Introduction to hematologic malignancies

What is hematologic malignancies?

What is hematologic malignancies?

§  Cancer that begins in blood forming tissue.

What is hematopoiesis?

§  The production of all blood cells beginning in the bone marrow.

True/False: the clinical presentation of hematologic malignancies depend on the type of hematologic malignancy.

-True

What would be the clinical presentation of a hematologic malignancy if a patient has pancytopenia?

§  They will feel fatigue.

§  Infections

§  Gingival bleeding

§  Epistaxis

What would be the clinical presentation of a hematologic malignancy if a patient has leukicytosis?

§  Splenomegaly ( enlarged spleen).

§  Bone pain

What would be the clinical presentation of a hematologic malignancy if a patient has leukostasis?

§  Abdominal pain from splenic infarctions

§  Priapism

§  Hemorrhage

What are some constitutional ( common) symptoms of hematologic malignancies?

§  Fatigue

§  Weight loss

§  Anorexia

§  Elevated temperature ( can be from the disease or signs of infection).

What can happen to a patient if their hematologic malignancy spreads to the brain?

§  It can cause confusion and motor impairment.

Where does leukemia occur?

in the leukocytes( WBCs)

What are some types of leukemia’s?

o   Chronic Myeloid Leukemia: CML

o   Acute Lymphocytic Leukemia (ALL)

o   Acute Myeloid Leukemia (AML)

Where do lymphoma’s occur?

-in the lymphatic system

What are some types of Lymphoma’s?

o   Hodgkin’s Lymphoma

o   Non-Hodgkin’s Lymphoma ( Diffuse Large B-cell, Burkitt’s, Mantle Cell, Follicular)

Where does multiple myeloma take place?

it happens in the plasma cells

Which cancers originate from the myeloid lineage?

§  Acute myeloid leukemia ( AML ) and other related neoplasms

§  Myelodysplastic syndrome (MDS)

§  Chronic myeloid leukemia

§  Chronic neutrophilic leukemia

§  Chronic eosinophilic leukemia

When a patient is getting their CBCs taking what cell line are they taking from?

§  Myeloid progenitor cells

What are the cells of the myeloid Lineage Cell Line?

§  Myeloid Progenitor Cell:

·         Erythroblast:

o   Erythrocytes ( RBCs)

·         Megakaryoblast:

o   Platelets

·         Myeloblast:

o   Neutrophils

o   Basophils

o   Eosinophils

·         Monoblasts:

o   Monocytes

o   Macrophages

Myeloid dendritic cells

Which cancers originate from the lymphoid neoplasms lineage?

§  Hodgkin’s Lymphoma

§  Diffuse Large B- cell lymphoma

§  Burkitt lymphoma/leukemia

§  Follicular lymphoma

§  Mantle cell lymphoma

§  Multiple Myeloma

What are the cells of the Lymphoid Cell Lineage?

§  Lymphoid Progenitor Cell:

·         Pre-B cell:

o   B-lymphocytes – Plasma cells

·         Pre-T cell:

o   T-lymphocytes

How would a healthcare provider diagnose/stage a person with hematologic malignancies?

§  1^st you take a CBC ( complete blood count).

§  2^nd you do a bone marrow biopsy and aspirate:

·         Flow cytometry:

o   Used to detect and measure physical and chemical characteristics of a population of cell particles.

·         Cytogenetics:

o   Study of chromosomes ( you study the number and appearance of the chromosomes)

·         Immunophenotyping:

o   Identify cells based on the types of markers or antigens present on the cell’s surface, nucleus, or cytoplasm.

§  3^rd you can do a lumbar puncture to determine if there is disease in the central nervous system.

What are the treatment options used in the healthcare system today to treat hematologic malignancies?

§  Chemotherapy

§  Targeted therapy

§  Immunotherapy:

·         Destroy the cancer cells while minimizing effects on healthy cells.

What are the treatment stages used in order to help treat hematologic malignancies?

§  Induction stage:

·         Administer medication to eradicate cancer cells.

§  Consolidation stage:

·         Administer medication with a complete remission ( disappearance of all cancer)

·         Eradicates any remaining disease.

§  Maintenance stage:

·         Sometimes administer medication after consolidation to prevent cancer from recurring.

After a patient has received treatment for their hematologic cancer, what would you look for in order to say that the patient had a complete response to treatment:

§  Disappearance of all clinical and BM evidence.

§  Most patients achieve after 1 or 2 courses of chemotherapy.

What things would you look for after hematologic malignancy treatment to say that a patient had a partial remission to treatment?

§  Significant response to treatment ( a decrease of greater than or equal to 50% of blasts) but evidence of residual disease in BM remains ( 5-25% blasts).

§  Considered a treatment failure requiring additional therapy.

After a patient has received treatment from their hematologic malignancy, what would a healthcare provider consider to be a relapse in treatment:

§  Return of disease or the signs/symptoms of disease after a period of improvement.

When a healthcare provider says that a patient had a refractory response to treatment, what do they mean?

-the patient did not respond to therapy.

Describe the steps of the Bone Marrow Transplant process:

§  Type of HCT

§  Stem cell collection

§  Conditioning chemotherapy

§  Cell infusion

§  Engraftment

§  Post HCT care

What can be a complication of allogenic HCT?

§  Graft Versus Host Disease ( GCHD):

·         Body fights itself.

·         Acute ( within 3 months post-transplant)

·         Chronic ( within 1 year of transplant)

·         Risk factors:

o   Mismatched donor

o   Unrelated donor

o   Increased age

o   Previous acute GVHD

What are things patients take as bone marrow treatment aftercare?

§  Take immunosuppressants.

§  Take steroids.

§  Get vaccinations. ( giving between 18-24 months’ time span)