Hodkins' & Nhl

Front 1

Cyclin D1 (t11:14)

Back 1

Mantle cell Lymphoma

Front 2

IPI

Back 2

Age >60, LDH elevated, Advanced Stage (III or IV), Zubrod

Front 3

BCL2 staining

Back 3

indicates BCL-2 t(14:18)
Follicular lymphoma

Front 4

Ki-67

Back 4

measures nuclear proliferation
High in Burkitts (Highly aggressive), low in Follicular (Low grade)

Front 5

Waldenstrom's Macroglobulinemia ID

Back 5

Cold Agglutination Rouleaux formation (RBC agglutination)
Raynaud's syndrome
Nephrotic Syndrome, CHF, Skin problems

Front 6

CLL

Back 6

"smudge" cells, virgin B-cells (now known to come from memory B-cells too)
BM replaced neoplastic B-cells -> hypogammaglobulinemia, Normocytic Anemia (50%), Thrombocytopenia (40%)
5X10^9/L cloncal CLL B-cells
CD5+, CD20+ (dim), CD23+, sIg (dim)

Front 7

13q-

Back 7

deletion has favorable prognosis

Front 8

17p-

Back 8

adverse

Front 9

Mantle Cell

Back 9

CD20+, neg for other markers

Front 10

Low Grade NHL

Back 10

"CaLL Waldenstrom's for Marge's Hairy Follicles"

Front 11

Hair Cell CD

Back 11

CD20+, CD10- (CALLA), CD5- (B1-B-cells, also T-cell), CD25+ (IL-2R)
IMPORTANT CD11c+, CD103+ (ITGAE - Hairy cell only one w/ - only on T-cells)

Front 12

CLL CDs

Back 12

CD5+ (B1-B-cell), CD20+, CD19+, CD103-, CD11c-

Front 13

Reed Sternberg Cell CD

Back 13

CD 30+ (TNFRSF8 - on active but not resting T- and B- cells), CD15+ (on neutrophils - mediates phago and chemotaxis) , CD45- (on hematopoetic cells except RBC and plasma), CD20-

Front 14

Sweet's Syndrome

Back 14

neutrophilic dermatosis
see in MDS and AML

Front 15

M4 & M5

Back 15

extramedullary leukemia
bad prognosis

Front 16

bad prognosis chromosomes

Back 16

t(9:22) (BCR-ABL aka Phil), t(4:11), 5q-, 7q(-), FLT3-ITD

Front 17

good prognosis chromosomes

Back 17

Hyperdiploidy, t(12:22) TEL-AML1

Front 18

Burkitt's translocation

Back 18

CMYC next to Ig promoter
t(8:14)

Front 19

AML M3 genes

Back 19

DIC
t(15:17), PML-RARalpha fusion protein

Front 20

Philadelphia gene

Back 20

t(8:21) -FLT3-ITD better
worse is11q23

Front 21

AML M3 treatment

Back 21

all trans retinoic acid

Front 22

ALL classification in adults
most common

Back 22

L1 = small lymphoblasts, L2 large lymphoblasts, L3 Burkitt type w/ vacuoles
pre-B cell is most common

Front 23

ALL treatment

Back 23

L-Aspariginase: only approved use is for ALL
Ph1(+) = philadelphia chromosome -> TKI

Front 24

AML treatment

Back 24

All-trans retinoic acid (ATR) and arsenic: AML M3 ONLY
Complete remission -> start on consolidation therapy -> Maintenance therapy
Sunitinib: (tyrosine-kinase inhibitor)

Front 25

CML treatment

Back 25

Imatinib (a TKI, aka Gleevec)
Allogenic BMT in younger pt (if match) = curative in 70-80%
Blast transformation: Lympoid: treat as for ALL + dasatinib
Myelod: treat as for AML + dasatinib

Front 26

JAK2 mutation

Back 26

Essential thrombocythemia and PRV and AMMM
renders hemopoietic cells more sensitive to TPO and EPO

Front 27

Internal deletion of Chromosome 4

Back 27

HES (Hypereosinophilic syndrome)
can have a constitutively Tyrosine Kinase

Front 28

Macrocytic anemia w/ normal B12 & Folic acid

Back 28

Refractory anemia

Front 29

5q- Syndromes

Back 29

MDS
responds to lenalidomide

Front 30

CML (general)

Back 30

40-60 yo Expansion of pluripotential stem cell -> lympoid or myeloid lineage
WBC 50-200,000/μL
anemia (normocytic to macrocytic), Ph+ t(9:22), BCR-ABL (Tyr-Kinase), low LAP

Front 31

CML Stages

Back 31

Chronic ↑ Granulocytes in Marrow
Accel (3yrs) basophilia, thrombocytosis, progressive anemia, weird RBC shapes (aniso/poikilocytosis)
Blast Crisis: >30% blasts (myeloid or lymphoid) rapid ↑blasts (TdT +)

Front 32

CML Clinical

Back 32

Hepatosplenomegaly, general lymphadenopathy, myeloblasts w/o Auer rods
WBC 50,000-200,000/μL, Thrombocytosis or thrombocytopenia, BM hypercellular

Front 33

CLL

Back 33

>60 yo, General lymphadenopathy, ↑ immune hemolytic anemia (Warm IgG & Cold IgM)
WBC 15,000-200,000 lymphoblasts <10%, Neutropenia, SMUDGE CELL
Normocytic anemia or Thrombocytopenia
Hypogammaglobinemia

Front 34

AML

Back 34

M0-M7, Auer rods in M2&M3, M3 (DIC - responds to all-trans Retinoic acid)
>20% blasts in marrow, extramedullary masses , low platelets

Front 35

ALL

Back 35

0-14yrs, Clonal pre-B cell (80%) or B, T-cell
CALLA+ (CD10+), TDT+, L1 (small lymphoblasts), L2 (Larger lymphoblasts), L3 (Burkitts)
Bcell: CNS & Tests metastasis, Tcell: Mediastinal or acute
WBC 10,000-100,0000, >20% blasts in PERIPH blood, normocytic anemia w/ thrombocytopenia, BM often replaced by blasts
40% CNS -> Cauda equina symptoms

Front 36

Burkitt's Lymphoma

Back 36

30% of children , Aggressive, EBV relation w/ t(8:14), "Starry Sky"
American: GI & Para-Aortic, African: Jaw
BM involvement, leukemic phase common

Front 37

Diffuse Large B-cell Lymphoma

Back 37

50% of adults w/ NHL (children too), B-cell derived from Germinal center -> SVC Symptoms
Localized disease w/ extranodal involvement (GI, Brain), EBV Assoc. w/ AIDS

Front 38

Follicular lymphoma

Back 38

B-cell from germinal center, t(14:18) -> overexpress BCL2 (anti-apoptosis)
General lymphadenopathy, BM involvement

Front 39

Extranodal Marginal Zone Lymphoma

Back 39

Assoc. w/ H.Pylori - Dervies from MALT (Maltoma - B-cells)
low grade

Front 40

Mantle Cell Lymphoma

Back 40

t(11:14), Cyclin D1
Painless lymphadenopathy and splenomegaly

Front 41

Anaplastic T-cell

Back 41

Ki-1 protein positive

Front 42

Hairy Cell

Back 42

NO lymphadenopathy, pancytopenia (hair-like projections)
TRAP+, CD11+, CD103+
B-cell leukemia

Front 43

Adult T-cell Leukemia

Back 43

WBC 10-50,000 (>20% blasts)
Normocytic anemia & thrombocytopenia (BM replaced by lymphoblasts)
Assoc w/ HTLV1
SKIN infiltration, Lytic bone lesions (hypercalcemia results)
CD4+, TdT -

Front 44

MDS; Age, Signs, Blasts, Histology

Back 44

50-80yo, Sweet's Syndrome (Neutrophilic dermatosis)
Normocytic to macrocytic anemia
Ringed sideroblasts, Myeloblasts <20%, HYPOSEGMENTED PMN (Pelger-Huet change)
hypercellular BM
5q - = good
7- = bad

Front 45

Essential Thrombocytopenia

Back 45

JAK2 (V617F) in 30-40%
Bleeding (usually GI), splenomegaly
Thrombocytosis (platelets >600,000) w/ abnormal morphology
Mild neutrophil leukocytosis, hypercellular BM w/ abnormal megakaryocytes

Front 46

PRV

Back 46

↑ RBC mass & Hb >20, ↓ EPO, Leukocytes >12,000
4H's (Hyperviscosity, Hypervolemia, Histaminia, Hyperuricemia
Pruritis after bathing, Thrombotic events, Splenomegaly
JAK2

Front 47

AMMM

Back 47

MASSIVE splenomegaly, Splenic infarcts
Normocytic anemia - teardrop cells, circulating, RBC precursors
Ph -, LAP score ↓ or normal
Early: Panhyperplasia -> Myelofibrosis/osteosclerosis

Front 48

Multiple Myeloma

Back 48

Hypercalcemia, ↑ESR, ↓platelets, Mott cell w/ Russell bodies (Excess Ig)
Flame cell, Normocytic anemia w/ Rouleaux
Lytic bone lesions, Fx, Hyperviscosity, Kidney problems

Front 49

Lymphoblastic Lymphoma (Waldenstrom's Macroglobinemia)

Back 49

Retinal hemorrhage, stroke (hyperviscosity), Lymphadenopathy, no lytic bone lesions, Raynaud's phenomenon, Dutcher body, IgM spike, BJ protein
no Renal disease/amyloidosis

Front 50

ALL vs AML

Back 50

Precursor B ALL: Blasts that express CD10 (CALLA), CD19 (follicular dendritic cells and B-cells, lost on plasma cells), and CD20 (standard on all B-cells), and CD22 (Sialic acid receptor)
AML - Blasts that express CD13 (Granulocytes & monocytes), CD14 (Innate immune – coreceptor for LPS), CD15 (neutrophil chemotaxis/phagocytosis), and CD33 (Cells of myeloid lineage)

Front 51

MGUS

Back 51

No BJ protein, small IgM spike
most common monoclonal gammopathy

Front 52

Mycosis Fungoides & Sezary Syndrome

Back 52

CD4 T-helper cells, 40-60yo
Skin rash spread to lymph nodes, lung, liver, spleen
groups of neoplastic cells in skin = Pautrier's microabcesses
Sezary = Mycosis Fungoides w/ leukemic phase (Circulating cells = Sezary cells)