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HemeOnc3
Acute Myelogenous Leukemia (AML)
Myeloblasts Increase on Peripheral Smear
Median Onset 60 Years
T 15;17 M3 Subtype
Auer Rods
Disseminated Intravascular Coagulation (DIC) is a Common Presentation
M5 Gum Infiltration
Responds to Vitamin A
3 mins
Chronic Myelogenous Leukemia (CML)
Pathophysiology
BCR-ABL
9;22 Translocation
Philadelphia Chromosome
Signs & Symptoms
Tyrosine Kinase
Low Alkaline Phosphatase
Splenomegaly
Considerations
Blast Crisis
Age 30 to 90 Years
Responds to Imatinib
3 mins
Leukemia Interventions
Diagnosis
Bone Marrow Aspiration
X-Rays
Interventions
Chemotherapy
Bleeding Precautions
Neutropenic Precautions
Strict Asepsis
Bone Marrow Transplant
Blood Transfusions
Monitor Temperature Elevations
Adequate Nutrition
Imatinib (Gleevec) for Chronic Myelogenous Leukemia (CML)
3 mins
Multiple Myeloma Pathophysiology
Pathophysiology
Monoclonal Plasma Cell Cancer
Clock Face Chromatin
Diagnosis
M Spike on Protein Electrophoresis
Increased IgG and IgA
Fried Egg Appearance (BM Biopsy)
Rouleaux Formation
Stacked RBC's
Bence Jones Protein
2 mins
Multiple Myeloma Signs and Symptoms
Signs and Symptoms
Increased Susceptibility to Infection
Back/Bone Pain
Punched Out Lytic Bone Lesions
Hypercalcemia
Primary Amyloidosis
Renal Insufficiency
Anemia
2 mins
Burkitt's Lymphoma
Adolescents or young adults
C-myc gene moves next to heavy chain Ig gene
T 8;14
Starry sky appearance
Sheets of lymphocytes with interspersed macrophages
Jaw lesion in endemic (African) form
Pelvis or abdomen in non endemic form (American form)
Associated with EBV
2 mins
Follicular Lymphoma
Derives from Germinal Center
Occurs in adults
T14;18
BCL 2 overexpression
BCL 2 inhibits apoptosis
Indolent
Generalized lymphadenopathy
Bone marrow involvement
2 mins
Mantle Cell Lymphoma
Older Males
Activation of Cyclin D Gene
T 11;14
CD5
Poor Prognosis
55 secs
Adult T Cell Lymphoma
Caused by HTLV 1
Japan, West Africa, Caribbean
Present with cutaneous lesions
Aggressive
1 min
Diffuse Large B Cell Lymphoma
Epidemiology
Most Common Non-Hodgkin’s Lymphoma
Usually in Older Adults
20% in Children
Features
May be Mature T Cell in Origin
Derives from Germinal Center
GI Tract and Brain
2 mins
Hodgkin Lymphoma Signs & Symptoms
Signs and Symptoms
Localized Single Group of Lymph Nodes
Contiguous Spread
Constitutional B Symptoms
Low-Grade Fever
Night Sweats
Weight Loss
2 mins
Hodgkin Lymphoma Pathophysiology
Pathophysiology
Reed-Sternberg Cells
Binucleate
Owl's Eyes Appearance
CD 15 and CD 30
B Cell Origin
Bimodal Age Distribution
2 mins
Non-Hodgkin's Lymphoma Assessment
Cause
Lymphatic Cancer
Non-Contiguous Spread
B or T Cells
Assessment
Painless Lymphadenopathy
Constitutional B Signs
Night Sweats
Fever
Weight Loss
Mediastinal or Abdominal Mass
Considerations
Older Adults
> 60 Subtypes
2 mins
Acute Lymphoblastic Leukemia (ALL)
Ages < 15
May Present with Bone Marrow Involvement in Children
Mediastinal Mass in Adolescents
TdT Positive
CALLA Positive
t(12;21) Better Prognosis
Spread to CNS and Testes
Most Responsive to Chemotherapy
2 mins
Chronic Lymphocytic Leukemia (CLL)
Signs and Symptoms
Age > 60 Years
B Cell Neoplasm
Smudge Cells
Often Asymptomatic
Cold IgM Autoimmune Hemolytic Anemia
Warm IgG Autoimmune Hemolytic Anemia
Richter's Transformation
3 mins
Hairy Cell Leukemia
Pathophysiology
Mature B Cell Tumor
Signs and Symptoms
Splenomegaly
Diagnosis
Flow Cytometry
Cells Have Filamentous Hair-Like Projections
Stains TRAP Positive
Dry Tap on Bone Marrow Aspiration
Treatment
Cladribine
Pentostatin
2 mins
Leukemia Assessment
Cause
Immature WBCs
Assessment
Recurrent Infections
Easy Bruising
Bleeding
Anemia
Fatigue
Weight Loss
Bone Pain
Considerations
May Have Normal or High WBC Count
2 mins
Bleomycin
Indications
Testicular Cancer
Hodgkin's Lymphoma
Mechanism of Action
Induces Free Radical Formation
Breaks in DNA Strands
Side Effects
Pulmonary Fibrosis
Skin Changes
Mucositis
1 min
Cyclophosphamide
Mechanism
Requires Bioactivation by Liver
Cross-links DNA
Guanine N7 Position
Indications
Autoimmune Disorders
Leukemia
Lymphoma
Solid Tumors
Side Effects
Myelosuppression
Hemorrhagic Cystitis
Prevent with Mesna
3 mins
Fluorouracil (5-FU)
Mechanism
Antimetabolite
"Thymine-less Death"
Indications
Slow-growing Solid Tumors
Co-administered with Leucovorin for Stomach Cancer
Basal Cell Carcinoma (Topical)
Side Effects
Myelosuppression
Mucositis
Severe Diarrhea
3 mins
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