Heme Neoplasms: Leukemia and Lymphoma overview

• Four main categories of heme neoplasms exist.

Leukemia

• Mainly involves white blood cell proliferation, predominantly in blood and marrow.
• Acute leukemia is characterized by immature cells (blasts), failures of maturation, and aggressive behavior, often treated with curative intent.
  • Acute Myeloid Leukemia (AML) involves immature, myeloid cells.
  • Acute Lymphoblastic Leukemia (ALL) involves immature, lymphoid cells.
• Chronic leukemia is characterized by mature cells, indolent behavior, and therapy that is not usually curative.
  • Chronic Myeloid Leukemia (CML) involves mature, myeloid cells.
  • Chronic Lymphocytic Leukemia (CLL) involves mature, lymphoid cells.
• Notable symptoms and signs of leukemia include bruising/bleeding, fevers and infections, fatigue and dyspnea, swollen gums, body aches, neurological issues, and splenomegaly.

Lymphoma

• Neoplasm of lymphoid cells, predominantly in lymph nodes and tissue.
• Hodgkin lymphoma is often more localized.
• Non-Hodgkin lymphoma is commonly widespread and can be B-cell or T-cell.
• Notable symptoms and signs of lymphoma include lymphadenopathy, splenomegaly, "B symptoms," and cytopenias.
  • "B symptoms" include fever, weight loss, night sweats, and severe fatigue.

Myelodysplastic Syndrome

• Ineffective hematopoiesis resulting in cells that don’t work right.

Myeloproliferative Neoplasms

• Effective hematopoiesis but with too many cells.

Labs in Neoplastic Hematopathology

• Auer rods are associated with myeloid cells.
• Initial labs include CBC with differential and peripheral blood smear.
• Chemistry panel including LFTs is important due to potential abnormalities in electrolytes, renal function, and liver function.
• Coagulation panel is used if there are concerns for coagulation abnormalities.
• Bone marrow biopsy and molecular studies are used beyond primary care and the ED.

Approach to the Patient with Hematologic Neoplasm

• Concerning "B" symptoms include fever without infection, unintentional weight loss, night sweats, and severe fatigue.
• Other concerning symptoms include early satiety and pain (visceral or bone).
• Signs include mass, lymphadenopathy, and hepatosplenomegaly.
• Lab findings include -penias and -cytoses, hypercalcemia, and unexplained changes in liver/renal function.
• Imaging techniques include plain films, CT, PET, and MRI.
• Biopsies, including FNA, core, and excision, are crucial to determine the nature of lumps or masses.
• Acute leukemias are not staged.
• Staging for lymphoma is based on lymph node distribution.
• Staging for Hodgkin specifically includes the absence or presence of B symptoms.

Treatment Options

• Medical treatments consist of chemotherapy, immunotherapy, and other biologics.
  • Classical antineoplastics are categorized by whether they bind DNA or interfere with the synthesis
  • Antifolates
• Other treatments include radiation therapy and surgery.
• Supportive care includes anti-infectives, transfusions, growth factors, and antiemetics.
• Stem cell transplants can be autologous or allogeneic.
  • Autologous transplants involve saving the patient's stem cells, administering chemotherapy, and then returning the good stem cells.
  • Allogeneic transplants involve using someone else's stem cells, which can cause graft-versus-host or graft-versus-leukemia effects, and there's a concern for infection.

Overview of Heme Neoplasms in Leukemia and Lymphoma, including Acute and Chronic Myeloid Leukemia (AML, CML) and Lymphoblastic Leukemia (ALL, CLL). Key symptoms include bruising, fever, fatigue, and splenomegaly.