic neoplasms
Examples of metastatic neoplasms of the bone marrow:
- carcinoma
- malignant melanoma
- sarcoma

Question 7

Response to Therapy

Answer 7

Medical intervention will effect biological behaviour of the neoplasm and consequently the characteristics of the neoplasm
Some of the effects:
- cytotoxic drugs that destroy cells
- drugs can inhibit proliferation
- drugs can promote differentiation
These lead to effects on morphology