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179 Cards in this Set
- Front
- Back
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what is "philia"
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reactive increase in #
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what is caused by neutrophilia
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bacterial sepsis
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what is caused by lymphocytosis
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viral, immune
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what is caused by eosinophilia
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allergy/parasites
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what is "penia"
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decreased #
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neutropenia, lymphocytopenia, eosinopenia, and pancytopenia are seen in what
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drugs, viral infections, radiation, chemotherapy, etc.
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what are the characteristics of B lymphocytes
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- part of humoral immune sys. - live for yrs -5-15% lymphocytes
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what roles do B cells play
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-stimulate change to plasma cells - make specific antibodies (1st IgM then IgG)
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What are the characterisitics of T lymphocytes
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- triggered by antigens from macrophages - cell mediated immunity - 70% in peripheral B - selected in thymus - 2/3 helper; 1/3 cytotoxic
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What is the role of helper t cells
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-recognize antigen and self HLA on presentng cell
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what is the role of the cytotoxic t cell
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binds w/ anitgen and HLA of target cell
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what are natural killer cells
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- subsets of CD8's - kill by adhesion to target cell or antibody dependent cell mediated toxicity
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what caused lymphocytes to increase
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- infections - lymphatic leukemia CLL, ALL, NHL - physiological - thyrotoxicosis - hypopituitarism - some carcinomas - myasthenia
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what causes lymphocytes to decrease
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- inflammation - corticosteroids - immune deficiency - some cancers - CT diseases
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what is a CD3
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mature T cell
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what is a CD4
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helper t cell
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what is a CD5
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T and B subset
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what is a CD8
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killer t cell
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what is a CD10
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precursor b (seen in ALL)
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what is avCD 14+
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monocyte
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what is a CD19
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B cell
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what is a CD34
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stem cell
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what is a CD56
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natural killer cell
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where did the name "hodgkin's" lymphoma come from
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Thomas Hodgkin- English pathologist who described the disease in 1832
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what are the essentials of dx of hodgkin's lymphoma
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- B cell lymphoma - painless lymphadenopathy - constitutional symptoms may/may not be present - pathological dx by lymph node bx
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what is the epidemiology of hodgkin's lymphoma
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-biomodal age distribution= 1 peak age 15-40; 2nd peak >50-60 male/female - 20,000 cases annually in N.A./Europe - higher in higher in socioeconomic - lifetime risk 1/250-1/300 in N.A.
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what is the A & P of hodgkin's lymphoma
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-group of cancers characterized by Reed Sternberg cells in appropriate reactive cellular background - several subtypes: 1. lymphocyte predominance 2. nodular sclerosis 3. mixed cellularity 4. lymphocyte depletion
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what are the important features of hodgkin's lymphoma
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- tendency to arise w/in single lymph node and spread in orderly fashion to continuous lymph nodes - widespread hematogenous dissemination only late in course
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what is the etiology of hodgkin's lymphoma
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exact etiology remains unclear
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what increases the risk of hodgkin's lymphoma
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EBV increases 3 fold
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what is the causiologse/pathophysiology of hodgkin's lymphoma
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-cells are unable to manufacture intact antibodies - Hodgkin/Reed Sternberg cell avoids self destruction - no consistent translocation noted
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what are the % of classic hodgkin's lymphoma
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nodular sclerosis 60-80%; lymphocyte rich 5%; mixed cellularity 15-30%; lymphocyte depleted <1%
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what is the predominant hodgkin's lymphoma
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nodular lymphocyte 5%
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What are the characteristics of nodular sclerosing HL
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-most common subtype - composed of large tumor nodules w/ scattered lacuna of classical Reed-Sternberg cells in a background of reactive lymphocytes, eosinophils, and plasma cells w/ varying degrees of collagen fibrosis/sclerosis
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what are the characteristics of mixed cellularity HL
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- common subtype - composed of numerous classic Reed-Sternberg cells mixed w/ numerous inflammatory cells w/out sclerosis
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what are the characteristics of lymphocyte rich or lymphocytic predominance HL
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-rare subtype - most favorable prognosis
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what are the characteristics of lymphocyte depleted HL
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-rare subtype - large #'s of often pleomorphic Reed-Sternberg cells w/ only few reactive lymphocytes
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what are the symptoms of HL
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- majority asymptomatic - painless lymphadenopathy (mass): painless, firm, rubbery common in neck - const. symptoms- fever, weight loss, drenching night sweats 25-30% - Pel Ebstein fever - generalized puritis - pain in lymph node after alcohol ingestion is an unusual symptom
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what is Pel Ebstein fever
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-relapsing, high grade can reach 105-106 for 7-10 days - fever spikes abrupt in onset and resolution
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what are the signs/physical exams signs of HL
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-cervical adenopathy 80-90% - nontender lymphadenopathy in the neck, supraclavicular area, and axilla - mediastinal adenopathy >50% @ dx - T cell immune def. even in early stage - prone to infection: HZ/shingles in 1/4 pt; fungal/mycobacterial - immune defect may persist after lymphoma cured
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what are the D dx of HL
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-NHL - TB lymphadenitis (scrofula) - cat scratch - metastatic cancer - drug induced pseudolymphoma (phenytoin)
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what is sclerosis
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disease where abnormal collections of chronic infammatory calls (granulomas) form as nodules in mutliple granulomas (of non caseating type) most often appear in lungs/lymph nodes but any organ can be affected
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what diagnostic studies are done for HL
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-CBC - ESR - serum chemistry - lactate dehydrogenase level LDL - immunophenotyping CD30/CD15 - lymph node histopathology - chest radiography CXR PA and Lat - CT-neck thorax abdomen pelvis - PET - Gallium scan
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what is seen in the lymph node histopathology of HL
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most cells are normal lymphoid, plasma cells, monocytes, and eosinophils - Reed sternberg cells-pathognomonic finding
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what are the decisions and dx of HL based on
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staging
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What are the stages of the Ann Arbor nomenclature
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Stage I- 1 lymph node region involved Stage 2- 2 node areas on 1 side of diaphragm Stage 3- lymph regions involved on both sides of diaphragm Stage 4- disseminated w/ bone marrow or liver involvement
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what are the "destinations" of HL
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Stage A- lack of const. symptoms; Stage B- 10% weight loss over 6 mo., fever, night sweats (B symptoms) Stage X- bulky dz Stage E- extranodal dz
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what is the acute Tx plan for HL
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comb. chemo for most pt including all stage IIIB and IV stages
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What are the drugs used for HL
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MOPP-Mechlorethamine, Oncovin, Procarbazine, Prednisone
ABVD- Adriamycin, Bleomycin,Vinblastine, Dacarbazine BEACOPP- Bleomycin, Etoposide, Doxorubicin (adriamycin), Cyclophosphamide, Vincristine (onocovin), Procarbazine, Prednisone |
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What is the chronic Tx plan for HL
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-if relapse after radiotherapy= salvage chemo - comb. chemo/radiotherapy for bulky mediastinal masses - chem now tested for earlier stages of dz
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who has excellent prognosis in HL
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IA IIA dz treated by radiotherapy 10 yr survival rates >80%
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who has a 5 year survival rate for HL
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disseminated dz- IIIB IV 5 yr survival rates of 50-60%
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who has poor prognosis for HL
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pt who are older, have bulky dz, lymphocyte depletion HL, or mixed cellularity HL
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what is the prognosis for pt w/ recurrent dz after initial radiotherapy
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may still be cureable w/ chemotherapy
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what does a high dose chemo w/ autologous stem cell transplantation for relapse offer
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35-50% chance of cure if dz is still chemo sensitive
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what are the complications of HL
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- secondary malignancies (leukemia 1st 10 yrs/ solid tumors over time) - leukemia - lung/breast cancer - hypothyroidism -constrictive pericarditis - infertility - heart failure
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when is leukemia a complication for HL
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if pt receives alkalating agents/ comb. chemo/XRT
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when is lung/breast cancer a complication for HL
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if pt receives XRT to chest, especially high in smokers
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when is hypothyroidism a complication for HL
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after irradiation of meck
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when is constrictive pericarditis a complication for HL
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after radiotherapy to mediastinum
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when is infertility a complication for HL
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after using akylating agents
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when is heart failure a complication for HL
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after adriamycin Tx
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What are the essentials of Dx for NHL
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-fever, anemia, infections - marked lymphadenopathy - no Reed sternberg sells or eosinophilia - large group different lymphomas
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what is the clinical aspect of NHL lymphomas
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low, intermediate, high grade
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what are the cell types of NHL
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B, T, histocyte, other
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what is the histology found in NHL
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follicular and diffuse
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What is the A & P of NHL
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-solid tumors of immune system
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what is the important feature of NHL
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tendency to arise w/in single lymph node area and spread in orderly fashion to contiguous lymph nodes - widespread hematologous dissemination only late in course
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what is the epidemiology of NHL
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- increased incidence/mortality in 1990's - since 1970- incidence doubled - common, 4th rank heme cancer - 63000 cases -US 2007/19000 deaths
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what is the lifetime risk of develpoment of NHL
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1/46 men 1/56 women more freq. in elderly 3:1 men : women
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what ages are present in NHL
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any age; median 55-75
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what is the etiology of NHL
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of most NHL-unknown
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who is at higher rish of NHL
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ppl: exposed to chemicals, pesticides, solvents; EPV, family history of NHL, HIV
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is there any hereditary pattern of NHL
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no
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what do the types of NHL reflect
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development of stages of lymphocytes - each type lymphoma arrested at certain stage of dev. & transformed into a malignant cell
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what % of NHL originate from B cells or T null cells
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85% B 15% T null
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What are the characteristics of indolent low grade NHL
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life expectancy in yrs if untreated - 85-90% present in Stage III or IV -incurable
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what are the characteristics of aggressive high grade NHL
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life expectancy in weeks if untreated - potentially cureable
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what are the symptoms of NHL
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lymphadenopathy - const. symptoms 20%- fever, night sweats, weight loss, B symptoms more common in high grade lymphomas
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what are the signs/phy. exam signs of NHL
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-cytopenias - hepatosplenomegaly - lymphadenopathy - hematogenous spread of dz (no predictable pattern) - classic lymphoma - extranodal primary - waldeyer's ring
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what are the characteristics of lymphadenopathy in NHL
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may fluctuate or spontaneously remit especially in low gade lymphomas
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what are the characteristics of hematogenous spread of dz in NHl
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no predictable pattern
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what are the characteristics of classic lymphoma
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arises in lymph node or bone marrow
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what are the characteristics of extranodal primary in NHL
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more common in high grade lymphoma
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what are the characteristics of waldeyer's ring in NHL
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frequent in GI lymphomas
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what are the D dx of NHL
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- hodgkin's dz - metastatic cancer - infectious mononucleosis - cat scratch - sarcoidosis - drug induced pseudolymphoma
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what are the diagnostic studies for NHL
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-chromosome changes - CBC, cehmistries, urinalysis - CT chest abdomen pelvis - bone marrow bx/aspirate - LP - PBS - cerebrospinal fluid cytology - serum LDH
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what is a Lp done for in NHL
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-AIDS lymphoma - t cell lymphoblastic lymphoma - high grade lymphoma w/ positive marrow
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what will cerebrospinal fluid cytology show in NHL
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malignant cells in some high grade lymphomas w/ meningeal involvement
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what is serum LDH useful for in NHL
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prognostic marker/ incorporated into risk stratification of Tx
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what are teh imaging tests done in NHl
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CT abdomen chest pelvis and chest x-ray- mediastinal mass in lymphoblastic lymphomas and others
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what are the types of B cell lymphoma
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-90% - percurser b cell lymphoblastic lymphoma - small lymphocytic lymphoma/ chronic lymphocytic leukemia marginal zone lymphomas- MALT - hairy cell leukemia - follicular lymphoma -matle cell lymphoma - diffuse large b cell lymphoma - burkitt's lymphoma
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what are the marginal zone lymphomas
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nodular, extranodal, splenic
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what are the t cell lymphoma types
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- anaplastic large cell lymphoma- peripheral t cel lymphoma - mycosis fungoides
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what is decision making and dx based on for NHL
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staging- same as HL
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what is the acute Tx plan for NHL
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-chemo w/ ackylating agents - fludarabine - rituximab - short course chemo - chemo w/ CHOP - rituximab + chop
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what are teh alkylating agents used w/ chemo in NHL
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- chlorambucil .6-1 mg/kg q 3 weeks - comb. chemo w/ cyclophosphamide, vincristine, and prednisone CVP
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what may produce quivalent result w/ chemo + alkylating agents in some pt w/ NHL
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fludarabine
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what is rituximab and how is useful in NHL pt
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-monoclonal antibody directed against b cell surface antigen CD 20 - effective as salvage therapy for relapsed low grade b cell lymphomas/ may improve outcome when added to initial chemo
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what is short course chemo and how is it used in NHL
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3 courses of cyclophospamides, doxorubicin (hydroxydaunomycin;adriamycin) , vincristin (oncovin), prednisone CHOP plus localize radiation for localized intermediate grade lymphomas
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how should chemo with chop be used in NHL
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6-8 cycles for more advanced intermediate grade lymphomas
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how should rituximab + CHOP be used in NHL
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for elder pt. w/ diffue large cell lymphomas
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what is burkitt's lymphoma
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- african variety jaw tumor strongly linked to EBV- US 50% EBV infection
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how does burkitt's present
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many present as abdominal mass
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what is the burkitt's lymphoma growth pattern
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most rapidly growing human tumor
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what abnormalities are seen in burkitt's
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chromosome abnormality: c myc oncogene linked to one of immunoglobulin genes
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how is burkitt's treated
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w/ multidrug regimen similar to pediatric leukemia/lymphoma regimens
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what are mycosis fungoides
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most common form of cutaneous t cell lymphoma
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what does mycosis fungoides affect
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typically skin may progress internally over time
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is mycosis fungoides a fungal disease
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NO!!
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how was mycosis fungoide first described
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1st described skin tumors of severe case as mushroom like appearance
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how is mycosis fungoides treated
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electron beam radiation, UV light, or topical alkylating agents
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what is adult t cell leukemia-lymphoma associated w/
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HTLV 1 infection
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where is adult t cell leukemia-lymphoma common
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carribean southeastern us
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what are the signs/symptoms/phy. exam signs of adult t cell leukemia-lymphoma
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hepatosplenomegaly, leukocytosis, lymphadenopathy, skin involvement,lytic lesions of bone, hypercalcemia
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what might adult t cell leukemia-lymphoma respond to
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AZT and interferon
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what is adult t cell leukemia-lymphoma
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an oncogenic RNA retrovirus referred to as T cell leukemia and lymphoma- a demyleinating dz
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what is AIDS lymphoma
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agressive lymphomas of b cell origin - burkitts, burkitt's like and large cell immunoblastic
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what is treatment like for AIDS lymphoma
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often limited by immune compromise of pt
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what is the prognosis of AIDS lymphoma
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improved w/ HAART therapy
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what is malt lymphoma
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mucosa-associated lymphoid tissue lymphoma- chronic infection of stomach by helicobacter pylori
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where is MALT loaclaized
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stomach, indolent course
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what is the prognosis for MALT
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can be cured inmany cases by antibiotics against H. pylori
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what is ocular adnexal lymphoma OAL
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lymphoma affecting tissues surrounding the eye that may arise after chronic inflammation
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what is the Tx of OAL
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-antibiotic therapy against chlamydia - 1 pt treated w/ doxycycline 100 mg bid 3 weeks had complete remission for more than a yr, another pt had minimal remission for more than 18 months
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what is the therapeutic procedure if a pt w/ lymphoma that is not bulky and asymptomatic
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no initial therapy, some have spontaneous remission (most indolent lymphomas are disseminated at dx)
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what is the therapeutic procedure for special forms of lymphoma (burkitt's, lymphoblastic, mantle)
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require individualized therapy
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what is the therapeutic procedure for clincally aggressive low grade lymphomas
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allogenic transplantation
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what is the therapeutic procedure for pt w/ limited indolent dz
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localized radiation therapy
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what is the prognosis for pt w/ indolent lymphomas
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median survival 6-8 years dz ultimately becomes refractory to chemo
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what is the prognosis for pt w/ relapse after initial therapy
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if lymphoma is still partiallyt sensitive to chemo autologous transplantation- 50% chance long term salvage
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what is the international prognostic index
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widely used to categorize pt w/ intermediate grade lymphoma into risk groups
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what are dz related complications
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- cytopenia secondary to bone marrow infiltration - bleeding secondary to thrombocytopenia, DIC - cardiac secondary to large pericardial effusion - respiratory secondary to pleural effusion - SVC syndrome secondary to vertebral metastases - neurologic secondary to primary CNS lymphoma - GI obstruction, perforation, bleeding in pt w/ GI lymphoma (or caused by chemo) - pain secondary to tumor invasion - leukocytosis (lymphocytosis) in leukemia phase of dz
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what is superior vena cava syndrome SVCS or SVCO (obstruction)
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result of direct obstriction of superior vena cava by malignancies such as compression of vessel wall
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what are the signs/ symptoms of SVCS
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shortness of breath most common, followed by face/arm swelling
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what is multiple myeloma also know as
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plasma cell myeloma or kahler's dz (plasma cell malignancy, b-cells)
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How common is MM
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less common than NHL
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how deadly is MM
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more deadly that NHL
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what is the avg life expectancy of ppl w/ MM
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30-36 mo.; some pt develop indolent form and live for 10+ yrs
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Is MM cureable
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potentially w/ high dose chemo (bone marrow or stem cell transplantation)
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what is MM
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dz of malignant b lymphocytes
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what are the patterns of signs/symptoms of MM
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variable approx. 20% pt have no signs/symptoms
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what is the etiology of MM
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unknown
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what are the suggested predisposing factors of MM
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viral infection w/ HHV 8, MGUS (monoclonal gammopathy of undetermined significance)
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what is a paraprotein
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immunoglobulin or immunoglobulin light chain produced in excess by clonal proliferation of plasma cells often associated w/ benign MGUS
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what is the avg age at presentation of MM
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65
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who is affected more by MM
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males more than females blacks twice as much as whites
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what is the % of 5 yr survival rate of MM
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25-30% median survival 30-36 mo.
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what are the clinical features of MM
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- bone marrow failure: anemia, thrombocytopenia, neutropenia - renal failure - bone dz w/ skeletal destructucion: lytic lesions, gen. decrease in bone density - hypercalcemia - hyperviscosity syndrome - recurrent infections - amyloidosis
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what are the labs done for MM
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RBC/morphology, neutrophil/plt counts, calcium/proteins, erythrocyte sedimentation rate, PBS, serum protein electrophoresis, immunoelectrophoresis, urine IEP, B microglobulin level, urinalysis, bone marrow bx, bone xray, radionucleotide bone scaan
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what is the pattern of anemia in MM
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almost universal
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what is seen in the RBC morphology of MM
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normal, but rouleau formation common and may be marked
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what is seen in the neutrophil and plt counts in MM
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normal at presentation
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what is the pattern of calcium and protein in MM
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hypercalcemia and bence jones proteins (monoclonal globulin protein)
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what is seen in the erythrocyte sedimentation rate of MM
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elevated
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what is seen in the PBS of MM
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plasma cells rarely visible (plasma cell leukemia)
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what is seen in the serum protein electrophoresis of MM
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it demonstrates paraprotein in the majority demonstrateable as a monoclonal spike in B or y globulin region
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what is seen in the immunoelectrophoresis of MM
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monoclonal protein- 60% IgG 25% IgA 15% light chains only
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what is seen in the urine IEP of MM
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either complete immunoglobulin or light chains in 15% who have no demonstratable paraprotein in serum
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what is seen in the B-microglobuling level
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>3mg/L associated w/ poor survival
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what is seen in the urinalysis in MM
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may reveal proteinuria but dipstick test unreliable for light chains
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what is the dipstick test used for
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detects primarily albumin
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what is the pattern of proximal renal tubular acidosis in MM
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is seen w/ phosphaturia, glucosuria, uricosuria, and aminoaciduria
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what is seen in the bone marrow bx in MM
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infiltration by variable #'s of plasma cells (5% to 100%); dismal outcome if bone marrow cytogentic analysis shows deletions of chromosome 13q
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what are the imaging tests done for MM
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bone x rays, radionucleotide bone scan
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what is seen in the bone xray of MM
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lyric lesions especially i axial skeleton (skull, spine, proximal long bones and ribs) or generalized osteoporosis
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what is the acute Tx plan for MM
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-comb chemo w/ vincristine, doxorubicin (adriamycin) and dexamethosone (VAD) - Thalidomide and derivatives, experimental agents CC5013/PS341 (protease inhibitor) - thalidomide, berexomib (PS341, velcade), experimental agent CC5013 (revimid) - mobilization, hydration, biophosphonates - biophosphonates
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what are thalidomide/derivatives and experimental agents CC5013/PS341 (protease inhibitor) used for MM
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refractory dz
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what is thalidomide, berexomib and experimental agent CC5013 (revimid) used for in MM
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refractory dz
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what is mobilization hydration and biophosphates used for in MM
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hypercalcemia
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what are the biophosphates used in MM
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pamidronate 90 mg, zoledronate 4 mg IV Q month)
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what are the biophosphates used for in MM
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to reduce pathological fractures in pt w/ significant bony dz aredia/zometa
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what is the chronic Tx plan for MM
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observe w/out therapy, autologous stem cell transplantation, allogenic transplantation, less toxic forms of allogenic trasplantation, follow height of paraprotein spike on SPEP
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when would you observe w/out therapy in chronic MM
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if minimal dz or unclear whether paraproteinemia benign (MGUS) or malignant, since no advantage to early Tx of asymptomatic MM
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wheb would you use analogous stem cell transplantation in MM
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in pt <70, in relapse if dz still chemo sensitive
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why would you use allogenic transplantation in MM
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it is potentially cureative, but role limited by unusually high mortality rate (40-50%) in myeloma pt.
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what are the less toxic forms of allogenic transplantation in MM
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use nonmyeloablative regimens have produced encouraging results
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why would you follow height of paraprotein spike on SPEP in MM
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useful marker for monitoring response to therapy
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what are the prognoses of MM
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poor: >65, high tumor mass, high beta microglobulin, renal failure, hypercalcemia
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