leukemia and lymphoma

Question 1

prevalence of acute in leukemia in children vs adults

Answer 1

30% of childhood cancers

2.3% of adult cancers

Question 2

define leukemia

Answer 2

neoplastic disease, abnormal proliferation of WBCs

Question 3

name the 4 types of leukemia (that we need to know)

Answer 3

acute lymphoblastic leukemia
chronic lymphoblastic leukemia
acute myelogenous leukemia
chronic myelogenour leukemia

Question 4

difference between acute and chronic leukemia

Answer 4

acute is associated with proliferation of immature precursors in blood and marrow, chronic is associated with mature precursors

Question 5

which genetic conditions predispose you to leukemia

Answer 5

down syndrome, neurofibromatosis, BMF syndromes

Question 6

what environmental/iatrogenic factors predispose you to leukemia?

Answer 6

ionizing radiation, occupational exposure (benzene), prior radiation therapy, prior malignancy

Question 7

in acute leukemia, what is the outcome of malignancy in immature precursors/ early hematopoietic precursors?

Answer 7

cell progeny does not differentiate/mature but proliferates uncontrollably. These “blasts” overtake the bone marrow, peripheral blood stream, lymph nodes

Question 8

what is a typical WBC count with leukemia

Answer 8

varies widely
50% have normal-mild elevation
25% very high
25% decreased

Question 9

what does a bone marrow biopsy show in leukemia

Answer 9

hypercellular marrow
marrow fibrosis (AML)

Question 10

when do you order a lumbar puncture?

Answer 10

with ALL always

if there are neurologic symptoms in a patient with AML

Question 11

what disease presents with a mediastinal mass? (50%)

Answer 11

T-cell ALL

Question 12

What is the characteristic histology finding with AML?

Answer 12

Auer rods (found in 30% of patients)

Question 13

How long is induction with AML

Answer 13

10 days

Question 14

What is the most common form of cancer in children

Answer 14

acute lymphoblastic leukemia (ALL)

Question 15

associates symptoms common with ALL

Answer 15

splenomegaly, lymphadenopathy, bone pain

Question 16

How long is induction with ALL

Answer 16

4 weeks

Question 17

what is the management of ALL after induction?

Answer 17

post-remission consolidation for 6-8 weeks
maintenance doses daily or weekly for 2-3 years
CNS prophylaxis (intrathecal chemo)

Question 18

What disease is associated with the Philadelphia Chromosome

Answer 18

Characteristic finding of CML, but also seen in ALL- means worse prognosis- lower remission rates

Question 19

major sequelae of leukemia

Answer 19

subsequent cancers

Question 20

complications associated with chemo

Answer 20

osteopenia, endcrine abnormalities, poor cardiac function

Question 21

how does treatment of children with ALL differ from adults?

Answer 21

intensive multi-agent induction
less intensive maintenance
bone marrow transplant in 5%

Question 22

treatment of children with AML?

Answer 22

6 months inpatients treatment- intensive and toxic

bone marrow transplant in 30%

Question 23

Chronic lymphocytic leukemia (CLL) epidemiology

Answer 23

most common adult leukemia (western world)
male to female 2:1
median age of onset 72

Question 24

CLL definition

Answer 24

proliferation of mature B cells, accumulation of long-lived mature lymphocytes, hypogammaglobulinemia

Question 25

CLL clinical presentation

Answer 25

``` often asymptomatic- incidental finding fatigue appetite loss lymphadenopathy hepatosplenomegaly ```

Question 26

CLL immunologic abnormalities

Answer 26

auto-immune hemolytic anemia auto-immune thrombocytopenic purpura monoclonal spike hypogammaglobulinemia

Question 27

how do you Dx CLL?

Answer 27

Flow cytometry

Question 28

CLL staging

Answer 28

``` Rai Stage Stage 0 Lymphocytosis only Stage I Lymphadenopathy Stage II Splenomegaly Stage III Anemia Stage IV Thrombocytopenia ```

Question 29

CLL staging- ABC

Answer 29

Binet Stage A: <3 areas of lymphadenopathy. No anemia/ thrombocytopenia B: 3 or more involved LN areas. No anemia/ thrombocytopenia C: Hemoglobin <10 g/dl or <100,000 platelets

Question 30

Treatment of CLL

Answer 30

usually none, only if progressive/severe symptoms

Question 31

Define CML

Answer 31

proliferative hematopoeitic stem cells

Question 32

characteristic abnormalities

Answer 32

Philadelphia chromosome | BCR-ABL tyrosine kinase

Question 33

epi of CML

Answer 33

median age 45-65 slightly male increase risk with age

Question 34

3 phases of CML

Answer 34

chronic accelerated blastic crisis

Question 35

presentation of CML

Answer 35

``` often asymptomatic fatigue anorexia abdominal fullness splenomegaly ```

Question 36

CML CBC findings

Answer 36

leukocytosis thrombocytosis anemia basophilia

Question 37

lymphoma symptoms

Answer 37

painless lymphadenopathy constitutional symptoms extranodal involvement

Question 38

hodgkin lymphoma epi

Answer 38

bimodal- 15-34 years and >60 male associated with viral infections

Question 39

key finding to suggest hodgkin lymphoma

Answer 39

painless, mobile, rubbery lymph nodes worse/painful with alcohol B symptoms Reed Sternberg Cells

Question 40

how to Dx hodgkin lymphoma

Answer 40

biopsy- see Reed Sternberg cell

Question 41

treatment of hodgkin lymphoma

Answer 41

radiotherapy and chemotherapy, length depends on stage

Question 42

complications of hodgkin lymphoma treatment

Answer 42

immunologic deficit thyroid dysfunction cardiac dysfunction secondary malignancies

Question 43

non-hodgkin lymphoma epi

Answer 43

increasing prevalence- unknown why common in AIDS patients average age at Dx- 42 risk groups- occupational exposure to hazardous material, viral exposure, low veggie/high red meat diet drink a little wine to protect yourselves ladies

Question 44

clinical presentation of non-hodgkin lymphoma

Answer 44

lymph node involvement splenomegaly B symptoms

Question 45

non-hodgkin lymphoma staging

Answer 45

Stage I – Involvement of single lymph node (LN) region Stage II – >2 LN regions on same side of diaphragm Stage III – LNs on both sides of diaphragm Stage IV – Multifocal involvement of >1 extra-lymphatic sites (e.g., liver, bone marrow, lung)

Question 46

non-hodgkin treatment

Answer 46

chemotherapy +/- radiation depending on staging | prognosis variable depending on staging