LEUKEMIA AND MULTIPLE MYELOMA Flashcards
(32 cards)
What is Leukemia?
LEUKEMIA = #1 CHILD CANCER
= group of blood diseases
-Develops during formation of blood and lymphocyte production
The bone marrow is making abnormal white blood cells = leukemic cells
Leukemic cells are abnormal and do not die when they should, .:. They crowd together
This causes interference with normal processes , and explain impaired production of RBCs, WBCs and platelets.
If a decrease of formation of RBCs occurs = anemia (fatigue, pallor)
If low in platelets = Thrombocytopenia .:. EASY BRUISING, EPISTAXIS (NOSE BLEEDING EASILY)
If low in WBCs = Neutropenia (increased chance of having INFECTIONS)
What are the clinical symptoms of Leukemia?
-INFECTION!!!!
-Fatigue
-Pallor
-Bleeding
If Brain is affected:
-Headaches
-Vomiting
-Confusion
-Loss of muscle control
-Seizures
What are the 3 factors determining the classification of Leukemia?
- Lymphocytic, arising from other cells in bone marrow
1. Natural history
2. Cell maturation
3. Dominant cell line - Myelogenous, arising directly or indirectly from hematopoietic stem cells
- Acute, progresses QUICKLY, sudden Undifferentiated cells in bone marrow
- Chronic, SLOWER progression, asymptomatic for years, uncontrolled expansion of mature cells
What are the 3 main type of cells involved in Leukemia?
-RBCs or Erythrocytes, which carry OXYGEN to tissues in body
-WBCs or Leukocytes, which help fight INFECTION Composed of: Eosinophils (Granulocytes) Neutrophils Basophils Monocytes (Agranulocytes) Lymphocytes
-Platelets, which help to form BLOOD CLOTTING and control bleeding
What are the 3 symptoms due to Leukemic cells interfering with normal cell processes?
- Anemia, decrease in RBCs, fatigue, pallor
- Neutropenia, decrease WBCs, INFECTION
- Thrombocytopenia, decrease platelets count, low clotting factor, easy bruising, epitaxis (nose bleeding) and petechiae (red or purple dots).
What is the epidemiology of Acute Lymphocytic Leukemia (ALL)?
- Most common
- Mostly 2-5 yrs old
What is the etiology of Acute Lymphocytic Leukemia (ALL)?
-Previous Radiation exposure
-Hereditary factors:
sibling with ALL or Bloom’s syndrome
What are some characteristics of Acute Lymphocytic Leukemia (ALL)?
- Sudden onset
- Rapid Progression
- Fever
- Pallor
- Fatigue
- Bone pain
- SPLEENOMEGALY
- Recurrent infection
Diagnosis: CBC and bone marrow aspiration (if > 25% of the CBC are Leukoblasts = Leukemia)
What is the typical treatment for Acute Lymphocytic Leukemia (ALL)?
- Radiotherapy: 12 Gy/ 3 days BID
- Chemotherapy
- Bone Marrow Transplant (BMT)
75% complete remission
Survival 12-18 months for patients with complete remission
What is the epidemiology of Acute Myelogenous Leukemia (AML)?
- Onset > 40 yrs old
- M>F ratio
- Sudden onset
What is the etiology of Acute Myelogenous Leukemia (AML)?
Similar to ALL:
-Previous Radiation exposure
-Hereditary factors:
sibling with ALL or Bloom’s syndrome
What are the characteristics of Acute Myelogenous Leukemia?
- Symptoms are FLU-LIKE
- Fatigue
- Pallor
- Petechiae
- Neutropenia
Diagnosis:
- CBC
- Bone marrow biopsy
- Presence of AUER RODS (which are azurophilic granular material) in myeloids cells
What is the typical treatment for Acute Myelogenous Leukemia?
- Chemotherapy
- Radiotherapy
- Bone Marrow Transplant (BMT)
Survival: 12-24 months for patients with complete remission
What is the epidemiology of Chronic Lymphocytic Leukemia (CLL)?
- Onset 70 yrs old
- M 2 : 1 F
What is the etiology of Chronic Lymphocytic Leukemia (CLL)?
- NOT ASSOCIATED WITH RADIATION EXPOSURE!
- Hereditary factor
- Immune deficiencies
- Viruses
What are the characteristics of Chronic Lymphocytic Leukemia (CLL)?
-Insidious onset (gradual progression with no apparent symptoms)
-Slow progression
Symptoms:
-Malaise
-Fever
-Night sweats
-Weight loss
-Lymphadenopathy
-Spleenomegaly
What is the typical treatment for Chronic Lymphocytic Leukemia (CLL)?
-No optimal treatment:
-No benefit of treatment for early stages
-For advanced stages:
Radiotherapy
Chemotherapy
Surgery (spleenectomy)
Survival: 10-12 years if early stage
What is the epidemiology of Chronic Myelogenous Leukemia (CML)?
-Affects 20-40 yrs old
What is the etiology of Chronic Myelogenous Leukemia (CML)?
-Unknown
What are the characteristics of Chronic Myelogenous Leukemia (CML)?
-CML usually develops into a AML after 4-6 years!
Detection: PHILADELPHIA CHROMOSOME ALMOST ALWAYS PRESENT!
Symptoms: -Early: mild and non-specific Malaise Sweats Bruising -Late (after 3-4 years) BLAST CRISIS Increase leukemic blast cells Fever Bone pain Weight loss >10% in 6 months Spleenomegaly
What is the typical treatment of Chronic Myelogenous Leukemia (CML)?
Radiotherapy
Chemotherapy
Bone Marrow Transplant (BMT)
Survival: No Cure, approx. 1 year
What are the 3 main functions of Total Body Irradiation (TBI)?
- Immunosuppression to allow engraftment of donor Bone Marrow.
- Eradication of malignant cells
- Eradication of cell populations with genetic disorders.
What are 3 beam techniques for TBI?
- Single source short SSD,
- Head rotation
- Horizontal beam large SSD
AP/PA 12 Gy/6 fx (3 days BID)+ boost to testes 400 cGy/1-2 fx
This boost is done because testes and brain are a sanctuary for tumor cells
Side effects
-acute: nausea and vomiting
-late: pneumonitis, cataracts, hepatic or renal dysfunction, growth retardation
What is the rationale of Bone Marrow Transplant?
- harvest of healthy bone marrow from a suitable donor, usually long bones ie.iliac crest
- healthy bone marrow is infused into patient, whose bone marrow previously has been destroyed by chemo +/- radiation.
- transplanted bone marrow fills bone marrow cavities and supply normal and healthy hematopoietic cells.
