Term
| Leukemias and lymphomas are classified according to the stage of _______ _______ at which their _______ _____ appear to be blocked. |
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Definition
| normal hematopoesis, neoplastic cells |
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Term
| Leukemia is a neoplasm derived from ____ or _____ cells primarily affecting the _______ _______ and _______ _________. |
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Definition
| lymphoid, myeloid, bone marrow, peripheral blood |
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Term
| What does AML, ALL, CML, and CLL stand for? |
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Definition
| Acute myeloblastic leukemia, acute lymphoblastic leukemia, chronic myelogenous leukemia, chronic lymphocytic leukemia |
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Term
| Compare acute vs. chronic leukemia. |
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Definition
| Acute - immature blast cells, fulminant pres., aggressive course. Chronic - mature, differentiated cells, subclinical pres., indolent course. |
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Term
| Describe the cells of origin in lymphoid leukemias. |
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Definition
| ALL: lymphoblasts, CLL: mature lymphocytes |
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Term
| Describe the cells of origin in myeloid leukemias. |
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Definition
| AML: myeloblasts, CML: mature neutrophils |
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Term
| which CA is always of a lymphoid origin? |
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Definition
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Term
| Which CA is of B cell origin and has chac. Reed-Sternberg cells? |
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Definition
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Term
| Which type of lymphoma affects B, T, and NK cells? |
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Definition
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Term
| Differentiate b/t leukemia and lymphoma. |
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Definition
| Leukemia: affects blood (WBC) and bone marrow. Lymphoma: nodal dz (lymphadenopathy) |
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Term
| Name 3 proposed causes of leukemia d/t genetic damage to cells that disrupts growth control and differentiation pathways? |
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Definition
| 1) Viruses (retro, herpes) 2) Radiation 3) Chemicals (benzene, hair dye, marijuana) |
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Term
| Name 3 common clinical signs of leukemia. |
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Definition
| 1) Hepato-splenomegaly 2) Lymphadenopathy 3) Hyperplasia of gums |
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Term
| Name common sx of leukemia. |
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Definition
| Fever, night sweats, wt loss, pruritus, wt loss, bone pain, abd fullness, bleeding, bruising, frequent ifxns, HA, N/V |
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Term
| Name 4 findings on CBC in leukemia. |
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Definition
| 1) Leukocytosis or leukopenia 2) Anemia 3) Thrombocytopenia 4) Blasts on peripheral smear |
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Term
| what is the median age of AML dx? |
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Definition
|
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Term
| What is the subtype classification of AML? |
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Definition
| French-American-British (FAB) - M0 to M7 |
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Term
| Which has a worse prognosis, AML or ALL? |
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Definition
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Term
| What are the 2 phases of AML tx? |
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Definition
| 1) Remission induction (complete remission attempted) 2) Consolidation/post-remission |
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Term
| What tx are available for tx of AML? |
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Definition
| chemo, stem cell transplant (reduces mortality), monoclonal Ab |
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Term
| What is the difference in post-remission chemo tx? |
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Definition
| post-remission chemo uses only 1 drug instead of 3 |
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Term
| What is the survival rate of AML? |
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Definition
| <60yo: 30-40% in 4 yrs and >60yo: 20% in 2 yrs |
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Term
| What is the peak incidence of ALL? |
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Definition
| 3-7yo (2nd peak incidence middle age) |
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Term
| What is the 2nd leading cause of death in children? |
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Definition
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Term
| What abnormal cells are present in ALL? In the majority of cases it is a malignant transformation of which cells? |
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Definition
| Lymphoblasts (immature lymphocytes. B cells in 80% (T cells in 20%) |
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Term
| What do the lymphoblasts do pathologically? |
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Definition
| Accumulate in bone marrow and circulation stopping production of RBCs, WBCs, and platelets |
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Term
| What are the common clinical presentations in ALL? |
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Definition
| Bone pain (kids refuse to walk), brusing, fever, infection, anorexia, fatigue, abd pain |
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Term
| What is affected w/ leukemic infiltration? |
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Definition
| enlarged liver, spleen, lymph nodes, 3% brain (CNS) |
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Term
| What is the survival rate in children with ALL? Adults? |
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Definition
| 85% in 5yr for kids. 30-50% in adults. |
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Term
| Which forms of ALL have a better prognosis? Worse? |
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Definition
| Pre-B cell (90% cure rate in children). Worse in mature B cell or T cell. |
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Term
| When does transplantation become indicated in ALL? |
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Definition
| pts that don't respond to chemo tx, done in post-remission |
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Term
| Which type of leukemia carries the chromosomal abnormality Philadelphia chromosome? Why is it formed? |
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Definition
| CML - translocation b/t chromosomes 9 & 22 |
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Term
| What is the median age of onset of CML? |
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Definition
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Term
| What is seen on CBC in CML that distinguishes it from other forms of leukemia? |
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Definition
| greater degree of granulocyte segmentation |
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Term
| What is the prognosis for CML? |
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Definition
| poor (2yrs survival of untx), does not respond well to chemo |
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Term
| What is a known curative tx for CML? |
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Definition
| allogenic stem cell transplantation (mortality 25-50%) |
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|
Term
| What is the most common form of leukemia? |
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Definition
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Term
| What is the typical age of onset of CLL? Which cell type is typ affected? |
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Definition
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|
Term
| What are the typ. sx of CLL? |
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Definition
| typ. asymptomatic or vague non-specific c/o (indolent course) |
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|
Term
| Name 3 signs of CLL in order from most to least common. |
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Definition
| 1) Lymphadenopathy 2) Splenomegaly 3) Hepatomegaly |
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|
Term
| What is seen on bone marrow aspiration in CLL? |
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Definition
| small lymphoblasts w/ condensed nuclear chromatin |
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|
Term
| What is the staging system for CLL? |
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Definition
| Rai - stage I to V based on lymphocytosis + presence of absence of clinical signs indicating median survival rate |
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Term
| Lymphocytosis + what clinical signs indicates a worse survival rate (1-2 yrs) and a Rai stage IV and V? |
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Definition
| Anemia and thrombocytopenia respectively |
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Term
| Does tx of CLL prolong survival? What tx is used? |
|
Definition
| No. Sx tx: chemo, XRT, monoclonal Ab, stem cell transplant (if no remission) |
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Term
| If a pt w/ CLL has _____ gene mutation, the median survival rate is ______. If the pt lacks the _______ gene mutation, mean survival is ______. |
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Definition
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Term
| Multiple myeloma is a malignant d/o of mature, Ab secreting B lymphocytes, called ________. |
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Definition
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Term
| What is the typ age of onset of MM? Is it more common in men or women? |
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Definition
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Term
| MM tends to invade _____ and forms multiple tumor sites in ________ (4). |
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Definition
| Bone. Lymph nodes, liver, spleen, and kidneys. |
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Term
| Char. of MM is the excessive presence of light-chain Ab frgaments in the urine, called ________. What can this cause? |
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Definition
| Bence-Jones protein. Renal damage. |
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Term
| Bone destruction in MM releases _______ into the vlood causing ______. |
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Definition
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Term
|
Definition
| Typ. asymptomatic (insidious, slow onset). Polyuria and/or nocturia in 50%. |
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Term
| What c/o signifies the onset of the symtomatic phase of MM? |
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Definition
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Term
| Name 3 diagnostic tests/indicators for MM. |
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Definition
| 1) Protein electrophoresis (monoclonal Ab) 2) Urine Bence-Jone protein 3) Hypercalcemia |
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Term
| What test is done to confirm dx of MM? |
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Definition
| Bone marrow bx - 10-15% plasma cells is dx of MM (normal ~5%) |
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Term
| What do X-rays of rib, spine, skull, and pelvis show in a pt w/ MM? Why? |
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Definition
| Honey-comb appearance d/t demineralized bone |
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Term
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Definition
| High-dose chemo tx followed by allogenic BMT |
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Term
| What indicates that a pt is in the preneoplastic phase of MM? |
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Definition
| Monoclonal gammaopathy of undetermined signficance (MGUS) |
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Term
| What happens during chemo for tx of MM d/t rapid cell lysis? |
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Definition
| accumulation of excessive amts. of uric acid |
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