Lymphoid Leukemias - Harrington & Atallah Flashcards

1
Q

Describe the signifiance of clonality in assessing lymphocytoses.

A

Clonality will reveal if the proess is pathologic; neoplasms will cause a monoclonal expansion, whereas most infections or other benign expansions will exhibit polyclonal characteristics.

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2
Q

Infectious Mononucleosis

Describe the etiology.

What signs and symptoms are seen?

A

Infectious Mononucleosis

EBV infection (usually occurring in teenagers) causes a lymphocytic expansion and may go dormant in B cells.

Fever, sore throat, LAD, splenomegaly…

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3
Q

What absolute lymphocyte count is considered a lymphocytosis?

What are some benign causes for lymphocytosis?

A

>4000 per microliter.

Viral infection (CMV, adeno, hepatitis, mononucleosis), pertussis, TB, and “transient stress lymphocytosis”.

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4
Q

How can the clonality of a B cell colony be determined? T/NK cells?

A

Both can be studied immunophenotypically (presumably with flow cytometry).

Heavy chain (or TCR) gene can be assessed with PCR.

Light chain patterns on B cells can be studied with flow cytometry or IHC.

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5
Q

What is the pathognomonic histological finding in infectious mononucleosis?

What 3 diagnostic criteria are needed?

A

“Atypical” lymphocytosis.

>50% mononuclear cells in WBC diff, >10% reactive lymphocytes, marked lymphocytic heterogeneity.

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6
Q

What criteria determines an acute leukemia?

What is the difference between a lymphoma and leukemia?

A

Presence of >20% blasts in peripheral blood or bone marrow.

Lymphomas originate in the tissues (spleen, lymph nodes, MALT/GALT, etc). Leukemias originate in the blood & marrow.

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7
Q

What is the most common ALL?

Who does it predominanttly affect?

A

B-ALL.

Children.

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8
Q

What can distinguish an AML from an ALL?

A

Presence of Auer rods in AML, in addition to CD13/14/15/33/117 and MPO presence.

Presence of CD3/19/20 in ALL.

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9
Q

Who do AMLs generally affect?

What are their subclasses, again?

A

Adults more than children.

AML w/ recurrent cytogenetic abnormalities, MDS-associated changes, therapy-related, and “NOS”

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10
Q

Summarize the prognostic factors of B-ALL. Which are good? Bad?

A

Good: Age (2-10yrs), hyperdiploidy, t(12;21)

Bad: CSF involvement, high WBC count, marrow involvement following treatment, t(9;22), MLL mutation, hypodiploidy.

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11
Q
A
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12
Q

Try to recall B-ALL’s typical immunophenotype.

A

CD34+

CD10+

TDT+

CD19+

CD20-

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13
Q

Who does T-ALL classically affect?

Describe its presentation and outlook.

Try to recall its immunophenotype.

A

Adolescent males.

Present with mediastinal mass; aggressive.

CD3+, CD4/8+, TDT+.

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14
Q

What are the four steps used in a typical treatment regimen for ALL?

What sites must be treated directly?

A

Induction, intensification, CNS prophylaxis, maintenance.

The CNS…and testes.

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15
Q

Compare and contrast the outlook of ALL in general in adults and children.

A

In adults, half die from AML while half enter remission.

Better overall prognosis in children.

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16
Q

Name & describe two drugs used to treat ALL.

A

Blinatumomab: Bispecific antibody, directs CD8+ cells to destroy CD19+ cells.

Dasatinib: Kinase inhibitor, first-line treatment against t(9;22) ALL.

17
Q
A