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BDS2 HHD - Human Disease > 10. Haematology II: Leukaemia & Lymphomas > Flashcards

10. Haematology II: Leukaemia & Lymphomas Flashcards

(41 cards)

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1
Q

LOs

A
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2
Q

1.
what is leukaemia?

2.
what does it result in?

A

1
- Malignant neoplasms of haemopoietic stem cells

2
- Result in diffuse replacement of bone marrow and normal blood precursor cells by neoplastic cells

  • Bone marrow failure leads to anaemia, neutropenia and thrombocytopenia
  • Leukaemic cells spill over into blood and may infiltrate organs
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3
Q

how leukaemias classified?

A

classified based on cell type involved and its maturity:

  1. cell type
  2. maturity
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4
Q

what are the classes of leukaemia split into?

A
  • Cell type
    ~ Myeloid cell line
    ~ Lymphoid cell line
  • Maturity
    ~ Acute > 50% myeloblasts or lymphoblasts in
    bone marrow at clinical presentation
    ~ Chronic cells are more differentiated
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5
Q

myeloid cell line?

A
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6
Q

lymphoid cell line?

A
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7
Q

how are leukaemias diagnosed?

A
  1. BLOOD FILM
    ~ Suggests diagnosis
    ~ Due to presence of Abnormal WCC (white cells)
    ~ Presence of blasts
  2. BONE MARROW
    ~ usually confirms diagnosis
    ~ Hypercellular
    ~ Numerous blast cells
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8
Q

what can blood film test and bone marrow aspirate tell us?

A
  • Important prognostic indicators
    ~ Leukaemia type
    ~ Cell phenotype
    ~ Chromosomal abnormalities
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9
Q

aetiology of leukaemias

A
  • Ionizing radiation
  • Chemicals including benzene and alkylating agents
  • Viruses (e.g.. HTLV – human T-cell leukaemic virus)
  • Genetic factors (e.g.. Down’s syndrome)
  • Acquired haematological disorders such as aplastic anaemia
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10
Q

what can bone marrow infiltration result in?

A
  • can result in failure of other important cell lines
  • this can result in:
    ~ anaemias
    ~ impacted immune system
    ~ impact coagulation and platelet function
  • these over all can thus then cause:
  • pallor
  • malaise
  • fever + infection
  • bleeding
  • bruising / petechiae
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11
Q
  1. why may tissue infiltration occur?
  2. what can tissue infiltration result in/ cause?
A

1
- neoplastic cells may spill out of the bone marrow into the peripheral blood
- this can lead to infiltration of other organs

2
- Lymphadenopathy
- Hepatosplenomegaly
- Central nervous system

  • Bone and joint pain (ALL)
  • Testicular swelling (ALL)
  • Gingival hypertrophy (AML) (important for dentistry)
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12
Q

names of acute and chronic leukaemias?

A

ACUTE (immature cell lines) (could be myeloid or lymphoid depending on type of cell)
- Myeloid (AML = acute myeloid leukaemia)
- Lymphoid (ALL = acute lymphoblastic leukaemia)

CHRONIC (typically more mature cells)
- Myeloid (CML = chronic myeloid leukaemia)
- Lymphoid (CLL = chronic lymphocytic leukaemia)

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13
Q

ALL - Acute lymphoblastic leukaemia

1
age of peak incidence

2
management

A

1
Children - peak incidence 4-5 years

2
- Remission induced with non-myelosuppressive chemotherapy
- 2-12 years >60% cure rate with chemotherapy
- Adults 20% cure rate
- Combination chemotherapy to induce remission
- CNS treatment performed prophylactically
- Maintenance therapy for up to 2 years increases disease-free survival

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14
Q

AML - Acute myeloid leukaemia

1
incidence at what age most likely?

2
management?

A

1
- Most common leukaemia in adults
- Increasing incidence with age
- X400 higher incidence in children with Down’s syndrome

2 Management
- >80% cure rate with intensive chemotherapy in young patients
- 15% resistant disease
- 4-5 courses of intensive chemotherapy (each lasting 5-10 days)
- No maintenance therapy
- Autologous and allogenic stem cell transplant (if fail chemotherapy)

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15
Q

CLL - Chronic lymphocytic leukaemia

1
common age?
Male : female incidence?

2
clinical features

A

1
- 25 % of all leukaemias
- Elderly (>60years)
- M:F ~ 2:1

2
- Constitutional symptoms
- Lymphadenopathy
- Splenomegaly
- Recurrent infections
- Abnormal FBC (anaemia, thrombocytopenia)
- Hypogammaglobinaemia

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16
Q

CLL - Chronic lymphocytic leukaemia

treatment?

A
  • Asymptomatic patients do not require treatment (monitoring only)
  • 30% of patients with early stage disease die of unrelated cause
  • Chemotherapy typically effective
  • Median survival 10-12 years
  • Mortality usually due to infection or bone marrow failure
  • Bone marrow transplantation occasionally attempted in younger patients with poor prognostic disease
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17
Q

CML - Chronic myeloid leukaemia

1
median onset age?
more common in M or F?

2
clinical features

Study These Flashcards
A

1
- < 20% of all leukaemias
- Median age of onset 40-50 years
- Slight male predominance
- Chronic phase for years – no treatment
- Accelerated phase and then blast crisis - require treatment

2
- Bone marrow failure (anaemia, thrombocytopenia)
- Hypermetabolism (anorexia, weight loss, night sweats)
- Splenomegaly
- Leucostasis (visual disturbances, priapism)
- Hyperuricaemia (gout, renal failure)

18
Q

CML - Chronic myeloid leukaemia

what is philadelphia chromosome?
what did it lead to?

Study These Flashcards
A
  • > 90% have ‘Philadelphia chromosome’
  • ‘Balanced translocation’ between 9 and 22
  • Resultant oncogene with tyrosine kinase activity
  • Lead to first targeted therapy for leukaemia – imatinib (tyrosine kinase inhibitor)
19
Q

classifications of lymphomas

Study These Flashcards
A
  1. Hodgkin’s disease
  2. non-Hodgkin’s disease
20
Q

features of Hodgkin’s disease lymphomas

Study These Flashcards
A
  • Nodal (involves lymph nodes)
  • Contiguous (applies to serial lymph nodes)
  • Good outcome
  • Not associated with immunodeficiency
21
Q

features of non-Hodgkin’s disease lymphomas?

Study These Flashcards
A
  • Extranodal
  • Non-contiguous
  • Variable outcome
  • Associated with immunodeficiency
22
Q

Hodgkin’s disease lymphomas

1
peak incidence age?

2
annual incidence (M + F)?

3
aetiology?

Study These Flashcards
A

1
- Peak incidence in third decade
- Possible bimodal age with second peak adults> 60yrs)

2
Annual incidence
Male - 3 per 100,000
Female - 1.8 per 100,000

3
Aetiology unknown
EBV (infectious mononucleosis) suggested

23
Q

Hodgkin’s disease lymphomas clinical features?

Study These Flashcards
A
  • Lymphadenopathy
    (particularly cervical lymph chain)
    ~ Cervical and contiguous
    ~ Painless, non-tender, rubbery
    ~ Alcohol induced pain
  • Constitutional ‘B’ symptoms
    ~ Fever
    ~ Night sweats
    ~ Weight loss >10% in 6 month period
  • Anorexia and fatigue
  • Pruritus and erythematous rash
  • Mediastinal lymph node involvement
    ~ Hilar lymphadenopathy
    ~ Bronchial compression
    ~ SVC obstruction
  • Hepatosplenomegaly
24
Q

how is Hodgkin’s disease lymphomas staged?

Study These Flashcards
A
  • staged based on Ann Arbor system
  • I Single LN region
  • II Two LN regions
  • III Groups on both sides of
    diaphragm
  • IV Widespread disease outside
    lymphatic tissues
  • B symptoms
    ~ Weight loss
    ~ Night sweats
    ~ Unexplained fever
25
Hodgkin's disease lymphomas management? 1 investigations 2 treatment
1 - FBC (full blood count) (normochromic normocytic anaemia) - Elevated ESR (inflam markers) - LFTs / U&Es / bone profile / LDH (liver+renal blood test) - CXR / CT - Lymph node biopsy (Reed-Sternberg cells presence?) - Rarely bone marrow examination 2 treatment (curative) - Early stage disease (IA/IIA) ~ Chemotherapy + radiotherapy - Advanced stage disease ~ Combination chemotherapy ~ Complete remission 60-90% - Prognosis is relative to stage of disease - 90% Stage I (5 year survival) - B symptoms presence worsens prognosis
26
Non-Hodgkin's disease lymphomas 1 presentation? 2 incidence in pop? 3 age? 4 male or female more common?
1 - Varied presentation - Heterogeneous group of disorders 2 Annual incidence 11 per 100,000 3 Slight male preponderance 4 Increases with age - rare < 40 years
27
aetiology of Non-Hodgkin's disease lymphomas
- Immunodeficiency (acquired + congenital) - Infections - Ionizing radiation - Carcinogenic chemicals - Inherited disorders affecting DNA damage and repair
28
Non-Hodgkin's disease lymphomas clinical features
- Generalised lymphadenopathy - Oropharyngeal involvement (Waldeyer’s ring) - Bone marrow infiltration ~ Anaemia ~ Recurrent infections ~ Haemorrhage
29
Non-Hodgkin's disease lymphomas management?
- based on grade of disease - LOW GRADE DISEASE ~ May be asymptomatic requiring no treatment ~ Intermittent oral chemotherapy - HIGH GRADE DISEASE ~ Combination chemotherapy ~ 30% cure
30
Multiple myeloma 1 what/ cause? 2 age range?
1 - Arises from malignant transformation of terminally differentiated B cell (plasma cell) - Monoclonal expansion results in secretion monoclonal Ig or light chains (paraproteins) - Typically long asymptomatic phase that can last for many years (MGUS – monoclonal gammopathy of undetermined significance) 2 - Most patients are between 40-80yrs old
31
Multiple myeloma clinical features?
- Bone destruction ~ Myeloma cells stimulate osteoclasts causing bone destruction and classic well-defined osteolytic lesions and raised serum Ca2+ - Bone marrow failure ~ Marrow infiltration leads to anaemia, thrombocytopenia and neutropenia and recurrent infections - Renal failure ~ Due to deposition and accumulation of paraproteins - Hyperviscosity syndrome ~ Headache and dizziness - Amyloidosis (development of abnormal protein cells - deposit in various tissues + infiltrate organs around body)
32
Multiple myeloma 1 investigations? 2 Management?
1 - FBC = bone marrow failure - Raised ESR and Ca2+ - U&Es demonstrate renal damage - Protein electrophoresis demonstrates monoclonal paraprotein - Bence-Jones proteins in urine 2 - Only if evidence of organ damage - Chemotherapy if evidence bone marrow failure or bone lesions - Most patients respond however relapse if common - Radiotherapy useful if bone pain
33
DENTAL RELEVANCE OF LEUKAEMIAS + LYMPHOMAS - oral manifestations may result as secondary to the underlying process
- Secondary ~ Manifestations anaemia ~ Haemorrhagic tendency ~ Increased susceptibility to infection ~ Neutropenic ulceration
34
DENTAL RELEVANCE OF LEUKAEMIAS + LYMPHOMAS Leukaemic infiltration?
- in some patients leukaemic cells spill out of bone marrow and deposit in various tissues - this can include gingiva + bone - Typically gingival however also bone infiltration - 3.6% of dentate patients -c18.5% in AML - Friable and haemorrhagic - Increased tooth mobility
35
DENTAL RELEVANCE OF LEUKAEMIAS + LYMPHOMAS 1 Intraoral lymphomas 2 management
- can develop intraorally - Typically non-Hodgkin lymphomas (NHL) associated with HIV - Most commonly affected sites are the fauces and gingivae - Typically present as rapidly enlarging masses with bone destruction 2 - Chemotherapy - Radiotherapy
36
DENTAL RELEVANCE OF LEUKAEMIAS + LYMPHOMAS treatment of conditions can lead to oral complications
- Mouth care can be overlooked - Oral complications ~ 90% of children ~ 50% of adults - Mucositis (damage to lining of mouth) - Infection including candidosis and viral (HSV, VZV) - Mucosal bleeding - Xerostomia
37
DENTAL RELEVANCE OF LEUKAEMIAS + LYMPHOMAS Mucositis 1 associated with what radiotherapy + chemotherapy agents 2 - onset/ how to stope? - what is severity of mucositis related to?
1 - Associated with number of chemotherapy agents and radiotherapy - 5-fluorouracil - Methotrexate - Bleomycin - Daunorubicin - Doxorubicin 2- - Rapid onset and good recovery following cessation of chemotherapy - Severity related to white cell depletion - Increases risk of infection and may limit chemotherapy
38
DENTAL RELEVANCE Radiotherapy common complications
- Mucositis - Xerostomia - Caries - Candidosis - Loss of taste - Trismus - Osteoradionecrosis and osteomyelitis
39
DENTAL RELEVANCE 1 oral care before radiotherapy 2 oral care following radiotherapy
1 - Assessment and treatment dental disease - Meticulous oral hygiene and preventative care - Minimum 2 week interval between extracting and commencing radiotherapy (no bone should be left exposed) 2 - Reinforcement of oral hygiene and preventive dental care - Palliation for dry mouth - Dental extractions ~ Minimal trauma with careful suturing ~ Prophylactic antibiotics
40
Haematopoietic stem cell transplant (HSCT)
41
Graft vs host disease
- Serious complication of allogenic HSCT - Divided into acute and chronic GvHD based on clinical findings - Oral cGvHD most of most common presentations - Characterised by lichenoid inflammation - particularly on the tongue and buccal mucosa - Salivary glands may also be involved with hypofunction (major glands) and recurrent mucoceles (minor glands) MANAGEMENT - Lichenoid treated with topical steroids - Xerostomia treated in same way as any other cause

BDS2 HHD - Human Disease (21 decks)

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