W3: Leukaemias, Lymphomas and Myelomas

Question 1

define leukaemia

Answer 1

cancer of wbcs

Question 2

define lymphoma

Answer 2

cancer of lymphoid tissue

Question 3

define myeloma

Answer 3

cancer of clonal plasma cells in BM (B cells)

Question 4

4 main types of leukaemia

Answer 4

Acute myeloid leukaemia (AML)
Acute lymphoblastic leukaemia (ALL)
Chronic myeloid leukaemia (CML)
Chronic lymphoid leukaemia (CLL)

Question 5

2 types of lymphoma

Answer 5

Hodgkin’s
Non-Hodgkin’s

Question 6

2 cell cycle abnormalities that cause cancer + where do they occur

Answer 6

mutations in proto-oncogenes

mutations in tumour suppressor genes

occurs in BM or peripheral lymphoid tissue

*mutation in single gene

Question 7

incidence vs prevalence

Answer 7

i = rate of new cases in given time period/ % of pop at risk of dev

p = no. of people already w condition

Question 8

known causes of leukaemia

Answer 8

• previous chemotherapy w alkylating agents
• radiation exposure
• benzene/ formaldehyde exposure
• genetic conditions (down’s syndrome)
• myelodysplasia (pre-leukaemia)

Question 9

dysplasia vs myelodysplasia

Answer 9

d = abnormal dev
md = abnormal dev of myeloid cells (pre-leukaemia)

Question 10

define acute myeloid leukaemia

Answer 10

> 20% myeloblast cells (immature wbcs) in blood/ BM

affects myeloid line (granulocytes + monocytes)

Question 11

define acute lymphoid leukaemia

Answer 11

> 20% lymphoblast cells (immature wbcs) in blood/ BM

affects lymphoid line

Question 12

define chronic myeloid leukaemia

Answer 12

chronic = incr no. of mature cells than blast cells

affects myeloids (granulocytes + monocytes)

Question 13

define chronic lymphoid leukaemia

Answer 13

chronic = incr no. of mature cells than blast cells

affects lymphocytes

Question 14

AML: median age

Answer 14

60yrs

Question 15

AML: signs + symptoms + why

Answer 15

• Acute, often critically ill
• Malaise, fever, sweats (high E use of uncontrolled prolif - hot + sweaty)
• Symptoms of anaemia (BM too crowded so no space + nutrients to make rbcs)
• Neutropenia - infections
• Thrombocytopenia - bleeding / DIC

Question 16

what type of anaemia can be seen in AML + why

Answer 16

normocytic normochromic bc nothing wrong w prod of rbcs just not enough space to make them

Question 17

testing to distinguish btwn myeloid leuk vs lymphoid leuk

Answer 17

m = myeloperoxidase (MPO) pos (enzyme found in granulocytes)

Question 18

prognosis of AML

Answer 18

chemo leads to complete remission in 80-90% younger patients
cure rate lower ~45%

older patients - 5yr survival rate ~15%
cure rate rare

Question 19

define “in remission”

Answer 19

cancer repressed to <5% blast cells

Question 20

chemotherapy side effects

Answer 20

chemo = cytotoxic drugs = toxic to all rapidly dividing cells (healthy or not)

side effects:
- hair loss (bc hair follicles divide fast)
- nausea + vomiting (bc mucus mem gut lining cant divide)
- decr in sperm prod -> infertility

Question 21

ALL: peak age, % of childhood leukaemias, ratio caused by B to T cells, categories

Answer 21

0-4 yrs
80%
85:15
L1-L3

Question 22

ALL signs + symptoms

Answer 22

• Starts abruptly
• Bone + joint pain
• Symptoms of BM failure (anaemia, infection, haemorrhage)
• Generalised lymphadenopathy (enlarged lymph nodes in multiple places)
  Hepatosplenomegaly (liver + spleen reactivated to prod wbcs)
• Testicular involvement
• CNS manifestations

Question 23

define sanctuary site

Answer 23

places in body where chemo struggles to reach

Question 24

ALL blood test

Answer 24

leukocytosis/ leukopenia/ normal wbc count

normo, normo anaemia

neutropenia
thrombocytopenia
wbcs MPO neg

Question 25

ALL prognosis

Answer 25

children curable w chemo + CNS prophylaxis adult cured less freq - stem cell transpalnt 35% 5y survival adults

Question 26

CML common age range

Answer 26

65-85 yrs

Question 27

CML associated w presence of which chromosome

Answer 27

Philadelphia

Question 28

CML S+S

Answer 28

fatigue, weight loss, sweaty splenomegaly hepatomegaly (sensation of fullness) gout, bruising leukostasis (clumping of leukocytes)

Question 29

CML blood test

Answer 29

leukocytosis, neutrocytosis incr basophils normo normo anaemia thrombocytosis most freq incr lactate dehydrogenase (LDH)

Question 30

CML prognosis

Answer 30

50% 5y survival indolent (slothful), followed by period of acceleration + final generally fatal leukemic phase stem cell transplant - can cause mortality tyrosine kinase inhibitor - imatinib as initial therapy

Question 31

CLL age

Answer 31

50+ , peak at 90+

Question 32

CLL S+S

Answer 32

asymptomatic symmetrical + painless enlargement of lymph nodes symptoms of anaemia weight loss indolent

Question 33

CLL blood test

Answer 33

lymphocytosis wbcs appear as small + round lymphocytes smear cells (fragile lymphocytes burst during processing) immunotyping - shows as almost always B cells (bc CD19+ on surface) normo normo anaemia thrombocytopenia

Question 34

CLL prognosis

Answer 34

initially indolent chemo not needed immediately 705 5y survival often die of other causes becomes more aggressive in advanced stages

Question 35

lymphoma is

Answer 35

cancer of lymphoid tissues e.g spleen, lymph nodes, tonsils, adenoids, thymus

Question 36

lymphoma effects

Answer 36

swollen lymphod tisses fileld w B or T cells

Question 37

% ratio of hodgkins vs non-hodgkins lymphoema + which cells + how distinguished

Answer 37

40% H (B lymphs) 60% non-H (T or B lymphs) biopsy node + stain lymphs CD15 marker of Reed-Sternburg cells (in hodgkins)

Question 38

hodgkins lymphoma

Answer 38

Malignant B-cells accumulate in lymph nodes malignant cells = minority of tumour inflammatory cells = majority

Question 39

2 peak ages of hodgkins

Answer 39

15-35 over 50

Question 40

hodgkins S+S

Answer 40

asymmetrical + painless lymphadenopathy (swollen lymph nodes) splenomegaly fever, night sweats, wt loss, pruritus (itching), fatigue in minority

Question 41

hodgkins blood test

Answer 41

normo normo anaemia eosinophilia neutrophilia normal/ incr platelet count advanced disease - lymphopenia, thrombocytopenia

Question 42

hodgkins prognosis

Answer 42

80% 10y survival largely determined by stage of disease chemo -> high cure rates risk of 2ndary malignancy as late side effect of treatment

Question 43

non-hodgkins age

Answer 43

85-89

Question 44

non-hodgkins S+S

Answer 44

asymmetrical painless lymphadenopathy Less fever, night sweats + wt loss than w Hodgkin’s Sore throat Symptoms of anaemia/ thrombocytopenia/ neutropenia w infections Acute abdominal symptoms due to spleen/ liver enlargement + involvement of GI tract

Question 45

non-hodgkins blood tests

Answer 45

normo normo anaemia - maybe autoimmune haemolytic anaemia in advanved diseas w marrow involvement - neutropenia, thrombocytopenia lymph node biopsy cytogenics (chromosome mapping)

Question 46

non-hodgkins prognosis

Answer 46

55% 10y survival indolent chemo effective cure elusive aggressive NHL cured w chemo + ruiximab stem cell transplant

Question 47

multiple myeloma (MM)

Answer 47

cancer of clonal plasma cells in BM (B cells)

Question 48

MM detected by

Answer 48

Ab secreting B cells that secrete paraprotein (aka M protein) (detectable in serum/ urine)

Question 49

MM age + race most effected

Answer 49

85-89 african americans

Question 50

MM S+S

Answer 50

bone pain, fractures anaemia symptoms thrombocytopenia leukopenia renal failure, hypercalcaemia amyloidosis (deposition of abnormally folded proteins)

Question 51

MM blood tests

Answer 51

incr plasma cells in BM presence of paraprotein normo normo OR macro anaemia pancytopenia hypercalcemia

Question 52

normo