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clin med IV > lymphoma > Flashcards

lymphoma Flashcards

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1
Q

multiple myeloma

A
  • increased production of non- functioning plasma cells

- plasma cells produce IgG with excess light chains

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2
Q

RF for MM

A
  • usu dx in 60s
  • no clear RF
  • assoc with woodworkers, farmers, leather craftsmen
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3
Q

si/sx of MM

A
  • bone pain*
  • weakness, fatigue, wt loss
  • dyspnea
  • fever
  • repeated infx
  • SC compression
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4
Q

PE findings for MM

A
  • pallor
  • organomegaly
  • radiculopaty
  • peripheral neuropathy
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5
Q

lab findings for MM

A
  • hyper Ca
  • increased serum proteins
  • anemia
  • ARF
  • low anion gap
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6
Q

major criteria for MM dx

A
  • plasmacytosis on tissue bx
  • BM > 30% plasma cells
  • M spike on SPEP or UPEP
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7
Q

M spike levels that are diagnostic for MM

A
  • IgG > 35 on SPEP
  • IgA > 20 on SPEP
  • > 1g/24 hours on UPEP
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8
Q

minor criteria for MM dx

A
  • BM 10-30% plasma cells
  • M spike lower than major criteria
  • lytic bone lesion on xray
  • abnormally low immunoglobulin levels
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9
Q

dx of MM

A
  • 1 major + 1 minor criteria
    OR
  • 3 minor criteria
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10
Q

what is the classic triad of MM

A
  • lytic lesions
  • BM plasma > 30%
  • M spike on SPEP or UPEP
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11
Q

what are bad prognostic indicators for MM

A
  • “CRAB”
  • hyperCalcemia
  • renal failure
  • anemia
  • boney lytic lesions
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12
Q

what staging criteria are used for MM

A
  • durie salmon (I-IIIb)

- international staging systems ( I-III)

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13
Q

tx for MM

A
  • no cure
  • low threshold for infx- treat infx
  • HSCT gives pt 5 extra years
  • analgesia
  • hydration
  • plasmapheresis
  • xrt
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14
Q

prognosis of MM

A
  • fatal within 4-5 years without HSCT

- death d/t progression, renal failure, sepsis, tx related leukemia or myelodisplasia

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15
Q

what is MGUS

A
  • “pre-MM”
  • M spike
  • no sx
  • < 10% plasma cells
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16
Q

what is smoldering MM

A
  • “pre-MM”

- meets dx criteria for MM but no end organ damage

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17
Q

essential thrombocytosis

A
  • myeloproliferative disorder
  • produce too many dysfunctional platelets
  • usu dx incidentally
  • tx: plasmapheresis
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18
Q

what is the most common hematologic malignancy

A
  • non-hodgkins lymphoma

- common in adults > 50

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19
Q

non-hodkins lymphma (NHL)

A
  • over 35 dif types
  • majority are B cell
  • classified as indolent, aggressive, or highly aggressive
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20
Q

indolent NHL

A
  • follicular

- survival is years if untreated

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21
Q

aggressive NHL

A
  • Diffuse large B cell lymphoma (DLBCL)

- survival is months if untreated

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22
Q

highly aggresive NHL

A
  • burkitts lymphoma

- survival is weeks if untreated

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23
Q

RF for NHL

A
  • family hx
  • prev xrt or chemo
  • immunosuppressives
  • HTLV1, HIV, EBV, Hep B/C
  • inflammatory GI disease
  • autoimmune disorders
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24
Q

si/sx of NHL

Study These Flashcards
A
  • unexplained fever*
  • night sweats, fatigue, wt loss
  • painless LAD
  • cough or CP
  • bloating
  • rashes
  • hepato/ splenomegaly
25
extranodal involvement in NHL
- CNS - bone - GIT - dermis - testicular- most common testitcular ca if > 60 - waldeyer's ring
26
dx of NHL
- excisional LN bx - bone marrow aspiration - LP if suspect CNS involvment - PET for staging
27
prognosis of NHL
- determined by: - immunophenotype - cytogenetics - growth fraction - cytokine production
28
staging I lymphoma
- disease in single region
29
stage II lymphoma
- 2+ LN on same side of diaphragm
30
stage III lymphoma
- LN above and below diaphragm
31
stage IV lymphoma
- widespread disease | - multiple organs
32
modified ann arbor staging
- used for lymphoma - e= extranodal - s= spleen - x= bulky LN > 10 cm
33
follicular NHL
- indolent - grows/ spreads slowly - second most common type of NHL
34
what causes follicular NHL
- translocation between chromosome 14 and 18 -> BCL2 gene | - cells dont undergo apoptosis
35
prognosis of follicular NHL
- based on flipi score - nodal involvement - LDH level - age > 60 - stage III or IV disease - Hgb < 12
36
diffuse large B cell lymphoma (DLBCL)
- aggressive NHL | - most common type of NHL
37
what usu causes DLBCL
- long term immunosuppressive tx
38
cell markers for DLBCL
- CD19 - CD20 - CD79a
39
tx for DLBCL
- everyone gets chemo - stage I and II: 3-4 cycles - stage III and IV: 6-8 cycles
40
tx for follicular NHL
- stage I and II: xrt | - stage III and IV: chemo
41
burkitt's lymphoma
- highly aggressive NHL | - affects kids in Africa
42
si/sx of burkitt's lymphoma
- mandibular/ facial bone tumor - may have abd mass with ascites - renal and testicular involvement - spreads to CNS and bone marrow - can be assoc with HIV
43
dx of burkitt's lymphoma
- starry sky appearance on bx | - MYC translocation- chromo 8 and 24
44
prognosis of burkitt's
- rapidly fatal if untreated | - good prognosis/ cure rates with tx
45
T cell lymphoma
- uncommon type of NHL | - have a lot of cutaneous invovement
46
subtypes of T cell lymphoma
- precursor T lymphoblastic lymphoma | - peripheral T lymphoma
47
tx of T cell lymphoma
- topical: cutaneous and oral disease modifiers - systemic: poor outcomes -> early clinical trials, combo chemo, novel biologics - Car T cell tx
48
hodgkin's lymphoma
- reed sternberg cells - potentially curable - subclassified as classical vs nodular lymphocyte predominant HL - bimodal peak: 25-30 and > 55
49
reed sternberg cells
- seen in HL - express CD30 and CD15 antigens - have multiple nuclei
50
how does HL spread
- starts in single node/ chain of nodes | - spreads contiguously
51
RF for HL
- male predominance - SES and enviornment - EBV - mono - smoking - immunosuppression - autoimmune disease - family hx
52
decreased risk for HL
- breast feeding - chicken pox - MMR - pertussis
53
si/sx of HL
- painless LAD above diaphragm* - cyclic fevers* - night sweat - CP/ cough - pruritis - LN pain s/p alcohol ingestion - cerebellar degeneration - erythema nodosum
54
dx of HL
- LN bx and histology - BM bx - plain xrays show mediastinal mass - CT, PET - ESR for staging - LDH- marker of disease burden
55
tx of HL
- based on stage and clinical scenario | - early favorable vs. early unfavorable vs advanced
56
tx for early favorable HL
- 3-4 cycles of chemo | - xrt
57
tx for early unfavorable HL
- 4-6 cycles of chemo
58
tx for advanced HL
- 6-8 cycles of chemo | - xrt for bulky disease or residual activity on PET
59
criteria for favorable early HL
- < 2 sites - no extranodal invovlement - no mediastinal mass > 1/3 thoracic diameter - ESR < 50 or <30 with b sx

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