lecture 18 collins
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| 6 most common presentations of AML | anemia, thrombocytopenia, neutropenia, leukostasis, tumor lysis syndrome, DIC
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| leukostasis | blasts clog the vasculature in the CNS or lungs
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| tumor lysis syndrome in context of AML | excessive release of blast contents: uric acid, phosphate and K; can lead to uric acid nephropathy and renal failure, life-threatening acidosis and hyperkalemia
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| DIC in context of acute leukemia | VERY COMMON IN ACUTE PROMYELOCYTIC LEUKEMIA (APL) procoagulants are released from blasts that die inciting clotting cascade that uses up all the coagulation factors; manifests clinically as severe bleeding
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| supportive therapy for leukostasis | leukapheresis - reduces WBC levels in 2-3 hrs
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| when is allogeneic bone marrow transplantation indicated for acute leukemic pt? | only for the most aggressive or "bad" leukemias like secondary AML (ALL caused by previous chemo tx), elderly AML or Philadelphia chr + ALL
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| choice tx for APL | supraphysiologic doses of ATRA, results in 70% long-term cure rate
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| characteristics of LNs that suggest lymphoma | rubbery and nontender
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| suggested dz when LNs are hard as a rock | carcinoma
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| suggested dz when LNs are tender & "squishy" | infectious process
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| B sx of lymphoma | cytokines released by lymphoma cells cause fever, night sweats and weight loss
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| SVC syndrome | large mediastinal masses obstruct SVC causing upper trunk and facial swelling, engorged vessels
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| pts with lymphoma can sometimes also present with tumor lysis syndrome | especially those with very aggressive NHLs like Burkitt lymphoma
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| Ann Arbor staging | I - one group of LNs involved /// II - 2 groups of LNs on same side of diaphragm /// III - @ least 2 groups of LNs involved on both sides of diaphragm /// IV - involvement of other organs like liver or BM
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| 2 lymphomas treated with rituximab | diffuse large B-cell lymphoma and nodular lymphocyte predominant Hodgkin lymphoma (CD20+)
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| cytogenetics that are diagnostic for CML | Philadelphia chr or bcr-abl rearrangement = t(9;22)
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| imatinib (Gleevec) | used for CML tx in those with Philadelphia chr; competitively binds ATP-binding pocket of bcr-abl, inhibits the overactive tyrosine kinase
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