Leukemia, Lymphoma, Myeloma Flashcards Preview

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Flashcards in Leukemia, Lymphoma, Myeloma Deck (86)
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1

lymphoma vs leukemia

leukemia: typically involve marrow and blood -- not masses

lymphoma: typicaly form discrete masses in tissues/lymph nodes

BOTH: neoplasms of WBCs

2

stains myeloid cells

MPO
myeloid peroxidase

3

AML(acute myeloid leukemia)

at least 20% blasts in marrow/blood
- myeloblast(granulocyte precursor)
- monoblast(monocyte/macrophage precursor)
- blasts w/megakaryocyte/erythroid differentiation

4

General classifications of AML

genetic aberrations
- M3 most notable: t(15;17) -- auer rods (APL)

AML w/MDS-like features

therapy related; 
- alkylation, radiation, topoisomerase inhibitor

other...

5

acute promyelocytic leukemia

cause?
treatment?
unique histology?

M3 promyelocytes due to t(15;17) RARa/PML

arsenic or ATRA

large, bilobed nuclei, azurophilic granules, auer rods

6

disease state most commonly involving t(9;22)

what genes have been swapped?

treatment?

CML, philadelphia chromosome

BCR-ABL

imatinib

7

presentation of CML

overgrowth of maturing granulocytes; <10% blasts
- increased PMN
- increased metamyelocytes
- increased basophils
- splenomegaly

8

progression of CML

50% enter accelerated phase w/10-20% blasts
50% enter blast crisis directly 
- blast crisis looks like AML but w/BCR-ABL gene

9

two types of leukemia

myeloid  - AML, CML
lymphoblastic - ALL, SLL/CLL

10

ALL presents in what type of patients

young children (<15 y/o)

11

diagnosis of aLL

immuno/flow cytometry

differentiate ALL from AML: TdT(pre B/pre T cells)

differentiate B-ALL from T-ALL: subclass markers(CD10+ for pre-B cells)

12

T-ALL presentation

mediastinal mass +/- lymphadenopathy
more lymphomatous presentation than B-ALL

associated w/down syndrome

13

morphology of ALL

high N:C ratio immature lymphocytes(lymphoblasts)

14

CLL/SLL(chronic lymphocytic leukemia/small lymphocytic lymphoma)
age
cytology
diagnosis
unique histology

most common adult leukemia
CD20/CD5+ B-cell neoplasm(mature)

often asymptomatic; usually incidental WBC ^^ 

smudge cells

15

myelodysplastic syndrome

clonal populations with defective maturation
- drug, therapy, radiation, benzene exposure

high progression to AML!!

dysplasia of all lineages

16

name the myeloproliferative disorders 

CML 
Polycythemia Vera 
Essential Thrombocytosis 
Primary Myelofibrosis

17

polycythemia vera

JAK2 mutation

increased RBC, WBC and platelets

myeloproliferative disorder

18

common pathogenesis of myeloproliferative disorders

mutation in tyrosine kinases

activate growth survival but dont mess up differentiation

19

treatment for hyperuricemia

allopurinol(prevents formation)
rasburicase(metabolizes uric acid)

20

treatment for hyperleukocytosis(emergency)

hydroxyurea: stops cells from dividing(bring WBC donw)

leukaphoresis: mechanically pulls WBC off

21

acute leukemia

mechanism
presentation

neoplastic proliferation of blasts

>20% blasts in bone marrow
- type of blasts determines ALL vs AML

blasts crowd out normal hematopoiesis resulting in acute anemia(fatigue), thrombocytopenia(bleeding), or neutropenia(infection)

22

presentation of chronic leukemias

insidiuos onset
high WBC count

neoplastic proliferation of mature WBCs

CLL - naive B cells CD5/CD20+
CML - mature myeloid cells, esp. granulocytes

23

typical age of patients:
AML
ALL
CML
CLL

AML - older(>50)
ALL - younger (5-15)
CML - older(45-85)
CLL - older(>60; most common adult)

24

FLT3 internal tandem repeat is a negative prognostic factor for...

treatment?

AML

FLT3 is associated with relapses
sunitinib, sorafenib are FLT3 inhibitors

25

AML remission induction

post-remission treatment

induction:
chemo: cytarabine(antimetabolite), daunorubicin(topo II)

post-remission
- high dose chemo
- BMT

26

APL presentation

young patients
low blood count
bleeding/bruising(DIC)

marker: PML/RARa


27

ALL remission induction

post-remission therapy

induction
- chemo +/- BCR-ABL(if from CML progression)

post-remission therapy
- high dose chemo
- chemo drugs crossing brain(brain relapse, not   used in AML)
- BMT
- maintenance therapy(not used in AML)

28

blinatumomab

new drug/Mab for B-ALL

targets T cells to CD19+ B cells

29

t(15;17)

RARa/PML

Acute promyelocytic leukemia

auer rods

30

which CLL patients are classified as 'high risk'?

intermediate:
LAD
large spleen and or liver

high:
anemia
thrombocytopenia