Onc.2 Malignant Hematology

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2 defining features of stem cells

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1. ability to self renew

2. ability to diff't into other cells

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different types of stems cells.. 3

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different types of stem cell transplant: 2

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draw out hematopoeitic stem cell cascade

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note how size, cytoplasm, nucleus, etc. changes throughout cascade

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Observe the changes in size,cytoplasm (less and less basophilic (blue)), presence of nucleolus in earlystages but not in late stages and hw chromatin gets more mature and nucleuseventually gets segmented for granulocytes. Some concepts also apply to red cells (change in size and cytoplasmprogressively less basophilic)…

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concept: a neoplasm = abnormal growth of cells.

2 options for further growth ...

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benign or malignant..

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def'n: clonal proliferation

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clonal disorders.. basic explanation

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arise from abnormalities in stem cells or early progenitor cells. = abnormal clone with a survival advantage

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WHO:

3 groups of myeloid neoplasms

2 groups of lymphoid neoplasms

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Big concept 1: myeloid or lymphoid?

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where do myeloid precursors reside?

where do lymphoid precursors reside?

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Big concept # 2: what type of cell is accumulating?

what is significance?

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malignancy from immature cell is very aggressive. doubling time in the order of hours.. where most cancers have doubling time of weeks

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so: 2 conceptual axes to use

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Where do the acute leukemias arise from?

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where do lymphomas , CLL, myeloma arise from

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where does ET, PRV, CML arise from

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what leads to myelofibrosis

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proliferation of cells in marrow leads to deposition of fibrous connective tissue

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Myelodisplastic syndrome:

1. what is it?

2. what are downstream affects?

3. potential risks?

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Leukemia

1. what is it

2. 2 axes to classify (ultimately 4 types of leukemia)

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features distinguishing acute leukemia from chronic leukemia

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clinical symptoms of acute leukemia?

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Labs in acute leukemia?

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NB: acute leukemia is a hematologic emergency. call the hematologist!

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Blasts

1. 2 types of blasts

2. NOT NORMAL IF IN PERIPHERAL BLOOD

3. where are blasts normally found?

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how are Leukemic blasts different from normal blasts

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myeloproliferative disorders: basic description

1. acute/chronic?

2. def'n

3. resulting blood counts?

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resulting blood counts in a myeloproliferative neoplasm?

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depends on the lineage affected..

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note: a sort of natural history of myeloproliferative neoplasms ..3

and note risk for evolving to acute leukemia

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Myeloproliferative neoplasms:

1. BCR-ABL negative (3) vs. BCR ABL positive (1)

2. significacne of JAK2 test

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Myelodysplastic syndrome

1. chronic

2. def'n

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Myelodysplastic syndrome: where is the issue? resulting cell counts?

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pathophys of myelodysplastic syndrome (and explanation for pereipheral blood count/smear findings

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What am I looking at?

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1. clinical presentation of MDS (CBC and symptoms)

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MDS: workup and diagnostic test required

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Onto the lymphoid neoplasms.. where do the following arise from

lymphoma

myeloma

CLL

ALL

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• 2 lymphoproliferative disorders are... (broad categories)

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Leukemia

lymphoma

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2 types of leukemias

2 types of lymphomas

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Chronic Lymphocytic Leukemia

1. def'n

2. blood findings

3. LN's, spleen

4. Cytopenias?

5. immune dysregulation

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ways to classify lymphoma (6)

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features differentiating Non-hodgkin lymphomas (aggressive vs. indolent)

1. progenitor cells

2. grade

3. growth

4. tx required

5. curable?

6. goal of treatment

7. example diseases

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Clinical presentation of lymphoma

1. PE findings

2. Sx

3. CBC findings

4. extranodal sites?

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Plasma Cell Disorders

MGUS vs. Multiple Myeloma (more on this later

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formulate DDx for each of these.. eventually..

Pancytopenia

Splenomegaly

Lymphadenopathy

Elevated Cell counts

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