Leukaemia, Lymphoma and Myeloma

Question 1

A child presents with anaemia, neutropenia and thrombocytopenia. What is the likely diagnosis?

Answer 1

Acute lymphoblastic leukaemia.

Question 2

A 55 year old man is investigated for suspected anaemia. He is found to have anaemia and lymphoctytosis on FBC. Blood film reveals smudge cells. What is the likely diagnosis?

Answer 2

Chronic lymphocytic leaukaemaia

Question 3

A person with CLL gets recurrent infections. What is the likely complication that occured?

Answer 3

Hypogammaglobulinaemia

Question 4

An individual with CLL develops anaemia with reticulocytosis, raised LDH and jaundice.

What is the likely diagnosis and treatment?

Answer 4

Warm autoimmune haemolytic anaemia

Treat CLL, then steroids +/- ritixumab

Question 5

What is Richter’s transformation?

Answer 5

When a CLL patient develops high-grade non-Hodgkin’s lymphoma.

This makes them very unwell suddenly.

Question 6

A 70 year old man develops anaemia, weight loss and splenomegaly. On FBC granulocytosis and thrombocytosis is seen. Blood film reveals granulocytes at different stages of maturation. What is the likely diagnosis?

Answer 6

Chronic myeloid leukaemia

Question 7

What is first-line treatment for CML? How does it work?

Answer 7

Imatinib - tyrosine kinase inhibitor.

Question 8

A 70 year old man, who previously is known to have a myeloproliferative disorder, develops anaemia, neutropaenia, thrombocytopenia and splenomegaly. What is the likely diagnosis?

Answer 8

Acute myeloid leukaemia

Question 9

Auer rods are seen on blood film. What is the likely diagnosis?

Answer 9

Acute myeloid leukaemia

Question 10

What leukaemia are smear cells seen in?

Answer 10

Chronic lymphocytic leukaemia

Question 11

What is bone marrow failure?

Answer 11

Inability for bone marrow to produce blood cells:

Anaemia - low Hb
Infections - low neutrophils
Bleeding - low platelets

Question 12

What is the 4 approaches to management of acute lymphoblastic leukaemia?

Answer 12

Supportive - fluids, transfusion, allopurinol (to avoid TLS)

Infective - start prophylactic antibiotics, antifungals and antivirals due to neutropenia.

Chemotherapy (vincristine)

Matched related allogenic stem cell transplant (after 1st remission in younger patients)

Question 13

What is the management of acute myeloid leukaemia?

Answer 13

Supportive - fluids, transfusion, allopurinol (to avoid TLS)

Infective - start prophylactic antibiotics, antifungals and antivirals due to neutropenia.

Chemotherapy (daunorubicin)

Bone marrow transplant (ciclosporin + methotrexate for graft vs host disease prophylaxis)

Question 14

What are the 4 approaches to management of chronic lymphocytic leukaemia?

Answer 14

If symptomatic: fludarabine + rituximab +/- cyclophosphamide

Radiotherapy - for lymphadenopathy and splenomegaly

Stem-cell transplant - only in selected patients

Supportive - transfusions and IVIg if hypogammaglobulinaemia

Question 15

What is the prognosis for ALL?

Answer 15

Most children are cured. Nearly half of adults are cured.

Poor prognosis if relapsed.

Question 16

What is the prognosis of CML?

Answer 16

Median survival of 5-6 years

Question 17

What is the prognosis of CLL?

Answer 17

Rule of 3rds:
1/3 never progress
1/3 progress slowly
1/3 progress rapidly

Death is usually due to infection or Richter’s transformation

Question 18

What electrolyte disturbances are seen in tumour lysis syndrome?

Answer 18

High urate
High K+
High phosphate
Low Ca2+

Question 19

How is tumour lysis syndrome managed?

Answer 19

Prophylaxis - allopurinol

Acutely - hydration and urolytics (rasburicase, allopurinol)

Question 20

What are the 3 mains signs of tumour lysis syndrome?

Answer 20

AKI (raised creatinine)
Arrhythmia
Seizure

Question 21

What disease is indicated by Reed-Sternberg cells on blood film?

Answer 21

Hodgkin’s lymphoma

Question 22

What age group is commonly affected by Hodgkin’s lymphoma?

Answer 22

Bimodal - 30s and 70s

Question 23

What is the gold-standard investigation for Hodgkin’s lymphoma?

Answer 23

Lymph node biopsy

Question 24

A patient has lymphadenopathy that is more painful on consumption of alcohol.
What is the likely diagnosis?

Answer 24

Hodgkin’s lymphoma

Question 25

What 3 types of Hodgkin's lymphoma may indicate a good prognosis?

Answer 25

Nodular sclerosing Mixed cellularity Lymphocyte-predominating (best prognosis)

Question 26

What 4 features of Hodgkin's lymphoma indicate a poor prognosis?

Answer 26

Lymphocyte predominant subtype >10% weight loss in 6 months Nightsweats Fever >38 C

Question 27

How are the features of lymphadenopathy seen in Hodgkin's lymphoma?

Answer 27

Non-tender, painless, rubbery, asymmetrical.

Question 28

What is the management of Hodgkin's lymphoma? | What should the patient be warned about the treatment?

Answer 28

Chemotherapy - infertility | Radiotherapy - risk of further cancer down the line

Question 29

What blood cancer are HIV, EBV and autoimmune conditions risk factors for?

Answer 29

Hodgkin's lymphoma

Question 30

An individual has a normocytic anaemia, eosinophilia and raised LDH. What is the likely diagnosis?

Answer 30

Hodgkin's lymphma

Question 31

What is the staging system for Hodgkin's lymphoma? | How does it work?

Answer 31

``` Ann-Arbour: I - 1 node II - 2(+) nodes on 1 side of diaphragm III - nodes on both sides of diaphragm IV - disease beyond lymph nodes ``` subtypes: A - no systemic symptoms other than pruritis B - systemic symptoms (fever, weight loss, night sweats) Eg. Stage IIIB

Question 32

What are disease are EBV, malaria and HIV risk factors for?

Answer 32

Burkitt lympoma

Question 33

What are disease is H. pylori infection a risk factor for?

Answer 33

MALT lymphoma

Question 34

What are the subtypes of non-Hogkin's lympoma?

Answer 34

Burkitt MALT Diffuse, B-cell lymphoma

Question 35

What is the management of non-Hodgkin's lymphoma?

Answer 35

``` Watchful waiting Chemo Rituximab Radiotherapy Stem cell transplant ```

Question 36

What is myeloma?

Answer 36

Cancer of plasma cells that secrete a single type (monoclonal) antibody.

Question 37

What is monoclonal gammopathy of undetermined significance (MGUS)?

Answer 37

Myeloma with no symptoms | Incidental finding

Question 38

What is smouldering myeloma?

Answer 38

A progression of monoclonal gammopathy of undetermined significance But still considered pre-malignant

Question 39

What is Waldenstrom's macroglobulinemia?

Answer 39

A subtype of smouldering myeloma that secretes IgM

Question 40

What result is seen on FBC in myeloma?

Answer 40

Marrow failure: Anaemia Neutropaenia Thrombocytopaenia

Question 41

How can the features of myeloma be remembered with the pneumonic CRAB?

Answer 41

calcium high renal failure anaemia (normocytic, normochromic) Bone pain/lesions

Question 42

What investigations are there for myeloma? | Consider imaging also.

Answer 42

``` BLIP: urinary Bence jones protein serum free Light chains serum Immunoglobulin serum protein electrophoresis ``` Whole body MRI, CT, x-ray skeletal survey: raindrop skull bone lesions

Question 43

What is the management for myeloma?

Answer 43

Chemo + Boretezomid, Thalidomide, Dexamethasone Stem cell transplant VTE prophylaxis Bone disease: - Bisphosphonates - Radiotherapy - Surgical stabilisation

Question 44

What disease demonstrates Rouleaux formation on blood film?

Answer 44

Myeloma