Hemeonc 13

Question 1

Malignancies of hematopoietic stem cells, Characterized by the uncontrolled growth of abnormal white blood cells and deficiencies of normal hematopoietic cells
(Growth of the abnormal cells is clonal)

Answer 1

Leukemias

Question 2

Primitive cells that can:

• -make more primitive cells just like itself (self-renewal)
• -make lots of mature cells of different types
• -Source of all blood cells
• -Resides in the bone marrow
• -Normally quiescent (dormant)

Answer 2

Hematopoietic stem cells

Question 3

What is the largest tissue in the body?

Answer 3

bone marrow

Question 4

How would you expect an acute leukemia to present as far as lab values?

Answer 4

TYPICALLY, with low blood counts across the board (except WBC, which could be high or low)

Question 5

True or False, hematopoietic stem cells produce hundreds of billions of cells every day in a healthy person

Answer 5

True

200B-RBC, 200B-PLT, 70B-WBC

Question 6

When you think ACUTE leukemia, you should think?

Answer 6

Rapid proliferation, immature malignant WBC’s

Question 7

When you think CHRONIC leukemia, you should think?

Answer 7

Slow proliferation, partially differentiated mature WBC’s

Question 8

T-cells, B-cells, and natural killer cells come from what type of cell?

Answer 8

Lymphoid cell

Question 9

RBC’s, PLT, granulocytes, come from what type of cell?

Answer 9

Myeloid cell

Question 10

What cell is experiencing malignancy in an ALL?

Answer 10

ALL=acute lymphoid leukemia,
the Lymphoblast (acute is immature, therefore the blast cell)

Question 11

What cell is experiencing malignancy in an AML

Answer 11

acute = blast

Myeloblast cell

Question 12

Which leukemia is most common and highly curable in children?

Answer 12

ALL

Question 13

If all blood counts in acute leukemia are low (except WBC, could be high or low), what types of symptoms would you expect?

Answer 13

anemia, infection(WBC malfunctioning), bleeding (along with fever, fatigue, wt loss common in all cancer)

Also lymphadenopathy, splenomegaly, bone pain, meningeal symptoms, metabolic derangement (electrolyte imbalance, etc)

Question 14

what is the term for “thick blood” due to a white count >50,000?

Answer 14

Leukostasis

Question 15

how can you definitively determine whether a leukemia is ALL or AML?

Answer 15

bone marrow bx

Question 16

If you suspected an acute leukemia and your patient had gingival hyperplasia, which would you suspect?

Answer 16

AML

Question 17

Which leukemia has multiple classifications with many different genetic mutations?

Answer 17

AML

Question 18

What cytogenetic factor will cause AML patients to likely need a transplant even after remission?

Answer 18

high number of mutations, because recurrence is so likely

Question 19

What is the typical tx plan for AML?

Answer 19

Induction chemo-one round
consolidation chemo x 3-4 cycles
eval for transplant

Question 20

What is the typical tx plan for ALL?

Answer 20

Induction chemo x 6-12 months
Maintenance chemo x 2 years
eval for transplant

prophylactic intrathecal injections of chemo since these patients are more likely to have invasion of CSF

Question 21

your patient has Asymptomatic leukocytosis
Fatigue, weight loss, fever, night sweats
Splenomegaly (95%) and early satiety. What is her most likely leukemia classification?

Answer 21

Chronic stable phase CML or chronic stable phase CLL

Question 22

How do you treat a patient who has entered into the blast crisis of CML?

Answer 22

Just like an acute myeloid leukemia

Question 23

What is the name of a daily oral medication that can maintain remission for years?

Answer 23

Gleevec

Question 24

How do you manage asymptomatic CLL? When would you escalate treatment?

Answer 24

observation/watchful waiting.
Begin chemo for new symptoms or disease progression. May add Rituxan.

transplant rare and controversial