Leukemia and Lymphoma Overview
47 Questions
0 Views

Choose a study mode

Play Quiz
Study Flashcards
Spaced Repetition
Chat to lesson

Podcast

Play an AI-generated podcast conversation about this lesson

Questions and Answers

Which of the following is NOT a characteristic feature of leukemia?

  • Increased number of white blood cells (leukocytes) in circulation
  • Development of abnormal cancerous cells in the liver (correct)
  • Uncontrolled proliferation of hematopoietic stem cells in bone marrow
  • Disruptions in the normal cell regulatory process

    • What is a defining feature that distinguishes Hodgkin Lymphoma (HL) from Non-Hodgkin Lymphoma (NHL)?

  • HL is always treated with chemotherapy, while NHL is treated with radiation.
  • HL is a chronic condition, while NHL is an acute condition
  • HL involves malignant lymphoid cells called Hodgkin/Reed-Sternberg cells, while NHL does not. (correct)
  • NHL only affects the lymphatic tissue, while HL can affect multiple organs.

    • Which of the following statements accurately describes the role of "Post Remission Therapy" in leukemia management?

  • Post Remission Therapy is used to manage side effects of the initial induction therapy.
  • Post Remission Therapy is used to control the spread of leukemia to other organs.
  • Post Remission Therapy is a specific type of therapy only used in chronic leukemia.
  • Post Remission Therapy is used to prevent the leukemia from returning after achieving remission. (correct)

    • What are Auer Rods, and where are they typically found?

    <p>Abnormal rod-shaped structures found in the cytoplasm of myeloid blast cells. (C)</p> Signup and view all the answers

    Which of the following symptoms is MOST commonly associated with Leukopenia?

    <p>Swollen lymph nodes in the neck and groin. (B)</p> Signup and view all the answers

    Which of the following accurately describes the relationship between Leukopenia and Neutropenia?

    <p>Neutropenia is a type of Leukopenia, characterized by a decrease in neutrophils, a specific type of white blood cell. (D)</p> Signup and view all the answers

    What does the term "remission" refer to in the context of leukemia management?

    <p>A state where leukemia cells are undetectable in the bone marrow and blood. (C)</p> Signup and view all the answers

    What is the confirmatory finding for CML?

    <p>Evidence of Philadelphia chromosome (D)</p> Signup and view all the answers

    Which of the following is a characteristic of the chronic phase of CML?

    <p>Most patients are diagnosed in this phase (D)</p> Signup and view all the answers

    What is the primary difference between the accelerated phase and the blast crisis of CML?

    <p>The percentage of blasts in peripheral blood and bone marrow (B)</p> Signup and view all the answers

    What is the role of hydroxyurea in the management of CML?

    <p>To reduce the WBC count while awaiting diagnosis confirmation (B)</p> Signup and view all the answers

    Which of the following is considered a curative treatment for CML?

    <p>Allogenic hematopoietic cell transplantation (C)</p> Signup and view all the answers

    What is the primary goal of tyrosine kinase inhibitors in the treatment of CML?

    <p>To achieve long-term control of the disease (A)</p> Signup and view all the answers

    Which of the factors below generally contribute to a better prognosis in CML?

    <p>Diagnosis at a younger age (C)</p> Signup and view all the answers

    What is the approximate five-year survival rate for patients in the chronic phase of CML with treatment?

    <p>85% (A)</p> Signup and view all the answers

    Which of the following is NOT a tyrosine kinase inhibitor used to treat CML?

    <p>Hydroxyurea (D)</p> Signup and view all the answers

    Which of the following is NOT a common symptom of anemia associated with Myelodysplastic Syndromes?

    <p>Increased energy levels (B)</p> Signup and view all the answers

    What is the most common physical finding in patients with Myelodysplastic Syndromes?

    <p>Pallor (B)</p> Signup and view all the answers

    What is the diagnostic requirement for Myelodysplastic Syndromes, involving blood/marrow elements?

    <p>Unexplained quantitative change in one or more blood/marrow elements (A)</p> Signup and view all the answers

    Which of the following is NOT a characteristic of Myelodysplastic Syndromes?

    <p>Normal cellular maturation (A)</p> Signup and view all the answers

    What is the definitive diagnostic procedure for Myelodysplastic Syndromes?

    <p>Excisional biopsy (D)</p> Signup and view all the answers

    Which of the following is a potential complication of Myelodysplastic Syndromes?

    <p>All of the above (D)</p> Signup and view all the answers

    What is the significance of the Lanugo classification response scale?

    <p>To predict the prognosis of Myelodysplastic Syndromes based on histopathology (D)</p> Signup and view all the answers

    Which of the following is NOT a typical treatment option for Myelodysplastic Syndromes?

    <p>Antibiotics (A)</p> Signup and view all the answers

    What is the third diagnostic criterion for Myelodysplastic Syndromes?

    <p>Unexplained presence of blasts in the bone marrow (B)</p> Signup and view all the answers

    What is the significance of the presence of hepatomegaly, splenomegaly, or lymphadenopathy in patients with Myelodysplastic Syndromes?

    <p>These findings are uncommon and may suggest a transformation to acute leukemia (B)</p> Signup and view all the answers

    What is the treatment goal for patients with Myelodysplastic Syndromes (MDS)?

    <p>Maximize quality of life and minimize toxicity of treatment (C)</p> Signup and view all the answers

    Which of the following tests are commonly used to evaluate a patient with suspected MDS?

    <p>CBC with differential, peripheral smear, and reticulocyte count (B)</p> Signup and view all the answers

    Which of the following is a possible cause of neutropenia?

    <p>Lack of folate in the diet (A)</p> Signup and view all the answers

    What is the significance of a low absolute neutrophil count in a patient with suspected MDS?

    <p>It increases the risk of bacterial infections (D)</p> Signup and view all the answers

    Which of the following is a HIGH intensity therapy used in the treatment of MDS?

    <p>Allogenic Hematopoietic Cell Transplantation (HCT) (A)</p> Signup and view all the answers

    Which of the following are symptoms commonly associated with Chronic Myelogenous Leukemia (CML)?

    <p>Tenderness of the lower sternum (B), Early satiety and abdominal discomfort (C)</p> Signup and view all the answers

    What is a defining characteristic of Hodgkin's Lymphoma?

    <p>Presence of Hodgkin/Reed-Sternberg (HRS) Cells (A)</p> Signup and view all the answers

    Which of the following statements is TRUE about the epidemiology of Hodgkin's Lymphoma?

    <p>It is a commonly diagnosed disease in individuals under 16 years of age. (A)</p> Signup and view all the answers

    What is the primary difference between Leukemia and Lymphoma?

    <p>Lymphoma arises from lymphoid cells only, while Leukemia can arise from both lymphoid and myeloid cells. (A)</p> Signup and view all the answers

    What is the significance of finding a myelocyte bulge on a blood smear?

    <p>It is a hallmark of Chronic Myelogenous Leukemia (CML). (A)</p> Signup and view all the answers

    Which laboratory finding is most likely to be present in a patient with Chronic Myelogenous Leukemia (CML)?

    <p>Elevated WBC count with basophilia (D)</p> Signup and view all the answers

    What does the term "leukemic hiatus" refer to?

    <p>A lack of mature blood cells in the bone marrow. (C)</p> Signup and view all the answers

    Which of the following is a possible complication arising from CML?

    <p>Gouty arthritis (D)</p> Signup and view all the answers

    What distinguishes Hodgkin's Lymphoma from other types of lymphoma?

    <p>Its characteristic &quot;Owl's Eyes&quot; appearance. (B)</p> Signup and view all the answers

    Which of the following is NOT a characteristic feature of Chronic Myelogenous Leukemia (CML)?

    <p>Presence of Reed-Sternberg cells (B)</p> Signup and view all the answers

    Which type of cancer primarily affects the blood and bone marrow?

    <p>Leukemia (B)</p> Signup and view all the answers

    Match the following types of blood cancers with their characteristics:

    <p>Leukemia = Cancer of the bone marrow and blood Lymphoma = Cancer of the lymphatic system Myeloma = Cancer of plasma cells in the bone marrow Chronic Lymphocytic Leukemia (CLL) = A slow-growing form of leukemia</p> Signup and view all the answers

    Leukemia is a type of [blank] cancer that affects the blood and bone marrow.

    <p>blood</p> Signup and view all the answers

    Which of the following types of blood cancers are classified as leukemias?

    <p>Acute lymphoblastic leukemia (A), Chronic myeloid leukemia (C)</p> Signup and view all the answers

    What are common symptoms of leukemia?

    <p>All of the above (D)</p> Signup and view all the answers

    Which type of blood cancer primarily affects the bone marrow and blood?

    <p>Leukemia (B)</p> Signup and view all the answers

    Study Notes

    Hematologic Malignancies

    • Hematologic malignancies are a group of cancers affecting blood-forming tissues.
    • These malignancies are characterized by an increase in white blood cells (leukocytes) in the bloodstream or bone marrow.
    • They result from disruptions in the normal cell regulatory process, leading to uncontrolled proliferation of hematopoietic stem cells within the bone marrow.

    Hematologic Malignancy Subtypes

    • Acute/Chronic Lymphocytic Leukemia (ALL/CLL)
    • Acute/Chronic Myelogenous Leukemia (AML/CML)
    • Leukopenia
    • Lymphoma (Hodgkin and non-Hodgkin)
    • Multiple Myeloma
    • Myelodysplastic Syndromes (MDS)
    • Polycythemia vera (a chronic myeloproliferative neoplasm)
    • Essential thrombocythemia (a myeloproliferative neoplasm)

    Blood Cell Differentiation

    • Blood cell differentiation starts from pluripotent stem cells.
    • These cells then branch into lymphoid progenitor cells and myeloid progenitor cells.
    • Lymphoid progenitor cells further differentiate into T-lymphocytes, B-lymphocytes, and NK-cells.
    • Myeloid progenitor cells differentiate into RBCs (erythrocytes), megakaryocytes (platelets), myeloblasts, mast cells, monocytes, basophils, eosinophils, and neutrophils.

    Leukemia

    • Leukemia is a malignancy of blood-forming tissues.
    • It's characterized by an abnormal increase in white blood cells (leukocytes).
    • The four major subtypes of leukemia are Acute Lymphoblastic Leukemia (ALL), Acute Myelogenous Leukemia (AML), Chronic Lymphocytic Leukemia (CLL), and Chronic Myelogenous Leukemia (CML).

    Lymphoma

    • A heterogeneous group of malignant neoplasms of lymphocytes, involving lymphatic tissue, bone marrow, or extranodal sites.
    • Hodgkin Lymphoma (HL) is characterized by distinctive malignant lymphoid cells (Hodgkin/Reed-Sternberg cells) mixed with non-neoplastic inflammatory cells and/or fibrosis.
    • Non-Hodgkin Lymphoma (NHL) encompasses a diverse group of malignant lymphoid tumors. NHLs originate from B cells, T cells, natural killer (NK) cells or precursors of these cells.

    Leukopenia/Neutropenia

    • Low white blood cell count (WBC) is called leukopenia.
    • Neutropenia is a specific type of leukopenia referencing a decrease in circulating neutrophils.
    • Neutropenia can result from decreased neutrophil production, redistribution of circulating neutrophils, or immune destruction.

    Myelodysplastic Syndromes (MDS)

    • MDS is a heterogeneous group of hematological neoplasms.
    • The disorder is clinically characterized by clonal hematopoiesis, cytopenias (anemia, neutropenia, and/or thrombocytopenia) and dysplasia of cellular morphology
    • MDS is prone to progression to bone marrow failure or acute myeloid leukemia (AML)

    Multiple Myeloma

    • Multiple myeloma is a malignancy affecting plasma cells.
    • Characterized by neoplastic proliferation of plasma cells.
    • These plasma cells produce monoclonal immunoglobulins (IgGs, IgMs, or IgAs) or light chain (kappa or lambda) proteins.

    Other Hematologic Malignancies

    • Polycythemia vera is a chronic myeloproliferative neoplasm distinguished by an elevated red blood cell mass.
    • Essential thrombocythemia is a myeloproliferative neoplasm characterized by excessive clonal platelet production.

    Overview of Hematologic Malignancies Signs and Symptoms

    • Fatigue: Extreme tiredness and lack of energy, often associated with leukemia.
    • Weakness: Difficulty with daily activities.
    • Fever: Recurring fevers, suggestive of infection.
    • Weight loss: Unintentional weight loss.
    • Easy bruising and bleeding: Trouble stopping bleeding, caused by low platelet levels.
    • Lymph node enlargement: Swollen lymph nodes, often in the neck, armpits, or groin.
    • Bone pain: Leg and back pain in children with acute lymphoblastic leukemia; hallmark symptom of multiple myeloma.

    Acute Leukemia

    • The most common malignancy of childhood is acute lymphoblastic (lymphocytic) leukemia (ALL)/lymphoblastic lymphoma (LBL), accounting for 80% of acute leukemias.
    • Acute myeloid leukemia (AML) accounts for 15-20% of acute leukemias in children.
    • In adults AML is primary an adult disease with median presentation age at 60 years.
    • ALL is seen in 20% of adults.

    Acute Leukemia (Etiology, and Presentation)

    • Etiology: Most cases have no definite cause (idiopathic). Some genetic syndromes, radiation, toxins, and chemotherapeutic agents are some established risk factors involved.
    • Presentation: Symptoms relate to decreased production of normal blood cells: diminished production in red blood cells, platelets, and mature granulocytes, resulting in an increase of blasts in peripheral blood. Blasts in bone marrow are greater than 20%.

    Acute Lymphoblastic Leukemia/Lymphoma (ALL/LBL)

    • ALL/LBLs are grouped together due to overlapping clinical presentations.
    • Typically, ALL/LBL presents in children.
    • Most cases are NOT associated with genetic or environmental factors (idiopathic).

    Acute Leukemia (B-cell vs. T-cell)

    • B-cell ALL/LBL is the more common type, making up 85%.
    • It usually affects children aged 3-7, and morphologically indistinguishable from T-cell which is 10-15% of cases which usually affects males in teens/early twenties. The key to distinction is to perform flow cytometry or immunohistochemistry for surface markers.

    Pre-treatment Evaluation

    • Coagulation profile (PT, PTT)
    • Chemistries, such as CMP, Mg, Calcium, P, uric acid, and total protein.
    • Infection workup(s): (CMV, EBV, HIV, Hep B).
    • Echocardiogram
    • HLA typing (for hematopoietic stem cell transplant)
    • CT chest (mediastinal mass).

    Acute Myeloid Leukemia (AML)

    • AML is a diverse group of cancers involving myeloid precursors, primarily myeloblasts.
    • AML generally has a poor prognosis unless treated with intensive chemotherapy and/or targeted therapies.
    • In most cases, AML is related to acquired gene mutations, with the underlying cause being uncertain in the majority of individuals. Several risk factors, including prior chemotherapy/radiation, environmental toxins, tobacco use, pre-existing blood disorders (myelodysplastic syndromes, myeloproliferative neoplasms), and inherited genetic abnormalities are associated with AML.

    Epidemiology (Acute Leukemia)

    • AML is the most common form of acute leukemia in adults, though still relatively rare (less than 1% of adult cancer deaths in the US).
    • AML predominantly affects adults with a median age at diagnosis of 65 years.

    Presentation (Acute Leukemia)

    • Presenting symptoms commonly include non-specific signs and symptoms such as fever, malaise, fatigue, shortness of breath, weakness, bleeding, bruising, pallor, rashes, anorexia, or weight loss, and bone pain.
    • Other notable symptoms involve hepatomegaly, splenomegaly, or lymphadenopathy, which may also be found on a patient's physical exam. Symptoms can be generalized or location dependent.

    Physical Examination (Acute Leukemia)

    • Physical examination is critical for evaluation. Common findings may include hepatomegaly, splenomegaly, lymphadenopathy, pallor, petechiae, or purpura.
    • Cutaneous manifestations, like chloromas, may correlate with solid myeloblast tumors, often associated with the central nervous system, orbit, skin, or bone.

    Diagnostics (Acute Leukemia)

    • A complete blood count (CBC) with differential and peripheral blood smear analysis are essential to diagnose leukopenia.
    • Auer rods, a characteristic of AML, are discernible upon peripheral blood smear review.
    • A bone marrow aspiration or biopsy is crucial when quantifying blasts and detecting dysplasia in the bone marrow.
    • Imaging studies can be used to assess extranodal deposits (outside of bone marrow).

    Management (Acute Leukemia)

    • Treatment regimens can take 2-3 years to complete. Induction therapy aims for complete remission of the leukemia.
    • Consolidation (intensification) therapy is often similar to induction therapy, but can use a different combination or same or similar chemotherapy regimen.
    • Stem cell transplant may be considered if a patient has a high risk of relapse.
    • Maintenance (30-42 months) therapy may include 4-week intensive treatments in re-induction or delayed intensification depending on the subtype of AML

    Prognosis (Acute Leukemia)

    • Overall survival rates for childhood leukemia are generally high (90+% 5-year survival rate).
    • Adult AML survival rates range from 30-40% at 5 years.
    • B-cell types often have less favorable outcomes than T-cell types.

    Chronic Lymphocytic Leukemia (CLL)

    • CLL is a mature B cell neoplasm.
    • Characterized by clonal expansion of B lymphocytes that accumulate over time and typically manifest as a relentless increase in the number of circulating white blood cells. This often occurs later in life.
    • Chronic Lymphocytic Leukemia(CLL), is characterized by a slow progression (indolent), often asymptomatic in the early stages, making diagnosis difficult.

    Epidemiology (CLL)

    • The most prevalent leukemia in adults in Western countries, comprising 25-30% of all leukemias in the US.
    • It typically presents in older adults (90% of cases after age 50; median age at presentation is 70 years).

    Risk Factors (CLL)

    • No clear environmental or occupational risk factors have been identified; genetic predisposition does hold significance in relation to an increased likelihood of developing CLL.

    Symptoms (CLL)

    • Painless swelling of lymph nodes (often cervical).
    • Unintentional weight loss of at least 10% over the last six months.
    • Fever lasting over 2 weeks with no evidence of an infection.
    • Drenching night sweats
    • Fatigue.

    Signs (CLL)

    • Lymphadenopathy (firm, rounded, discrete, non-tender and freely mobile upon palpation) found in the cervical, supraclavicular, and axillary regions of the body
    • Splenomegaly (splenic enlargement)
    • Hepatomegaly (liver enlargement).
    • Leukemia cutis (cutaneous involvement, may correlate with facial involvement)

    Diagnosis (CLL)

    • CBC (complete blood count) with differential is often performed.
    • Expect elevated WBC with absolute lymphocytosis exceeding 5000/μL.
    • Peripheral smear may show the presence of smudge cells.
    • Bone marrow aspiration/biopsy may be required, though not always.
    • Lymph node biopsy or spleen biopsy may also be required in some cases.
    • Immunoglobulin abnormalities may be present to confirm CLL diagnosis.

    Clinical Interventions (CLL)

    • Early stage, asymptomatic CLL — Observation
    • Localized stage I & maybe stage II disease — Radiation to the affected site
    • "Active"/advanced conditions — Chemotherapy +/- radiation
    • Progressive marrow failure (worsening cytopenias)
    • Massive/progressive lymphadenopathy, splenomegaly
    • Progressive lymphocytosis (greater than 50% increase over 2 months)
    • Autoimmune anemia/thrombocytopenia unresponsive to traditional therapy
    • Symptomatic extranodal involvement (skin, kidney, lung, spine)
    • Constitutional symptoms – weight loss, fatigue, fever, night sweats

    Complications (CLL)

    • Chemotherapy-induced neutropenic fever
    • Chemotherapy-induced tumor lysis syndrome.

    Chronic Myelogenous Leukemia (CML)

    • Myeloproliferative disorder characterized by uncontrolled production of adult and maturing granulocytes (mostly neutrophils, basophils, and eosinophils).
    • Commonly associated with the Philadelphia chromosome, a specific chromosomal abnormality.

    Philadelphia Chromosome

    • A reciprocal translocation between chromosomes 9 and 22.
    • Resulting in a BCR-ABL fusion protein that plays a significant role in the pathogenesis of CML.

    Epidemiology (CML)

    • Represents 15-20% of leukemia cases in adults.
    • Slight male predominance
    • The median age of diagnosis is 50-60 years old.
    • Exposure to ionizing radiation is the only known and established risk factor involved.

    Symptoms (CML)

    • Common presentation involves asymptomatic phases in 20-50% of cases.
    • Common symptoms include fatigue, night sweats, low-grade fever, abdominal fullness, weight loss, and abnormal bleeding.

    Signs (CML)

    • Splenomegaly (splenic enlargement) and possibly abdominal tenderness to palpation in the upper left quadrant.
    • Tenderness upon palpation over the lower sternum is possible.
    • Acute gouty arthritis is another possible sign in relation to CML.

    Diagnosis (CML)

    • WBC differential shows absolute leukocytosis (median of 100,000/μL) with a left shift.
    • Peripheral and bone marrow morphology examinations show leukemic hiatus or myelocyte bulge and elevated, but not necessarily abnormal, platelet counts.
    • The presence of the Philadelphia chromosome through FISH, RT-PCR, or karyotyping is a diagnostic necessity.

    Clinical Course (CML)

    • Primarily in the chronic phase at diagnosis for 85% of cases.
    • The neutrophil differentiation becomes progressively impaired in the accelerated phase.
    • Elevated leukocyte counts become more difficult to control with treatment in the accelerated phase,
    • Increased blasts (10-19% in peripheral blood or bone marrow)
    • Blast crisis: resembling AML, characterized by blasts greater than 20% of the peripheral blood or bone marrow, and with uncontrolled proliferation of CML cells.

    Treatment (CML)

    • If untreated, the progression to terminal blast crisis remains inevitable.
    • Initial treatment involves hydroxyurea for reducing WBC count before definitive testing for the disease.
    • Allogenic hematopoietic cell transplantation (HCT) can be curative, particularly in younger patients with suitable donors, accelerated phase and blast crisis
    • Tyrosine kinase inhibitors (TKIs) effectively control the disease without curing it. The success of this therapy is mostly dependent on the phase of the disease at diagnosis. Available TKIs include Imatinib, Dasatinib, Nilotinib, and Bosutinib.

    Prognosis (CML)

    • Prognosis has significantly improved with available treatments.
    • Earlier diagnosis often correlates with elevated survival rates.

    Multiple Myeloma

    • Malignant proliferation of plasma cells (from B lymphocytes).
    • Extensive skeletal destruction can result, leading to osteolytic lesions, osteopenia or pathological fractures. Monocional immunoglobulin can be found.

    Epidemiology (Multiple Myeloma)

    • Represents 1-2% of all cancers.
    • Represents greater than 17% of hematological malignancies in the United States.
    • Slightly greater incidence affecting males than females.
    • Median diagnosis is 66 years of age.

    Clinical Manifestion (Multiple Myeloma)

    • Chronic intermittent bone pain that worsens with activity.
    • Anemia.
    • Renal failure and proteinuria
    • Hypercalcemia
    • Systemic signs and symptoms suggestive of malignancy.

    Evaluation (Multiple Myeloma)

    • Complete blood count (CBC) with peripheral blood smear.
    • Comprehensive metabolic panel (CMP)
    • Lactate dehydrogenase (LDH)
    • C-reactive protein (CRP)
    • Levels of beta-2 microglobulin, serum-free monoclonal light chains, and serum protein electrophoresis (SPEP) and 24-hour urine protein electrophoresis (UPEP) with immunofixation
    • Urinalysis (UA)
    • Bone marrow biopsy.

    Findings on Peripheral Smear (Multiple Myeloma)

    • Rouleaux formation (RBCs appear stacked like coins) commonly observed in over 50% of cases.
    • Anemia, Leukopenia, Thrombocytopenia.

    Treatment (Multiple Myeloma)

    • No curative treatment for multiple myeloma exists yet.
    • Treatment is dependent on stage and aggressiveness of the disease.
    • Often includes targeted drug therapy, biological therapy, chemotherapy, corticosteroids, radiation therapy and stem cell transplants to prolong survival. Relapse is inevitable in most cases.

    Myelodysplastic Syndromes (MDS)

    • Group of hematologic malignancies
    • Characterized by dysplastic and ineffective blood cell production, clonal hematopoiesis, and abnormal cellular maturation.

    Pathogenesis (MDS)

    • Incompletely understood; de novo oncogenic mutations are often recognized to be the underlying cause.
    • Certain exposures to oncogenic mutations, like chemotherapy, environmental toxins, and radiation, have been implicated.

    Epidemiology (MDS)

    • Occurs most commonly in older adults, with a median age at diagnosis of 65 years.
    • Predominantly affects males

    Presentation (MDS)

    • Nonspecific, often detected during routine CBC testing for other conditions.
    • The principal symptoms can include neutropenia and granulocyte dysfunction related infections.
    • Anemia-related fatigue, weakness, exercise intolerance, and angina, and lightheadedness are also possible symptoms.

    Physical Diagnosis (MDS)

    • The physical exam is vital, but often non-specific. Major findings can include pallor, petechiae and purpura.
    • Hepatomegaly, splenomegaly, and lymphadenopathy are less common findings, though still notable.
    • Cutaneous manifestations that correlate with a transformation to acute leukemia may be possible.

    Diagnosis (MDS)

    • All 3 of the following must be present for diagnosis:
    • Unexplained quantitative changes in one or more blood/marrow parameters.
    • Unexplained morphologic evidence of dysplasia on peripheral blood smear or bone marrow biopsy
    • Blasts accounting for less than 20% of the total nucleated cells in the bone marrow aspirate or peripheral blood.

    Management (MDS)

    • Referral to Heme/Onc
    • Depending on the performance score and symptoms, either serial monitoring of symptoms/blood counts or treatments may be required for applicable patients.
    • Patients with updated immunizations are crucial to consider.
    • Smoking cessation.
    • Most cases will not be cured by current therapies, but maximizing quality of life and minimizing toxicity is often the central goal of treatment.
    • Many individuals live a decade or longer without treatment.

    Evaluation (MDS)

    • CBC with differential
    • Peripheral smear
    • Retic count, EPO, folate, B12, ferritin, iron, TIBC.
    • Copper level
    • HIV testing
    • HLA typing (for future stem cell transplant cases)
    • Unilateral bone marrow aspiration and biopsy
    • ECOG Performance status

    Symptomatic Treatment (MDS)

    • Symptomatic anemia is common in MDS and can be managed by RBC transfusions and EPO (erythropoietin) therapy.
    • Symptomatic thrombocytopenia can be treated with platelet transfusions.
    • Neutropenia can respond well to granulocyte colony stimulating factors, though a separate review of antibiotics may be necessary for infection rates and/or survival rates.

    Disease-Modifying Treatments (MDS)

    • Low-intensity therapies, such as EPO, Azacitidine, Decitabine, and Lenalidomide
    • High-intensity therapies such as consolidation chemotherapy or allogenic HCT
    • Consider clinical trials for recurrent/refractory disease.

    Leukopenia/Leukocytosis

    • Low WBC count is leukopenia.
    • High WBC count is leukocytosis.
    • They are used independently to describe relative levels of white blood cells (WBC) in the blood.

    Neutropenia

    • Low Neutrophil count (ANC)<2,000/microL.
    • Increased risk of bacterial infection if less than 1,000/microL.

    Lymphopenia

    • Low lymphocyte count <1,000/microL

    Monocytopenia

    • Low monocyte count <100/microL

    Eosinopenia

    • Absolute eosinophil count <50/microL

    Studying That Suits You

    Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

    Quiz Team

    Related Documents

    Heme Malignancies 2025 PDF

    Description

    Test your knowledge on leukemia and lymphoma characteristics in this comprehensive quiz. Covering topics such as defining features, treatment protocols, and associated symptoms, this quiz will challenge your understanding of hematological cancers. Perfect for students and healthcare professionals alike.

    More Like This

    Lymphoma and Leukemia
    18 questions

    Lymphoma and Leukemia

    CheaperUnity avatar
    CheaperUnity
    Veterinary Lymphoma and CLL Overview
    159 questions

    Veterinary Lymphoma and CLL Overview

    LighterAmber avatar
    LighterAmber
    Blood Disorders and Cancers Quiz
    45 questions

    Blood Disorders and Cancers Quiz

    HandierMemphis avatar
    HandierMemphis
    Richter Transformation in CLL
    45 questions

    Richter Transformation in CLL

    RosyDiction avatar
    RosyDiction
    Use Quizgecko on...
    Browser
    Open
    Browser
    Browser