ON11 Leukemia & Lymphoma​

Leukemias​ - cancer of the body's blood-forming tissues: Acute Myeloid Leukemia​ Chronic Myeloid Leukemia​ Acute Lymphocytic Leukemia​ Chronic Lymphocytic Leukemia​ Note: Acute leukemia involves the immature cells, called [blank_start]stem[blank_end] cells, whereas chronic leukemia develops in [blank_start]mature[blank_end] cells. Myeloid = bone marrow and [blank_start]RBCS[blank_end], lymphocytic = [blank_start]WBCs[blank_end]. Lymphomas​(cancer beginning in lymphocytes) - Non-Hodgkin’s Lymphoma More [blank_start]common[blank_end], more likely to be in older patients. Begins in [blank_start]any[blank_end] nodes. - Hodgkin’s Lymphoma ​ Hodgkin's lymphoma is marked by the presence of [blank_start]Reed-Sternberg[blank_end] cells, which a physician can identify using a microscope. In Non-Hodgkin lymphoma, these cells are not present. Typically begins in the [blank_start]upper[blank_end] body, such as the neck, chest or armpits.

Choose the incorrect epidemiology statement.

Which of these is not a risk factor for leukemia?

Select ALL the risk factors for NON-Hodgkin's lymphoma.

There are no widely recommended screening tests​ for leukemias and lymphomas but they may be identified through routine bloodwork.

Clinical Presentation: Coughing / [blank_start]chest[blank_end] pain​ Fever / chills​ Frequent [blank_start]infections[blank_end]​ [blank_start]Itchy[blank_end] skin or rash​ Loss of [blank_start]appetite[blank_end] or nausea​ [blank_start]Night[blank_end] sweats​ Persistent [blank_start]weakness[blank_end] and fatigue​ Shortness of [blank_start]breath[blank_end]​ [blank_start]Swollen[blank_end], painless lymph nodes in neck, armpits, or groin ​

Leukemia diagnosis: - Signs and symptoms​ - Complete [blank_start]blood cell count​[blank_end] - [blank_start]Bone marrow[blank_end] biopsy Lymphoma diagnosis: - Signs and symptoms​ - [blank_start]Lymph Node[blank_end] biopsy/extraction​ - Complete blood cell count​ - Bone marrow biopsy​ - [blank_start]Imaging[blank_end] (look for signs in other parts of your body)​

Prognosis​: Leukemia - Children (ALL) - [blank_start]90[blank_end]% cured​ Adults (ALL) - [blank_start]80-90[blank_end]% achieve remission​ Adults (AML) - [blank_start]60-70[blank_end]% achieve remission​ + 70% 5-year survival ALL​. Lymphoma: HL - 5-year survival [blank_start]86%​[blank_end] NHL​: Localized - [blank_start]72%​[blank_end] Regional - 72%​ Distant - [blank_start]55%​[blank_end]

Treatment – Acute Lymphocytic Leukemia. 1. Induction of remission - [[blank_start]vincristine, steroid, anthracycline[blank_end], +/- [blank_start]imatinib[blank_end]]​ = 1-2 months​ 2. Consolidation (intensification) [same drugs, high doses]​ = [blank_start]2-4[blank_end] months​ 3. Maintenance [[blank_start]methotrexate, 6MP[blank_end], +/- imatinib]​ = 2 [blank_start]years[blank_end]​ CNS treatment/prophylaxis (may be continued through all phases)​: Intrathecal [methotrexate]​ High dose [blank_start]IV[blank_end] methotrexate​ [blank_start]Radiation[blank_end]​

Treatment – Chronic Lymphocytic Leukemia​: Watch and [blank_start]wait[blank_end]​ Once symptoms appear / disease progressing:​ Many different combinations of standard [blank_start]chemotherapy[blank_end] used, in addition to [blank_start]targeted[blank_end] therapy, and/or monoclonal antibodies [[blank_start]rituximab, imatinib[blank_end]]​. HSCT (Stem Cell Transplants) a possibility for high risk patients.

Treatment – Non-Hodgkin’s Lymphoma​ Chemotherapy – [blank_start]6-8[blank_end] cycles of combination therapy over several months​: - [blank_start]CHOP[blank_end] [Cyclophosphamide, Doxorubicin, Vincristine, Prednisone]​ - R-CHOP [add [blank_start]Rituximab[blank_end] if CD20 positive]​ - [blank_start]CVP[blank_end] [Cyclophosphamide, Vincristine, Prednisone]​ - [blank_start]ICE[blank_end] [Ifostamide, Carboplatin, Etoposide]​ Radiation and HSCT are also options for high risk patients .

Select all drugs in the CHOP chemo combo.

Monitoring intrathecal CT: - Every [blank_start]dose[blank_end], check symptoms - Headache, [blank_start]visual[blank_end] changes, fatigue, [blank_start]balance[blank_end] issues, soreness/[blank_start]bruise[blank_end] at entry​? - [blank_start]Weekly[blank_end] labs for blood cell [blank_start]count[blank_end] - Check for signs of infection [blank_start]daily[blank_end]

What are the signs/symptoms of Febrile Neutropenia?

Watch and wait is an appropriate strategy for which type of blood cancer?