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Leukemia/Lymphoma/Multiple Myeloma Flashcards

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1
Q

Leukocytosis

A

WBC greater than 10,000

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2
Q

Acute Myeloid Leukemia Epidemiology

A

Most common ACUTE leukemia in adults. White, males 65yo.

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3
Q

Acute Myeloid Leukemia Definition

A

accumulation of luekemic blasts in blood and bone marrow. With reduced production of normal cells (neutrophils, erythrocytes, platelets)

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4
Q

Acute Myeloid Leukemia Associations

A

Chemical exposure, some genetics, Myelodysplastic syndrome.

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5
Q

Acute Myeloid Leukemia Presentation

A

Anemia: angina, dyspnea with exertion, fatigue, pallor.
Neutropenia: delayed healing, enterocolitis, fever, infection, oral lesions, perianal abscesses, pneumonia, sinusitis.
Thrombocytopenia: bleeding, conjunctival hemorrhages, eccymoses, epistaxis, gingival bleeding, petechiae.

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6
Q

Acute Myeloid Leukemia prognosis

A

Good in younger patients. Poor if developed from myelodysplastic syndrome.

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7
Q

Acute Myeloid Leukemia CBC

A

elevated/decreased WBC, cytopenias, blasts

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8
Q

Acute Myeloid Leukemia peripheral smear

A

Auer Rods: elongated needles in neutrophils, clumps of azurophilic granule material.

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9
Q

Acute Myeloid Leukemia metabolic panel

A

elevated creatine and liver function tests. altered electrolytes. Elevated uric acid and LDH.

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10
Q

Acute Myeloid Leukemia bone marrow biopsy

A

Blasts greater than 20%.

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11
Q

Acute Myeloid Leukemia treatment

A

Induction: chemo
consolidation: stem cell transplant

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12
Q

Myelodysplastic syndrome Definition

A

ineffective hematopoiesis with cytopenia. Can progress to AML.

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13
Q

Myelodysplastic syndrome epidemiology

A

males, 60 years old. chemical exposure can be treatment related (chemo 4-6 years later).

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14
Q

Myelodysplastic syndrome treatment

A

hematopoietic growth factors, immunomodulatory agents, hypomethylating agents, immunosuppressants

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15
Q

Tumor Lysis syndrome Definition

A

Oncological emergency. Massive tumor cell lysis causes release of cellular contents (K, Pi, nucleic acids etc.)

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16
Q

Tumor Lysis syndrome causes

A

Initiation of cytotoxic treatment and can occur spontaneously.

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17
Q

Tumor Lysis syndrome treatment

A

Prevention! fluids, diuresis, monitoring. Xanthine oxidase inhibitors, monitor cardiac function, seizure precautions, dialysis, treat the hyperkalemia and phosphatemia.

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18
Q

Chronic Myelogenous Leukemia Epidemiology

A

Males around 50yo. Risk factors are ionizing radiation and benzene.

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19
Q

Chronic Myelogenous Leukemia definition

A

Clonal malignancy of B-lymphocytes. Due to transposition of 9 and 22 on the philadelphia chromosome.

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20
Q

Chronic Myelogenous Leukemia presentation

A

fatigue, malaise, abdominal fullness, splenomegaly, B symptoms (fever, weight loss and night sweats).

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21
Q

Chronic Myelogenous Leukemia Chronic Phase

A

Lasts 5-6 years 80% are diagnosed here. WBC is greater than 10,000. High chance of remission if caught here.

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22
Q

Chronic Myelogenous Leukemia Accelerated Phase

A

Anemia, fatigue, malaise, flu-like symproms. 10-19% of blasts.

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23
Q

Chronic Myelogenous Leukemia Blast Crisis Phase

A

20% or more are blasts. Fever extramedullary blasts and splenomegaly.

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24
Q

Chronic Myelogenous Leukemia diagnosis

A

bone marrow biopsy shows philadelphia chromosome.

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25
Chronic Myelogenous Leukemia treatment
Tyrosine Kinase inhibitors like Gleevac(imantinib) or an allogenic stem cell transplant=curative.
26
Chronic Myelogenous Leukemia Complications
Tumor lysis syndrome, hyperluekocytosis, Hyperviscosity.
27
Hyperluekocytosis
WBC greater than 100,000. Medical emergency. Decreased perfusion to the tissues. Can require leukapheresis.
28
Hyperviscosity Syndrome
spontaneous bleeding, visual distrubances, neuro symptoms, HA, vertigo, seizures, coma. Treat with leukapheresis or plasma exchange.
29
Acute Lymphocytic Leukemia Epidemiology
Most common cancer in children and teens. 60% are under 20. Caucasian and certain genetic conditions (down syndrome).
30
Acute Lymphocytic Leukemia symptoms
fever, fatigue, lethargy, pallor, petechiae, ecchymosis, bone pain. In the elderly dyspnea, angina, dizziness.
31
Acute Lymphocytic Leukemia Signs
LAD, thymic mass, testicular mass, limp, arthralgia
32
Acute Lymphocytic Leukemia Periperal smear
Lymphoblasts
33
Acute Lymphocytic Leukemia CBC
cytopenia
34
Acute Lymphocytic Leukemia LDH
elevated.
35
Acute Lymphocytic Leukemia bone marrow biopsy
morphology, immunotype, cytogenics
36
Acute Lymphocytic Leukemia precursor B cell type
80% express this CD10 type and it is favorable prognosis.
37
Acute Lymphocytic Leukemia T cell type
More serious. Common in males. Hyperleukocytosis, mediastinal masses and intramedullary disease. Worse prognosis.
38
Acute Lymphocytic Leukemia Mature B cell type
Burkitt lymphoma. More common in males. Extramedullary disease and CNS leukemia. Favorable prognosis with intensive chemo.
39
Acute Lymphocytic Leukemia treatment
Induction chemotherapy. Monoclonal antibodies and tyrosine kinase inhibitors.
40
Chronic Lymphocytic Leukemia epidemiology
Most prevalent leukemia in adults. Males, 72yo. Highest inheritability of any malignancy.
41
Chronic Lymphocytic Leukemia Definition
accumulation of incompetent lymphocytes in the blood, marrow and lymph nodes.
42
Chronic Lymphocytic Leukemia Presentation
Bone marrow failure: anemia, thrombocytopenia, neutropenia. | Organomegaly: LAD, spleno/hepatomegaly.
43
Chronic Lymphocytic Leukemia Indolent stage
Can be asymptomatic or have fatigue malaise. Lyphocytosis is usually an incidental finding.
44
Chronic Lymphocytic Leukemia Advanced stage
anemia, B symptoms, atypical infections. Death is usually due to an infection, bleeding or cachexia.
45
Chronic Lymphocytic Leukemia Diagnosis
CBC, bone marrow biopsy, Lymph node biopsy to look for incompetent lymphocytes.
46
Chronic Lymphocytic Leukemia treatment
chemo, immunotherapy ( retiximab and other mabs), radiation, splenectomy.
47
Hodgkins Lymphoma definition
Cancer of the lymphocytes
48
Hodgkins lymphoma presentation
Painless LAD (cervical and supraclavicular) pruritis, B symproms, alcohol induced pain of lymph nodes. Enlarged spleen and liver
49
Hodgkins lymphoma epidemiology
15-34yo. Often with EBV, HIV and smoking, obesity.
50
Hodgkins lymphoma prognosis
Worsens with advanced stages and prescence of B symptoms.
51
Hodgkins lymphoma Diagnosis
Reed-sternburg cells in the lymph node/bone marrow biopsy. Multinucleated, arrested development of B cells. "pop corn" cells. Then stage with a CT
52
Hodgkins lymphoma treatment
Combo chemotherapy (often curative) Combined with radiation in bulky disease Stem cell transplant if needed
53
Non-Hodgkins Lymphoma Epidemiology
66yo often associated with HIV, EBV, HCV, HBV etc. CLL can transition into Non-Hodgkins Lymphoma.
54
Non-Hodgkins Lymphoma Presentation
Painless, persistent LAB with B symptoms.
55
Aggressive Lymphomas
rapidly growing, B symptoms, elevated LDH and uric acid.
56
Indolent Lymphomas
LAD, hepato/splenomegaly, cytopenia.
57
Non-Hodgkins Lymphoma diagnosis
Biopsy of lymph nodes, stage with CT bone marrow biopsy if develop cytopenias.
58
Non-Hodgkins Lymphoma treatment
Indolent: radiation alone Aggressive: chemo, immuno and transplant.
59
Multiple myeloma definition
Malignancy of plasma cells. Replace the bone marrow, destroy the bone and form tumors. Instead of immunoglobulins the plasma cells release paraproteins (hyperviscosity and renal failure).
60
Multiple myeloma epidemiology
65, african americans.
61
Multiple myeloma symptoms
fatigue, back pain, bone pain, infections, renal failure, bleeding, neuro changes.
62
Multiple myeloma signs
pancytopenia, osteoporosis, hypercalcemia, pathologic fractures, plasmacytomas, spinal cord compression.
63
Multiple myeloma diagnosis
Protein electrophoresis (blood or urine) show paraproteins with an M spike. Will also have bence jones protein in the urine.
64
Multiple myeloma xrays
lytic lesions, osteoporosis
65
Multiple myeloma CRAB
Calcium greater than 10.5 Renal insufficiency (cre less than 2) Anemia Bone lesions
66
Multiple myeloma treatment
combo chemo, vertebroplasty, IV bisphosphates, marrow transplant.

Clinical Medicine (7 decks)

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