3.26 NIELL Myeloproliferative Diseases Flashcards Preview

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Flashcards in 3.26 NIELL Myeloproliferative Diseases Deck (22):
1

Myeloid Neoplasms Def and Types

Def: arise from hematopoietic progenitors and typically give rise to clonal proliferations that replace BM
AML: Blast accumulation >20-30% in BM and Replace Normal Elements
Myeloid Proliferative disorders: see terminal diff. but exhibits increase or dysregulated growth.
-Usually see increase in formed elements in peripheral blood

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Chronic Myelogenous Leukemia

-Usually Presents 45-55 age
-9:22 Philadelphia Chromo: present in 100% of RBC, WBC, Monocytes and platelets
--See cont activation of Tyrosine Kinase
-PB: WBC precursors present
-Basophilia is common
-Elevated Uric Acid: Excess purine breakdonw
-Increased B12 b/c increased Transcobalamine 1

3

Phases of CML

Chronic Phase (5-6yrs)
Accelerated Phase (6-9 months)
-Anemia, thrombocytopenia and increased blast cells
Blast Crisis (3-6 months)
-20% or more blasts in the marrow (decreased diff)

4

Older Treatments for CML

Busulfan
Hydroxyurea: maintains WBC in chronic phase but does not decrease % of BCR-ABL cells
Interferon: Replaced by Imatinib
BM transplant (not available with all pts)

5

Targeted Therapies

Imatinib: takes up ATP binding site
-!st line therapy (1st gen) May see Neutropenia and Thrombocytopenia
-Good response in Chronic Phase, some response in blast phase
Dasatinib and Nilotinib (2nd Gen)
-Both faster remission than Imatinib (less info known)
-higher affinity for BCR-ABL, Kinase and can be useful in imatinab resistance

6

JAK-2 Mutations

-MPD-associated mutation in JAK-2
V617F-JAK2 is a common mutation seen
-PV, ET and MF

7

Idiopathic Myelofibrosis (PMF)
-Causes

Occurs around 65
Causes:
-Myeloproliferation with granulocytic hyperplasia and megakaryocytosis
-Marrow fibrosis with increased collagen Type I, III, IV, and V in marrow (mostly III)
-Fibrosis closely coorelates with increased dysmorphic megakaryocytes in the marrow
-Fibrosis is the result of release of cytokines from the abnormal megakaryocytes

8

Clinical and Physical findings of PMF

Fatigue, weakness, shortness of breath, bone pain
Physical Findings:
-Hepatomegally (75%) Splenomegally (100%)
-Muscle wasting, pheripheral edema, purpura, bone tenderness

9

PMF labs

-Early: Thrombocytosis
-Bizarre changes in megs (peripheral and BM)
-Aniso and poikliocytosis
-TEAR DROPS
--Happen anytime there is a problem with BM architecture
-Nucleated RBCs and WBCs
BASOPHILIA
Marrow: increased fibrosis and abnormal megs

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Other Important Symptoms of PMF

Portal Hypertension: resulting in ascites, esophageal and gastric varices
Osteosclerosis: prox femur & humerus pelvis, vertebral bodies, ribs and skull

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Treatment of PMF

-Not very good at treating, give transfusions
-Lenalidamide may achieve remission
-Radiation used to manage symptoms
-BM transplant is curative but most pts are too old (high mortality rate)
-Roxolitinib: Jak2 inhibitor, some results but not great

12

Causes of Secondary Thrombocytosis

-Acute and transient: trauma, Major surgery and acute bleeding
-More sustained thrombocytosis: inro def, chronic infection, chronic inflamm disease, neoplasia
-Lifelong thrombocytosis: splenectomy or asplenic pts

13

Characteristics of Secondary Thrombocytosis

-Generally, no splenomegally
-no extreme plt elevations
-morphology and func is normal
-Thrombosis and bleeding is rare
-Usually see elevated levels of thrombopoetin that coorelates with the plt count

14

Essential Thrombocytosis

Least common of MPDs
Diagnosed age 50-60

15

ET Clinical Features

Splenomegally in 40% of pts
-Aortic and mitral valvular leaflet thickening or vegetations
-Leukemic transformation is less than othe other MPDs
-Serum Thrombopoetin levels are normal or elevated and does not coorelate with the platelet count****

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Risks of ET

-Some pts with only bleeding or thrombosis
--risk for thrombosis: previous, older age and ass CV risk factors (smoking)
Bleeding is >1,500,000 plts, b/c plts are not func normally
-Arterial Thrombosis is more common than venous

17

Treatment of ET

Hydroxyurea: brings down plt #
-Anagrelide: interferes with terminal differentiation of megas and also decreases # of ptls

18

Polycythemia

Increase in total # of RBC or decrease in plasma volume making the blood more viscous
-Appropriate if in response to Hypoxia, inappropriate if not hypoxic

19

Secondary Polycythemia

-Can be due to increase in alititude, is a response to hypoxic state
-Increase in Epo leading to increased synthesis of RBC
-Can also be caused by localized hypoxia of the kidney

20

Polycythemia Rubra Vera (PRV)

Myeloproliferative disease involving stem cells that are neoplastic w/ loss of all control of proliferation, nothing will inhibit
Common in 50-60yr olds
-Pruritus (itching) is a major symptom
-Thrombosis is a major concern, usually put on low dose aspirin to try and help

21

4H's of PRV (Goljan)

-Hyperviscosity: increase in peripheral resistance b/c of increase viscosity leads to sluggish circulation
--main cause of thrombosis (biggest problem)
--Why phlebotomies are done
-Hypervolemia: increase in plasma volume that matches increase in RBC syn
-Histonemia: All cells are increased (RBCs, WBC, Plts, Mast and basophils)
--Itching***:cause by increase in mast cells
-Hyperuriacemia: b/c hematopoietic cells are increased and when they die purine is breakdown and uric acid is increased
RBC mass: up, plasma volume: up, Oxygen saturation is Normal, Epo: low

22

Spent Phase of PRV

Eventually may develop:
-Anemia, Leucocyosis, marrow fibrosis, enlarging spleen
-Mimics Myeloidfibrosis at this stage