Leukemias and Lymphomas

Question 1

What is Leukemia

Answer 1

Cancer of the bone marrow, primarily WBC

Overgrowth of immature or abnormal cells leads to suppression of normal cells/cell growth

Question 2

What blast cell is effected in Myeloid Leukemia?

Answer 2

Myeloid Progenitor cells

Question 3

What blast cell is effected in Lymphoid Leukemia?

Answer 3

Lymphoid Progenitor cells

Question 4

Acute leukemias are more common in what age cohort?

Answer 4

Children

Question 5

Are chronic leukemias common in children?

Answer 5

No, more common in older adults

Question 6

Is acute or chronic leukemia more likely to have an insideous onset?

Answer 6

Chronic

Question 7

What is the goal of treatment in acute leukemias?

Answer 7

Goal is cure (chemo and bone marrow transplant)

Question 8

What is the goal of treatment in chronic leukemias?

Answer 8

Goal is to slow disease progression, normalize cell counts (less curative)

Question 9

What is the median age of diagnosis of acute myeloid leukemia?

Answer 9

68

Question 10

Is acute myeloid leukemia an acute or chronic leukemia?

Answer 10

Acute, but more common in adults than kids

Question 11

What is the presentation of acute myeloid leukemia?

Answer 11

Non-specific symptoms less than 3 months in duration

Fatigue most common presenting symptom

Question 12

What is the pathognomonic histology finding for acute myeloid leukemia?

Answer 12

Auer Rods, crystalized cytoplasmic inclusion granules

Question 13

Why is post-remission treatment important to consider in acute myeloid leukemia?

Answer 13

High chance for relapse, BMT is most effective and recommended for anyone less than 75 who has an HLA compatible donor

Question 14

If diagnosed with acute myeloid leukemia and febrile what should be initiated?

Answer 14

Prompt broad-spectrum antibiotic therapy

Question 15

What is the pathophysiology of chronic myeloid leukemia (CML)?

Answer 15

Not hereditary, secondary to chromosomal translocation of bcr-abl gene (Philadelphia chromosome)

Question 16

How are most cases of CML identified?

Answer 16

Routine screening, typically asymptomatic

Question 17

For patients without routine healthcare may be symptomatic and present with what type of symptoms in CDL?

Answer 17

Non-specific symptoms

Fatigue, weight loss, abdominal pain, blood clots, evidence of bleeding, bone pain

Question 18

What are going to be the laboratory findings in someone with CDL?

Answer 18

Primary leukocytosis (WBC > 50,000)
Thromboycosis
+/- anemia (1/3rd of patients)

Question 19

What is the definitive diagnosis for CML?

Answer 19

BM biopsy and genetic testing

Question 20

What is the first line treatment for CML?

Answer 20

Tyrosine Kinase Inhibitors (TKIs)

Imatinib (Gleevec), Dasatinib, hilotinib, bosutinib

Question 21

What is the most common malignancy in kids?

Answer 21

Acute Lymphoid Leukemia (ALL)

Question 22

What is the derivative cell lines in ALL?

Answer 22

B and T-cells, T-cell has the worst prognosis

Question 23

What conditions are at high risk for developing ALL?

Answer 23

Genetic condition, Trisomy 21 has a 20x increased risk

Question 24

What are the three most common presenting symptoms of ALL?

Answer 24

Fever, Fatigue/lethargy, Bone pain

Question 25

When is an anterior mediastinal mass found on x-ray?

Answer 25

Acute Lymphoid Leukemia (8-15% of cases)

Question 26

What adjunctive tests should be done when diagnosing ALL?

Answer 26

Imaging to rule out mediastinal mass CSF analysis to rule out lymphoblastic infiltration

Question 27

Who is more likely to be diagnosed with Chronic Lymphocytic Leukemia (CLL)?

Answer 27

More common in caucasian, males with the median age of 70 years at time of diagnosis

Question 28

What are the risk factors for Chronic Lymphocytic Leukemia?

Answer 28

Farmers Hairdressers HCV infection Agent orange exposure (Vietnam Vets)

Question 29

What are the common presenting symptoms for CLL?

Answer 29

Fatigue, lymphadenopathy most common Other sx include: recurrent infections, fevers, weight loss, night sweats, symptoms from anemia

Question 30

Is the platelet count usually normal or abnormal in the laboratory work-up of CLL?

Answer 30

Usually Normal

Question 31

What is needed for a definitive diagnosis of CLL?

Answer 31

Bone marrow biopsy

Question 32

What cell finding will be present on histology in CLL?

Answer 32

Smudge cells, ruptured CLL cells

Question 33

If patient is asymptomatic or with co-morbidities what is the first line treatment in CLL?

Answer 33

Observation

Question 34

If symptomatic, what is the treatment in CLL?

Answer 34

Bruton tyrosine kinase (BTK) inhibitors

Question 35

What is the most common cell origin for Non-Hodgkin Lymphoma?

Answer 35

B-cells

Question 36

What is the primary presenting symptom in Non-Hodgkin Lymphoma?

Answer 36

Lymphadenopathy

Question 37

What are the B symptoms?

Answer 37

Fever Night sweats (drenching) Weight loss (>10% of body weight in less than 6 m.o.)

Question 38

What is needed for the definitive diagnosis of Non-Hodgkin Lymphoma?

Answer 38

Lymph node biopsy

Question 39

What is the mainstay treatment for Non-Hodgkin Lymphoma?

Answer 39

Chemotherapy (+ prednisone)

Question 40

What are risk factors for Hodgkin Lymphoma?

Answer 40

Epstein Barr Virus (EBV) HIV or AIDS Positive family history

Question 41

What is a unique presenting symptom to Hodgkin Lymphoma?

Answer 41

Pruritis with ETOH ingestion and bathing

Question 42

What cells are found on lymph node biopsy in Hodgkin Lymphoma?

Answer 42

Reed-Sternberg cells (owl eye appearance, symmetric bilobed nucleus)

Question 43

Many patients are asymptomatic with Multiple Myeloma, but some are symptomatic and will present with what symptoms?

Answer 43

Bone pain- often first symptom Spinal cord compression Pathologic fracture (femoral neck or vertebrae)

Question 44

What will be the findings on MRI in Multiple Myeloma?

Answer 44

Lytic lesions, "moth eaten" or "punched out appearance"

Question 45

What are the symptoms in the CRAB mnemonic for Multiple Myeloma?

Answer 45

HyperCalcemia Renal insufficiency Anemia Bone lesions

Question 46

What is a pathognomonic finding for Multiple Myeloma on urine protein electrophoresis (UPEP)?

Answer 46

Bence Jones proteins

Question 47

What causes leukopenia?

Answer 47

Decreased production or increased destruction of WBC's Drugs (chemotherapy) Infections (flu, TB, malaria) Nutritional (B12 and folate deficiency) Genetic Hematologic diseases SLE Hypersplenism