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CFT II > Exam 4 - Leukemia & Multiple Myeloma > Flashcards

Exam 4 - Leukemia & Multiple Myeloma Flashcards

1
Q

how does the progenitor cell type decide what kind of cancer will occur in abnormal hematopoiesis?

A

if it is a common myeloid progenitor cell = myeloproliferative disease

if it is a common lymphoid progenitor cell = lymphoproliferative disease

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2
Q

what are the 2 types of leukemia seen? what defines them? what is the odd ball out that isn’t a leukemia but has a leukemic stage?

A
  1. acute - proliferation of immature cells (blasts)
  2. chronic leukemia - neoplastic proliferation of mature cells
  3. odd ball - lymphoma with a leukemic phase, stage V lymphoma!!!
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3
Q

what are the 3 types of acute leukemia that we see clinically?

A
  1. acute myeloid leukemia
  2. mixed phenotype or undifferentiated acute leukemia
  3. acute lymphoid leukemia - b cell, t-cell, or NK cell in origin
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4
Q

what are the 2 types of chronic leukemia that we see clinically?

A
  1. chronic lymphoid - b cell, t cell, or NK cell
  2. chronic myeloid
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5
Q

how do you determine if you’re dealing with a lymphoid or myeloid leukemia & if it is acute or chronic?

A

mostly done using flow cytometry

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6
Q

in a normal dog, what are the normal lymphocyte subsets seen in the peripheral blood?

A

t cell 80% - mostly CD4+ t helper cells, lesser cytotoxic CD8+ t cells

b cells 15%

~5% NK cells/double negative T cells (CD4-/CD8-)

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7
Q

for leukemia, the chronic type is most often _________ cell & the acute type is most often ________ cell but can be _____ cell

A

chronic - t cell

acute - b cell, but can be t cell

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8
Q

what are the two main categories of neoplasia seen in lymphoproliferative disease?

A

lymphoma & leukemia

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9
Q

what are the subsets of disease seen in lymphoma?

A

t cell or b cell

t cell is further differentiated

large t cell lymphoma - characterized by large immature lymphoblasts

small indolent t cell - characterized by small mature lymphocytes

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10
Q

why is CD34 an important stem cell marker?

A

it implies an acute phenotype & is expressed by both myeloid & lymphoid lineages!!!! can be used to make a presumptive diagnosis of acute leukemia

some exceptions - some t cell acute leukemias do not express CD34

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11
Q

does the absence of CD43 rule out acute t cell leukemia? does its presence confirm it?

A

nope

presence confirms diagnosis of acute leukemia

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12
Q

what does a stage V lymphoma mean?

A

there is involvement of the bone marrow, so these patients could have circulating neoplastic lymphocytes in their blood (which technically is a leukemia, but it’s not because it’s arising from the lymphoma)

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13
Q

acute or chronic primary leukemia patients can have soft tissue involvement, so disease that originates in the bone marrow & infiltrates the soft tissue, which can look like what?

A

primary large cell lymphoma

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14
Q

a dog has primary large cell lymphoma that shows bone marrow involvement, what kind of lymphoma is this classified as?

A

stage V lymphoma

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15
Q

why is it important to differentiate between stage V lymphoma & primary leukemia with soft tissue involvement?

A

significantly impacts prognosis!!!!

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16
Q

what is lymphocytic leukemia? is chronic or acute more common?

A

proliferation of neoplastic lymphocytes in the bone marrow +/- circulating blood

chronic more common than acute!!

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17
Q

what dogs are predisposed to getting lymphocytic leukemia?

A

middle aged to older dogs - goldens & GSD

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18
Q

what dog breeds are predisposed to getting b cell chronic lymphocytic leukemia?

A

middle aged small breed dogs - exception of english bulldog (happens when they are young)

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19
Q

what characterizes acute lymphoid leukemia? what is seen cytologically?

A

lymphoid precursor neoplasm

b cell acute lymphoid leukemia (90%) - CD21+, CD3-, CD4-, & CD8-

t cell acute lymphoid leukemia (10%) - CD3+, CD4-, CD8-, & CD21-

intermediate to large cells with moderate amount of basophilic cytoplasm & less condensed chromatin

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20
Q

what characterizes chronic lymphoid leukemia? what is seen cytologically?

A

3 forms!!!

t cell chronic lymphocytic leukemia is most common - CD3+/CD8+ granular lymphocytes

b cell chronic lymphocytic leukemia - CD21+

atypical chronic lymphocytic leukemia - represents a combination of immunophenotype - CD3-/CD8+, CD3+/CD4-/CD8-, CD3+/CD4+/CD*+, & CD3+/CD21+

small, mature, well-differentiated lymphocytes

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21
Q

what clinical signs are associated with acute lymphocytic leukemia? what treatment is indicated? what is the prognosis?

A

usually sick!! pyrexia, history of fever of unknown origin, anorexia, lethargy, moderate to marked cytopenias, may have soft tissue involvement, mild to moderate enlargement of the lymph nodes/liver/spleen

aggressive supportive care & CHOP

very poor prognosis

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22
Q

what clinical signs are associated with chronic lymphocytic leukemia? what treatment is indicated? what is the prognosis?

A

incidental finding - asymptomatic!! no or mild cytopenias, may have soft tissue involvement, mild to moderate enlargement of the LN/liver/spleen

lymphocytes may function abnormally - monoclonal gammopathies, IMHA, red cell aplasia, & hypercalcemia

low dose oral chemo - pred & chlorambucil

excellent prognosis! normalization/remission of lymphocyte count is expected in 70% of cases (max response can take several months b/c not rapidly dividing cells)

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23
Q

T/F: therapy is not always indicated for chronic lymphocytic leukemia, but active surveillance is imperative

24
Q

what criteria must be met for starting chemo for a dog with chronic lymphocytic leukemia?

A

lymphocyte count > 30,000

hematological abnormalities (anemia, thrombocytopenia, neutropenia)

peripheral lymphadenopathy

hepatic/splenic enlargement

any clinical signs

25
what is the concern for progressive disease in chronic lymphocytic leukemia?
can progress/transform into aggressive lymphoma (richter's syndrome) with a MST of 1.5 months
26
what is the importance of immunophenotyping all chronic lymphocytic leukemia patients?
important for prognosis T CLL - 930 days B CLL - 480 days A CLL - 22 days, VERY BAD
27
what is the treatment used for A CLL?
morbidity associated with effacement of bone marrow - sepsis & DIC supportive care - fresh whole blood transfusions, abx, fluid therapy, nutritional therapy chop based protocol - prognosis with treatment, 16 days to 3 months
28
what is the prognosis for myeloid leukemias?
acute myeloid - very grave chronic myeloid - variable myelocytic, megakaryocytic, erythrocytic, monocytic, etc
29
what are the most common acute myeloid leukemias?
monocytic most common myelomonocytic follows
30
what treatment is used for acute myeloid leukemias? what is the prognosis?
supportive care - treatment usually unrewarding, CHOP protocol + cytosine arabinoside MST 1-2 weeks, lucky to get them out of the hospital
31
what treatment is used for chronic myeloid leukemias? what is the prognosis?
has the BCR-ABL chromosomal abnormality, so theoretically can be treated wih GLEEVEC fairly resistant to treatment, so can try hydroxyurea patients enter the terminal phase relatively quick - poor prognosis
32
T/F: in cats, acute leukemia has neoplastic malignant infiltrates in organs
true
33
what was the most common leukemia seen in the FeLV era?
acute leukemia - t-cell, 60-80% of FeLV cats were t-cell positive
34
how is leukemia characterized in cats?
bony marrow aspiration with > 30% abnormal blast cells = acute leukemia bone marrow aspirate with > 15% mature lymphocytes = chronic leukemia
35
T/F: leukemia is rare in cats
true
36
what is the treatment for chronic leukemia in cats?
pred & chlorambucil - 90% response rate
37
what is the most common myeloma disorder seen in animals?
multiple myeloma - plasma cell origin others include extramedullary plasmacytoma, IgG macroglobulinemia, & solitary osseous plasmacytoma
38
what is multiple myeloma?
systemic proliferation of malignant plasma cells or their precursor arising as a clone of a single cell with range of differentiation of plasma cells varying from normal to large anaplastic round cells called plasmablasts
39
what are plasmablasts?
binucleate & multinucleate cells high mitotic index atypia
40
what is the m component in multiple myeloma?
overproduction of a single immunoglobulin or component of immunoglobulin that can be represented by any class of the entire Ig or only a portion of the molecule (light chain/bence jones, or heavy chain)
41
what are the most common m components seen in dogs & cats with multiple myeloma? what does it mean if the m component is IgM?
dogs - IgA or IgG cats - IgG:IgA (5:1) IgM = waldenstrom's
42
what is the pathology associated with multiple myeloma?
high circulation of levels of m component which makes the blood thick/nasty bone or organ infiltration
43
what are some examples of pathological conditions that multiple myeloma is associated with?
bone disease, bleeding diathesis, hyperviscosity syndrome, renal disease, etc
44
how is multiple myeloma associated with causing bone disease?
isolated & discrete osteolytic lesions or diffuse osteopenia - bones engaged in hematopoiesis most commonly involved (ribs, vertebrae, pelvis, metaphyses of long bones), so pathologic fractures are common pretty common in dogs/cats - up to 2/3 of the cases
45
how is multiple myeloma associated with causing bleeding diathesis?
most common presenting complaint!!!!! caused by the m component - inhibits platelet aggregation & release of platelet factor 3, absorption of minor clotting proteins, & functional decrease in calcium 1/3 of dogs will have clinical evidence of bleeding, & 50% will have abnormal PT/PTT - cats only 1/4 will be showing signs
46
how is multiple myeloma associated with causing hyperviscosity syndrome?
result of increased serum viscosity - magnitude depends on M component factors, but most common with IgM (biggest one) affects 20-40% of dogs symptoms - bleeding diathesis, neuro signs, eye abnormalities (retinal hemorrhage), increased cardiac workload, cardiomyopathy, +/- CHF
47
how is multiple myeloma associated with causing renal disease?
dogs & cats will likely have azotemia due to bence jones proteinuria (light chains are normally filtered through the glomerulus, so their presence results in protein precipitates & causes renal tubular damage) tumor infiltration into renal tissue hypercalcemia, amyloidosis, decreased perfusion (due to hyperviscosity syndrome), dehydration, & ascending UTI
48
how is multiple myeloma associated with causing hypercalcemia?
mostly dogs, 50%, 25% in cats due to the production of osteoclast activating factor from neoplastic cells that is then exacerbated by renal disease
49
how is multiple myeloma associated with causing cytopenias?
normocytic, normochromic non-regenerative anemias - up to 2/3 dogs & cats thrombocytopenia - more common in cats than dogs, 50% leukopenia - 80% dogs!!!! 1/3 cats!
50
what clinical signs are seen in dogs with multiple myeloma? what about cats?
dogs - lethargy & weakness most common, anorexia/weight loss, lameness, bleeding, ocular problems cats - lethargy/weakness most common, anorexia, pallor, ocular changes, vomiting/diarrhea, pu/pd
51
how is multiple myeloma diagnosed?
bone marrow aspirate & cytology - document bone marrow plasmacytosis (normal is <5% plasma cells) - dogs > 20% marrow plasmacytosis & cats > 10 marrow plasmacytosis demonstration of serum or urine myeloma proteins plasma cell clonality/PARR to confirm came cell lineage imaging - rads to look for osteolytic lesions, abdominal ultrasound in cats, organ involvement
52
how is multiple myeloma treated in dogs?
tumor cell mass & seconardy systemic effects are treated chemo - melphalan & prednisone radiation - palliation of bone lesions 86% objective response rate - reasonably good cancer to have for a dog MST 930 days, median remission 601 days
53
T/F: in animals with multiple myeloma, their immunoglobulin levels are decreased
true
54
how is multiple myeloma treated in cats?
cats have a 50-83% response rate with median survival time varying from 4-13 months treat the tumor mass & secondary systemic effects, radiation for bone lesions, & chemo - melphalan & prednisolone
55
what are negative prognostic factors for multiple myeloma in dogs?
hypercalcemia, bence jones proteinuria, excessive bone lysis, renal disease, & a high neutrophil: lymphocyte ratio

CFT II (28 decks)

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