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First Aid Step 3 Oncology 1
Leukemia
16
Medical
Professional
12/25/2013

Additional Medical Flashcards

 


 

Cards

Term
What is the difference between acute and chronic leukemia?
Definition

Acute leukemia: minimally differentiated cells; >20% blasts in bone marrow

 

Chronic leukemia: more mature differntiated cells

Term
Describe symptoms of ALL
Definition
Viral like prodrome (fever, sore throat, lethargy)
Kids may present with limpness, bone pain, easy bruising and fever
Exam shows pallor, widespread petechiae/purpura, multiple ecchymoses and bleeding
Signs of Extramedullary spread with adenopathy, hepatosplenomegaly, testicular/CNS involvement
Term
How do you diagnose ALL?
Definition
Leukocyte count: Increased or Decreased
Plt: Marked decrease
LDH and Uric Acid: INcreased
Biopsy: CALLA+, TdT+
CXR, LP, and CT to rule out mediastinal involvement and brain mets
Term
How do you treat ALL?
Definition
Induction: Induce remission (vincristine + prednisone + daunorubicin
Consolidation: To kill residual leukemia (High dose methotrexate)
Maintenance: Maintain remission (daily Methotrexate, 6-MP, or both)
80% achieve long term remission for kids
Term
What are the symptoms of AML?
Definition
Fatigue bruising, anemia, Fever Leukemia cutis (small painless skin lesions), history of frequent infections.
DIC, gingival hyperplasia or CNS involvement
Term
How do you diagnose AML?
Definition
Myelocytic cell lines: Increased
Leukocyte Alkaline Phosphatase (LAP): Decreased
Hypruricemia due to cell turnover
Myeloblasts with Auer Rods
Biopsy shows blasts +myeloperoxidase stain, Auer rods, and cytogenetic tests
Term
How do you treat AML?
Definition
Induction: cytsine arabinoside + anthracycline
Consolidation:
Exceptions: All-trans-retinoic acid for induction and maintenance for promyelocytic form (AML-3)
Allogenic BMT considered for pts with poor prognostic factors or those <60 yrs.
Term
70 yo man presents with fatigue. PE is unrevealing but a routine CBC shows lymphocytosis with a normal hematocrit and platelet count. What is the next step and what is the likely diagnosis?
Definition
Get a peripheral blood smear
CLL
Term
How does CLL present?
Definition
Incidental finding of lymphocytosis
Lymphadenopathy, fatigue, hepatosplenomegaly
Term
How do you diagnose CLL?
Definition
Isolated lymphocytosis with normal hematocrit and platelets
Peripheral smear shows small lymphocytes and smudge cells
Biopsy for confirmation
Term
What is found on Bone Marrow Biopsy in CLL?
Definition
Infiltrated with lymphocytes
Aberrant CD5+ expression
Term
How do you treat CLL?
Definition
No treatment indicated for asymptomatic patients
Anemia and thrombocytopenia are treated with fludarabine
May be associated with autoimmune hemolytic anemia and immune thrombocytopenia which are treated with splenectomy and/or steroids.
Term
How does CML present?
Definition
Routine CBC demonstrates leukocytosis with myeloid precursors
Fatigue, fever, mlaise, decreased exercise tolerance, weight loss, and night sweats
Blast Crisis presents as fever, bone pain, wt loss and splenomegaly
Term
What is the DDx for CML?
Definition
Hairy cell leukemia: (Pancytopenia in elderly, Malignancy of B lymphocytes, CD11c +)
Aplastic anemia
Myelofibrois (dry bone tap)
Term
How do you diagnose CML?
Definition
Prominent myeloid cells with basophilia
LAP: Decreased
B12 level: increased
Confirm wiht t(9,22) Philadelphia chromosome bcr-abl via karyotype, PCR, or fluroscence in situ hybridization (FISH) analysis of blood or marrow aspirate.
Term
What is the treatment for CML?
Definition
Sharl Azar MD's main man Brian Drucker MD from Oregon Health Sciences University in Portlandia developed the first good first-line therapy called GLEEVEC (Imatinib mesylate) a Tyrosine kinase inhibitor which rapidly leads to remission, by eliminating the CML clone. Pure Brilliance from Oregon! Who says people go there to retire?
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