Leukemias and Lymphomas Study Notes

A comprehensive set of flashcards covering key concepts, clinical features, and diagnostic criteria related to leukemias and lymphomas for exam preparation.

What is acute myeloid leukemia (AML)?

A malignant neoplasm characterized by clonal proliferation of myeloid progenitor cells with impaired differentiation.

What is the median age for acute myeloid leukemia (AML) diagnosis?

~65 years.

Which leukemia is the most common acute leukemia in adults?

Acute myeloid leukemia (AML).

What are some risk factors for developing AML?

Prior chemotherapy, radiation, certain genetic syndromes like Down syndrome.

What are common symptoms of bone marrow failure in AML?

Anemia, thrombocytopenia, and neutropenia.

What is leukostasis and its potential symptoms in AML?

WBC >100,000, leading to respiratory distress and neurologic symptoms.

What is the translocation associated with acute promyelocytic leukemia (APL)?

t(15;17).

What treatment is typically used for acute promyelocytic leukemia (APL)?

All-trans retinoic acid (ATRA) and arsenic trioxide.

What cytogenetic findings are associated with good prognosis in AML?

t(8;21) and inv(16).

What does a diagnosis of acute lymphoblastic leukemia (ALL) involve?

Malignant neoplasm of lymphoid progenitor cells (lymphoblasts).

At what age is acute lymphoblastic leukemia (ALL) most commonly diagnosed?

2-5 years old.

What are common clinical presentations of ALL?

Anemia, thrombocytopenia, and neutropenia.

What is unique about T-cell ALL clinical presentation?

Presence of a mediastinal mass causing superior vena cava syndrome.

How do you differentiate ALL from AML?

ALL is TdT positive and myeloperoxidase negative.

What is the prognostic importance of the Philadelphia chromosome in ALL?

Associated with a worse prognosis.

What is the definition of chronic myeloid leukemia (CML)?

A myeloproliferative neoplasm characterized by uncontrolled proliferation of myeloid cells associated with the Philadelphia chromosome.

What are the three phases of chronic myeloid leukemia (CML)?

Chronic phase, accelerated phase, and blast crisis.

What mutation is commonly associated with myeloproliferative neoplasms?

JAK2 V617F mutation.

What clinical features are seen in polycythemia vera?

Hyperviscosity, thrombosis, and pruritus after warm baths.

What genetic mutation is found in over 95% of cases of polycythemia vera?

JAK2 V617F mutation.

What indicates a diagnosis of multifocal lymphoma?

Presence of Reed-Sternberg cells.

What are B symptoms in lymphoma?

Fever, night sweats, and weight loss.

What is the most common subtype of Hodgkin lymphoma?

Nodular sclerosis.

What are the histological markers of Reed-Sternberg cells?

CD15+ and CD30+.

What is the most common non-Hodgkin lymphoma in adults?

Diffuse large B-cell lymphoma (DLBCL).

What is the typical presentation of Burkitt Lymphoma?

Jaw or facial bone mass in endemic type, abdominal mass in sporadic type.

What is a characteristic histological appearance of Burkitt lymphoma?

Starry sky appearance.

What is the treatment regimen commonly used for DLBCL?

R-CHOP (Rituximab, Cyclophosphamide, Doxorubicin, Vincristine, Prednisone).

What is multiple myeloma?

A malignant plasma cell neoplasm characterized by clonal proliferation of plasma cells, producing monoclonal immunoglobulin.

What symptoms characterize the CRAB criteria in multiple myeloma?

C: Calcium elevation, R: Renal insufficiency, A: Anemia, B: Bone lesions.

What is the most common presenting symptom of multiple myeloma?

Bone pain.

What laboratory finding is indicative of multiple myeloma?

Presence of monoclonal protein (M spike) on serum protein electrophoresis.

How do you differentiate between multiple myeloma and monoclonal gammopathy of undetermined significance (MGUS)?

MGUS has less than 10% plasma cells and no CRAB criteria.

What is the characterization of acute myeloid leukemia (AML) related to Auer rods?

Auer rods are pathognomonic for AML.

What cytochemical stain is positive in acute myeloid leukemia (AML)?

Myeloperoxidase (MPO).

What immunophenotype is typically found in acute lymphoblastic leukemia (ALL)?

TdT positive; CD10+, CD19+, and CD20+ for B-cell ALL.

What causes the leukocytosis seen in chronic myeloid leukemia (CML)?

Uncontrolled proliferation of myeloid cells at all stages of maturation.

What is the main treatment for chronic myeloid leukemia (CML)?

Tyrosine kinase inhibitors (TKIs) like Imatinib.

What cytogenetic abnormality is correlated with chronic myeloid leukemia (CML)?

BCR-ABL fusion gene (Philadelphia chromosome).

What is the prognosis for patients diagnosed with acute lymphoblastic leukemia (ALL)?

Generally better in children than adults.

What characteristic feature is often seen in CLL on blood smear?

Smudge cells.

What is the major criteria for diagnosing polycythemia vera?

Increased red cell mass and JAK2 mutation positivity.

How is mycosis fungoides identified histologically?

Pautrier microabscesses in the epidermis.

What mutations are associated with multiple myeloma?

Various mutations including t(11;14) and t(4;14).

How is treatment tailored for Hodgkin lymphoma?

Combination of chemotherapy and possibly radiation based on stage.

What is the common clinical presentation of hairy cell leukemia?

Pancytopenia and massive splenomegaly.

What is a significant feature in the pathology of follicular lymphoma?

Characteristic translocation t(14;18) leading to BCL2 overexpression.

What is the primary goal of induction chemotherapy in acute leukemias?

To achieve remission.

What distinguishes between Hodgkin and non-Hodgkin lymphoma?

Presence of Reed-Sternberg cells in Hodgkin lymphoma.

What are the main laboratory tests for diagnosing multiple myeloma?

Serum protein electrophoresis and bone marrow biopsy.

Name a poor prognostic factor in acute lymphoblastic leukemia (ALL).

The presence of the Philadelphia chromosome.

What role does the JAK2 V617F mutation play in myeloproliferative disorders?

It causes autonomous proliferation of blood cells independent of EPO regulation.

How is lymphocyte-rich Hodgkin lymphoma characterized?

Few Reed-Sternberg cells with abundant normal lymphocytes.

What sign might be produced from mediastinal mass in T-cell ALL?

Superior vena cava syndrome.

What is the first-line treatment for acute promyelocytic leukemia (APL)?

All-trans retinoic acid (ATRA) plus arsenic trioxide.

What is a unique feature of follicular lymphoma on histology?

Follicular growth pattern with centrocytes and centroblasts.

What is the typical management approach for low-grade non-Hodgkin lymphoma?

Watchful waiting; these are often indolent.

What is the significance of diagnosing multiple myeloma?

It requires identifying myeloma-defining events or criteria.

What subtype is characterized by 'hairy' projections in hairy cell leukemia?

Hairy lymphocytes.

What conditions are classified as B symptoms in lymphoma?

Fever, night sweats, and weight loss.

What treatment is associated with good prognosis in Burkitt lymphoma?

Intensive chemotherapy with CNS prophylaxis.

How is splenomegaly classified in chronic myeloid leukemia (CML)?

Massive splenomegaly is characteristic.

What cytogenetic marker indicates a poor prognosis in chronic lymphocytic leukemia (CLL)?

17p deletion.

What is the recommended treatment for localized gastric MALT lymphoma?

H. pylori eradication.

What does the ‘starry sky’ appearance indicate in lymphoma?

Burkitt lymphoma.

What immunophenotyping marker is characteristic for chronic lymphocytic leukemia?

CD5+ with a dim expression of CD23.

What clinical finding is often present in patients with multiple myeloma?

Rouleaux formation (RBCs stacked like coins).

Which treatment is considered standard for adult patients with DLBCL?

R-CHOP chemotherapy regimen.

What is the hallmark of systemic amyloidosis related to multiple myeloma?

Light chain deposition leading to various organ dysfunctions.

What is a common presenting symptom of lymphoid leukemias in general?

Lymphadenopathy.

Which leukemia is more common in children?

Acute lymphoblastic leukemia (ALL).

How are lymphomas typically staged for treatment decisions?

Using the Ann Arbor system.

What is the primary lab test that aids in diagnosing myeloproliferative neoplasms?

JAK2 mutation analysis.

What does ‘dry tap’ refer to in bone marrow aspiration of hairy cell leukemia?

Difficulty in obtaining bone marrow fluid due to fibrotic tissue.

Which lymphoma is characterized by the presence of 'popcorn cells'?

Nodular lymphocyte-predominant Hodgkin lymphoma.

What feature distinguishes low-grade lymphomas from high-grade lymphomas?

Slow growth pattern.

What is typically proposed for the chemotherapy of acute leukemias?

Induction, consolidation, and sometimes maintenance chemotherapy.

What does the CRAB criteria refer to in multiple myeloma?

Calcium elevation, Renal insufficiency, Anemia, Bone lesions.

What cells are primarily involved in the pathology of multiple myeloma?

Clonal plasma cells.