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Leukemia/Lymphoma
blood and lymph II
52
Medical
Graduate
02/25/2011

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Cards

Term
Which lymphoma does not contain Reed-sternberg cells?
Definition
- Diffuse Large Cell Lymphoma
- Follicular Lymphoma
- (NHL's)
Term
Classical Hodgkin's LYmphoma evaluation
Definition
-H&P
CBC
CT scan (chest, abd, pelvis)
PET-CT
BM biopsy
Cardiac echo
Pulmonary Function Tests
Term
What is the malignant cell in Hodgkin's Lymphoma?
Definition
Reed-Sternberg cell
Term
What kind of cell is a Reed-sternberg cell?
Definition
-B cell
Term
Factors associated with Hodgkin's
Definition
- Family Hx
- EBV
-High Standard of living
-immunosupression
-young age
-old age
Term
Ann Arbor Staging
Definition
I - one LN area (above or below)
II - two LN on same side (above or below)
III - LN's on either side
IV - extra LN locations (bone marrow etc)
Term
"B" Sx
Definition
-Fever
-Night Sweats
-Weight Loss (>10% in 6 mo)
Term
What are the four types of Hodgkin's Lymphoma?
Definition
1. Nodular Sclerosing
2. Lymphocyte Depleted
3. Lymphocyte Predominant
4. Mixed Cellularity
Term
Hodgkin's Tx
Definition
-radiation for early stage
-ABVD (Adriamycin, Bleomycin, Vinblastine, and Dactinomycin)
Term
Hodgin's TX
Definition
1. Adriamycin=Anthracycline Antibiotics
Term
Bleomycin
Definition
-MOA:
-Uses: Broad spectrum, IV... hodgkin's, testicular cancer,
-SE: low BM toxicity (good combo drug), LUNG toxicity :( cumulative, dose/age/smoking related (Pneumonitis, pulmonary fibrosis)
Term
Vinca Alkaloids
Definition
1. Vinblastine, Vincrostine (Oncovin) ... from periwinkle
2. MOA: binds tubulin and blocks metaphase/anaphase
3.Use: Vinblastine (ABVD
4.SE: Vincristine (***Neurotoxicity... peripheral neuropathy, paresthesis... but low incidence of BM depression)
Term
Dacarbazine (DTIC-Dome)
Definition
1. MOA: alkylating agent, bind to DNA and decrease rep
2. Uses: Hodgkin's, malignant malinoma
3. SE: mild NV
Term
What are three things that have reaaallllyyy low platelet count?
Definition
1. ITP (other counts usually normal)
2. Aplastic anemia (everything's low)
3. Acute Leukemia
Term
What causes Acute Lymphocytic Leukemia?
Definition
We don't know!
Term
What tests do we need to diagnose ALL?
Definition
-BM biopsy and Aspirate
-BM Cytogenetics
-peripheral blood for flow cytometry (**quickest)
-BM flow cytometry
-BM fish for common genetic abnormalities
Term
How is ALL Classified?
Definition
1. Morphology (size, variability of blasts)
-L1: uniform
-L2: not as uniform
-L3: white inclusion bodies
2. Immunophenotype (pattern of expression of surface Ag)
Term
Ag surface markers
Definition
#68
Term
ALL Prognostic Factors
Definition
bad:
-male, black, WBC >30k, age <1 or >11, CNS involvement at Dx. #72
Term
ALL management
Definition
1. Induction Chemo, recovery period, Intensification chemo + bone marrow transplant
2. Drugs: hyperCVAD (Cyclophosphamide, vincristine, daunorubicin, Dexamethasone, cytarabine (pyrimidine antagonist), methotrexate.... intrathecal therapy
Term
Cyclophophamide (Cytoxan)
Definition
1. from Nitrogen Mustard
2. MOA: alkylating agent of DNA... inhib DNA replication
3. Prodrug (P450) -> Acrolein (toxic metabolite.. bladder toxicity) and Phosphoramide Mustard
4. Uses: oral... ALL, NHL(CHOP), breast/ovarian cancer
5. SE: **Hemorrhagic cystitis... bladder problems (give Mesna, a thiol drug, as uroprotectant w. lotsa H20)
Term
Adrenocorticosteroids
Definition
ex. dexamethasone
1. MOA: inhibit mitosis, lympholytic... immunosuppressive
2. Uses: ALL, ACL, Hodgkin's, NHL
3. SEL cushings, peptic ulcers... etc
Term
What kind of drug is methotrexate?
Definition
Folic Acid Antagonist
Term
Folic Acid Antagonists
Definition
ex. Mehtotrexate
1. MOA: inhibit DHFR, thymidylate/DNA synth
** rescued/reversed by folinic acid (Formyl-tetrahydrofolate)... not folic acid
2. Uses: ALL (intrathecally- direct CNS), Choriocarcinoma (DOC!!!), CNS lymphoma
3. SE: alkyline the urine... to increase excretion
***Teratogen
Term
Where would you find smudge cells?
Definition
CLL
Term
Does Follicular Cell lymphoma circulate?
Definition
No
Term
What the most important test in the initial evaluation of suspected CLL?
Definition
- peripheral blood for flow cytometry

- CT Chest Abd Pelvis
- LN Biopsy ... also important
Term
Rai clinical staging for CLL
Definition
0: low risk ... lyphocytosis
I: intermediate ... + LAN
II: high ...+organomegally
III: hi ...+... #101
Term
other classification
Definition
#102
Term
most common leukemia in western world
Definition
CLL
Term
SLIDE #103
Definition
Term
Are proliferation centers are pathognomonic for CLL/SLL?
Definition
yes
Term
Prognosis of CLL
Definition
significant
- Genetic abnormalities
- VH gene mut
-CD38
-ZAP-70
-beta2microglobulin
-lymphocyte doubling
Term
CLL management
Definition
- treat only when it causes Sx
-Rx: FCR (Fludarabine, Cytoxan, Rituxan)
Ri
Slide #111
Term
Fludarabine
Definition
fluorinated purine analog...
1. MOA: prodrug -> 2-fluoroara-ATP which interferes w. DNA synth/repair by inhibit DNA Pol
#112
Term
Rituximab
Definition
MOA: recombinant monoclonal Ab against CD20 Ag on B cells.
Uses: NHL, CLL (combo Tx) #113
SE:
Term
Bendamustine
Definition
MOA: cross-linking of DNA
Uses: CLL, NHL
SE: standard
Term
Alemtuzumab
Definition
MOA: deplete leukemic/normal cells by direct Ab-dependent lysis... CD52
Uses: B cell CLL in pt refractory to FCR regimen- IV
SE: monitor for infections!
Term
CHOP Tx
Definition
Cyclophosphamide (cytoxan)
Doxorubicin (Hyrdroxdy
#116
Term
THings to look out for in the management of CLL
Definition
- infections (bc humoral immunity is down)
- Autoimmune complications (Hemolytic anemia, ITP, etc)
Term
enlarged LN DDx
Definition
-infectious mononucleosis (EBV)
-CMV
-Toxoplasmosis
-TB
-Inflammatory States
-Cancers (Lymphoma, H & N, Breast)
Term
How do you stage NHL - Nodular Large Cell Lymphoma?
Definition
FLIPI Score
Factors
Slide #146
Term
Hodgkin's Lymphoma Management
Definition
- Watch and wait
- Chemotherapy (CHOP)
- Rituxan
- #149
Term
MM Sx
Definition
-Age
-Bone pain
-Anemia
-renal disfunction
-hypercalcemia
-proteinuria
-neuropathy
-hyperviscocity
-pathologic fractures
Term
What would the serum protein electrophoresis show in a Pt with MM?
Definition
- increased monoclonal immunoglobin (usually IgA or G) = M spike
- slightly decreased albumin
Term
MM Bone Marrow Aspirate
Definition
- lots of perinuclear clearing...(golgi)
- lots of plasma cells (normal is 5%)
- crystals
Term
Solitary Plasmacytoma
Definition
-no clinical critera of myeloma
-radiation is curative
-25% chance of getting myeloma
Term
MM Staging
Definition
I: Hg >10, Ca: normal or <12mg,

Slide #166
Term
MM Prognosis markers
Definition
B2 microglobulin
C-reactive protein
Chomosome 13 deletion
Term
MM Tx
Definition
MP regimen (Melphalan, Prednisone)
VAD regimen (Vincristine, Doxorubicin/Adriamycin, Dexamethasone)
Term
Thalidomide
Definition
MOA: inhibits angiogenesis... anti-inflammatory/immunomodulatory... inhibits TNF-alpha, decrease phagocytosis, increase CMI
Uses: MM, leprosy
SE: Teratogenic (Phocomelia), peripheral neuropathy, etc
Term
Bortezomib
Definition
MOA: reversible proteasome inhibitor. Block proteosome -> apoptosis. and decrease NF-kB
Uses: MM: Palliative
SE: pheripheral neuropathy, ND, Asthenia, THombocytopenia, neutropenia, fever...
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