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ClinAspectsLeukLymph

lecture 18 collins

QuestionAnswer
6 most common presentations of AML anemia, thrombocytopenia, neutropenia, leukostasis, tumor lysis syndrome, DIC
leukostasis blasts clog the vasculature in the CNS or lungs
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
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
supportive therapy for leukostasis leukapheresis - reduces WBC levels in 2-3 hrs
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
choice tx for APL supraphysiologic doses of ATRA, results in 70% long-term cure rate
characteristics of LNs that suggest lymphoma rubbery and nontender
suggested dz when LNs are hard as a rock carcinoma
suggested dz when LNs are tender & "squishy" infectious process
B sx of lymphoma cytokines released by lymphoma cells cause fever, night sweats and weight loss
SVC syndrome large mediastinal masses obstruct SVC causing upper trunk and facial swelling, engorged vessels
pts with lymphoma can sometimes also present with tumor lysis syndrome especially those with very aggressive NHLs like Burkitt lymphoma
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
2 lymphomas treated with rituximab diffuse large B-cell lymphoma and nodular lymphocyte predominant Hodgkin lymphoma (CD20+)
cytogenetics that are diagnostic for CML Philadelphia chr or bcr-abl rearrangement = t(9;22)
imatinib (Gleevec) used for CML tx in those with Philadelphia chr; competitively binds ATP-binding pocket of bcr-abl, inhibits the overactive tyrosine kinase
Created by: sirprakes
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