Leukemia/Lymphoma

Question 1

With an Acute Leukemia, what cells predominate in the blood/BM?

Answer 1

> 20% BLASTS

Question 2

With a Chronic Leukemia, what cells predominate in the blood/BM?

Answer 2

Mature cells – NOT blasts

Question 3

What specific finding in the cells will be seen with Acute Myeloid Leukemia?

Answer 3

Auer rods

Question 4

How do you treat AML with Auer rods?

Answer 4

ATRA – All trans retinoic acid

Question 5

What marker will be positive with Acute Myeloid Leukemia?

Answer 5

MPO (+)

Question 6

What markers (2) will be positive with Acute Lymphocytic Leukemia?

Answer 6

Tdt
CaLLa

Question 7

Acute Lymphocytic Leukemia has a predilection for the CNS. What should be given in addition to chemo/radiation?

Answer 7

ARA-c for CNS disease

Question 8

What translocation is present with Chronic Myeloid Leukemia?

Answer 8

9;22 = BCR-ABL fusion

Question 9

What translocation is present with Chronic Myeloid Leukemia?

Answer 9

9;22 = BCR-ABL fusion

Question 10

The BCR-ABL fusion creates a tyrosine kinase protein for CML. What is the specific treatment?

Answer 10

Imatinib (TK inhibitor)

Question 11

If a patient has NONtender LAD, what is the best next step?

Answer 11

Excisional biopsy

Question 12

Following an Excisional biopsy for NONtender LAD, what 3 things need to be done to stage?

Answer 12

CXR
CT abdomen/pelvis/chest
BM biopsy

Question 13

What cells are seen with Hodgkin’s Lymphoma?

Answer 13

Reed Sternberg cells
= Bi-lobed Nuclei

Question 14

Lymphomas often present with what?

Answer 14

NONtender LAD

Question 15

What are the B symptoms?

Answer 15

Fever
Night sweats
Weight loss
Pruritus

Question 16

What is unique about the LAD with Hodgkins’s Lymphoma?

Answer 16

May become painful after alcohol consumption

Question 17

What are Plasma Cell Dyscrasias?

Answer 17

Monoclonal expansion of plasma cells in the BM

Question 18

List 3 Plasma Cell Dyscrasias

Answer 18

• Multiple Myeloma
• MGUS
• Waldenstrom’s

Question 19

What occurs with Multiple Myeloma?

Answer 19

Monoclonal plasma cells secrete IgG, Bence Jones Proteins and (+) Osteoclasts

Question 20

Pneumonic to remember Multiple Myeloma symptoms?

Answer 20

CRAB

Question 21

Signs of Multiple Myeloma?

Answer 21

CRAB
- Hypercalcemia
- Renal disease
- Anemia
- Bone pain with lytic lesions

Question 22

First test to obtain if concerned about a Plasma Cell Dyscrasia?

Answer 22

SPEP (serum electrophoresis)

Question 23

With Multiple Myeloma, what will the Spep, Upep and skeletal survey be?

Answer 23

(+)!!
Spep = M spike
Upep = M spike

Question 24

What will be seen on BM biopsy that defines Multiple Myeloma?

Answer 24

> 10% plasma cells

Question 25

What will be seen on BM biopsy that defines Multiple Myeloma?

Answer 25

> 10% plasma cells

Question 26

With MGUS, what will be the result of the Spep, Upep and skeletal survey?

Answer 26

ONLY the Spep is (+)!! = M spike

Question 27

With MGUS, the patient will likely be asymptomatic with what?

Answer 27

Elevated protein gap > 4

Question 28

Treatment for MGUS?

Answer 28

Observe to see if it transitions into Multiple Myeloma

Question 29

What do the plasma cells secrete with Waldenstrom's?

Answer 29

IgM

Question 30

How will Waldenstrom's present?

Answer 30

Hyperviscosity syndrome -- tortuous retinal veins!

Question 31

What will a BM biopsy show with Waldenstrom's?

Answer 31

> 10% LYMPHOMA

Question 32

What will a BM biopsy show with Waldenstrom's?

Answer 32

> 10% LYMPHOMA

Question 33

What is the treatment for Waldenstrom's?

Answer 33

Rituximab

Question 34

First test to get that is likely positive with all etiologies of Plasma Cell Dyscrasias?

Answer 34

Spep!

Question 35

Signs of Multiple Myeloma?

Answer 35

CRAB - Hypercalcemia - Renal disease - Anemia - Bone pain with lytic lesions

Question 36

What is a possible complication of AML?

Answer 36

Life-threatening hemorrhage