24- Leukemias and Lymphomas

What does actue myelogenous leukemia arise from?

myeloid stem/blast cells

What is the most common leukemia for adults?

acute myelogenous leukemia

Which chronic leukemia is more common?

chronic lymphocytic leukemia

What does acute lymphoblastic leukemia arise from?

lymphoid stem cells/blast cells

What is the most common cancer for children?

acute lymphoblastic leukemia

What cells does chronic myelogenous leukemia arise from?

myeloid blasts/mature myeloid cells

What cells does chronic lymphocytic leukemia arise from?

early lymphocytes

Which leukemia has the best prognosis?

chronic lymphocytic leukemia

rank leukemias from worst to best prognosis

1. AML

2. ALL

3. CML

4. CLL

What cell does NHL arise from?

circulating naive B + T cells

What is the most common form of blood cancer?

NHL

What cell does HL arise from?

activated B plasma cell without Abs

What cell does multiple myeloma arise from?

activated B plasma cell making Abs

What blood cancer is the most deadly?

multiple myeloma

What is more deadly, NHL or HL?

NHL

Shared Characteristics of Acute Leukemia

≥20% circulating blasts

pancytopenia (systemic + eye)

Systemic Presentation of pancytopenia

1. ecchymosis + hemorrhages (low platelets)

2. anemia (low erythrocytes)

3. infections (low neutrophils)

Eye presentations of pancytopenia

1. retinal hemorrhages and roth spots

a. retinal detachment

2. hyphema

3. ocular infections

Shared presentation of chronic leukemia

usually asymptomatic (no pancytopenia/ocular)

no/low circulating blasts

good prognosis

Shared presentation of lymphoblastic/cytic leukemi

severe lymphadenopathy, splenomegaly, hepatomegaly

Epidemiology of AML

chemo, radiation

not inherited

Treatments for AML

chemo with bone marrow transplant (4-6 weeks)

Systemic Presentation of ALL

severe lymphadenopathy, splenomegaly, hepatomegaly

Most common subtype of ALL?

B-ALL

What age does risk for B-ALL peak?

4 years old

What increases your risk for B-ALL?

down syndrome

Unique ocular presentation of ALL?

Orbital infiltrates causing proptosis

Treatments for B-ALL?

1. chemo with bone marrow transplant (2-3 years)

2. CAR-T therapy

What is CAR T cell therapy?

genetically engineered CTLs that used CD19 to recognize B cells and blasts, causing apoptosis

Side effects of CAR T therapy

1. cytokine storm

2. Ab infusions for rest of life

Epidemiology of CML? How

associated with philadelphia chromosome

BCR-ABL fusion causes GOF oncogene mutation

Unique Presentation of CML?

leukocytosis

cardiac problems due to thickened blood

Treatments for CML

1. gleevec (imatinib)

2. light chemotherapy

What is the MOA of Gleevec (Imatinib)?

blocks BCR-ABL binding to ATP, inhibiting cell division

Epidemiology of CLL?

BCL-2 GOF mutation

What is the etiology of NHL?

chromosomal instability due to EBV or radiation/chemo

Systemic presentation of NHL

1. salmon colored tumors

2. lymphadenopathy

3. pink + rubbery lymph nodes

4. no pattern to lymph spread

Ocular presentation of NH

cancer can affect any part of eye/orbit

1. red eye

2. painless

most common subtype of NHL

Diffuse large B cell

What subtype of NHL is highly aggressive?

Diffuse large B cell

What is treatment for diffuse large B cell NHL?

CAR-T therapy

What is second most common subtype of NHL?

follicular

Presentation of follicular NHL?

follicles formed within lymph tissue,, bumpy

What is Burkitt's lymphoma?

disfiguring NHL caused by EBV

What lymphoma do you almost never see in the eye?

hodgkins lymphoma

What is the epidemiology of hodgkins lymphoma?

EBV

Presentation of Hodgkin's lymphoma

1. orderly disease lymph node spread

2. affects hilar/cervical lymph nodes first, causing dyspnea + cough

3. reed-sternberg cells

What is pathognomonic for hodgkins lymphoma?

Reed-Sternberg cells

What is multiple myeloma usually due to?

radiation

What are treatments for multiple myeloma?

CAR-T

What causes the damage in multiple myeloma?

cancer of the plasma cells AND

overproduction of antibodies

What are the presentations of multiple myeloma and what is it due to?

Due to cancer of B cells:

1. bone pain + fractures (punched out)

2. pancytopenia

Due to overproduction of Ab:

1. blood hyperviscosity

2. proteinuria with Bence Jones proteins

3. corneal deposits