Leukemia

Hairy Cell Leukemia

--B lymphocytes normally produce antibodies to help fight infections. --Hairy cells tend to accumulate in the bone marrow, liver and spleen. Even though hairy cell leukemia affects the white cells, the lymph nodes usually don't enlarge. --Hairy cells multiply uncontrollably and crowd out normal white cells, red cells and platelets. Sx: Fever without an obvious cause or a lasting, low-grade fever Chills Frequent infections Discomfort or a "dragging" feeling on the upper left side of your stomach (caused by an enlarged spleen) Unexplained weight loss Black-and-blue marks (bruises) with no clear cause Pale skin Tiredness or no energy Shortness of breath during normal physical activity Dx: Identifying hairy cells on smear elevated WBC

Multiple Myeloma

--cancer formed by malignant plasma cells --punched-out lytic lesions present (visualized via X-ray) --pathological fx are common Multiple myeloma causes cancer cells to accumulate in the bone marrow, where they crowd out healthy blood cells. Rather than produce helpful antibodies, the cancer cells produce abnormal proteins that can cause kidney problems. Bone pain, especially in your spine or chest Nausea Constipation Loss of appetite Mental fogginess or confusion Fatigue Frequent infections Weight loss Weakness or numbness in your legs Excessive thirst

Non-hodgkin's Disorder

--more common B lymphocytes (B cells), which produce antibodies to help combat infections T lymphocytes (T cells), which have several functions, including helping B lymphocytes make antibodies Natural killer (NK) cells, which attack virus-infected cells or tumor cells About 85 percent of NHL cases start in the B cells. Your doctor plans your treatment according to the type of cell your NHL developed in. The abnormal lymphocyte grows out of control and produces more abnormal cells like it. These abnormal lymphocytes (lymphoma cells) accumulate and form masses (tumors). If NHL isn't treated, the cancerous cells crowd out normal white cells, and the immune system can't guard against infection effectively. NHL that develops in or spreads to other areas of the body where lymphoid tissue is found, such as the spleen, digestive tract and bone marrow, is called primary extranodal lymphoma. NHL is classified into more than 30 different subtypes. Doctors classify the NHL subtypes into categories that describe how rapidly or slowly the disease is progressing: Aggressive NHL Indolent (slow-growing) NHL Sx: --Painless, swollen lymph nodes in your neck, armpits or groin --Abdominal pain or swelling --Chest pain, coughing or trouble breathing --Fatigue --Fever --Night sweats --Weight loss Dx: The hematopathologist uses one or more lab tests such as those below to examine your cells: Immunophenotyping confirms an NHL diagnosis and identifies the lymphoma cells as B cells, T cells or natural killer cells. Cytogenetic analysis looks for changes in chromosomes. The abnormalities help identify the NHL subtype. Gene expression profiling and microarray analysis identify the subtype and risk factors. They help predict treatment response and identify patients who may be at increased risk for relapse. Polymerase chain reaction (PCR) analyzes certain genes to help predict treatment response. This test is also used to detect residual lymphoma cells too small to be seen under a microscope.

Acute Myelogenous Leukemia

--most common acute leukemia among adults --rapid progression --affects myeloid cells --symptoms mimic the flu --accumulation of leukemic blasts --anemia (normocytic normochromic) and bleeding common --Auer rods easily identified --bone marrow eosinophilia FAB M0, M1, M2, M3, M4, M5, M6, M7 Sx: --symptoms related to complications of pancytopenia (eg, anemia, neutropenia, and thrombocytopenia) --weakness --easy fatigability --infections of variable severity --gingival bleeding, ecchymoses, epistaxis, or menorrhagia --General fatigue --Pallor and weakness are common and attributed to the anemia. --Bone pain is infrequent in adults with AML, although some individuals describe sternal discomfort or tenderness --fever due to infection --pallor --petechiae or ecchymoses due to thrombocytopenia --hemorrhages and/or whitish plaques on fundus Dx: Leukemic blast cells in bone marrow samples The percentage of blast cells. Blasts are normally 1 to 5 percent of marrow cells. Having at least 20 percent blasts is generally required for a diagnosis of AML. But AML can also be diagnosed if the blasts have a chromosome change that occurs in a specific type of AML, even if the blast percentage is less than 20 percent. Characteristic markers (antigens) on the surface of blast cells, such as CD13 or CD33 (CD is an abbreviation for "cluster designation"). Cells based on the types of markers (antigens) on the cell surface, using a process called "immunophenotyping." "Flow cytometry" is the name of one test that may be used to do immunophenotyping. Prognosis: 26% alive in 5 years 3.5 months post-diagnosis

Acute Lymphocytic Leukemia

--most common form of cancer in children --L1, L2, L3 Sx: The most common presenting symptoms of ALL are nonspecific --fever --infection --bleeding (bruisng or petechiae) --bone pain --lymphadenopathy Dx: --The percentage of leukemic blast cells present --Specific chemical activity in blast cells --Characteristic markings (antigens) on the blast cells' surface (CD10) --The number and size of chromosomes Prognosis: 70% alive after 5 years

Chronic Lymphocytic Leukemia

--routinely perform fluorescence in situ hybridization (FISH) of the peripheral blood --progresses more slowly than other types of leukemia --large number of smudge cells --most common form of leukemia --disease of the elderly --usually involves B cell Sx: --Tire more easily --SOA due to anemia --Lose weight due to decreased appetite --lymph node enlargement and splenomegaly as a result of an accumulation of CLL cells (leukemic lymphocytes) --possibility of infection

Juvenile myelomonocytic leukemia (JMML)

--very rare --progresses rapidly without treatment --In JMML, monocytes multiply uncontrollably and crowd out normal white blood cells, red blood cells and platelets. Sx: --Enlarged liver, enlarged spleen and enlarged lymph nodes --Pale appearance --Fever --Rash Dx: A persistent high level of monocytes in the blood (greater than 1,000 monocytes per microliter of blood [1,000/μl]) No indication of the Philadelphia chromosome (Ph chromosome) or BCR-ABL gene rearrangement. The Ph chromosome is an abnormality of chromosome 22 found in the marrow and blood cells of patients with CML Less that 20 percent of blast cells in the blood and bone marrow

Chronic Myelogenous Leukemia

CML is associated with the fusion of two genes: BCR (on chromosome 22) and ABL1 (on chromosome 9) resulting in the BCR-ABL1 fusion gene. --Philadelphia gene --overproduction of predominantly neutrophils, but also basophils and eosinophils --15-20% of leukemia in adults Sx: 20% to 50% of patients are asymptomatic platelet dysfunction (bleeding) fatigue early satiety enlarged spleen anemia tenderness over lower sternum Dx: Philadelphia (Ph) chromosome via Cytogenetic analysis The number of cells with the BCR-ABL oncogene -Fluroescence in Situ hybridization (FISH) Prognosis - 90% still alive after 5 years

Hodgkin's Disease

Sx: Painless swelling of lymph nodes in your neck, armpits or groin Persistent fatigue Fever and chills Night sweats Unexplained weight loss — as much as 10 percent or more of your body weight Loss of appetite Itching Increased sensitivity to the effects of alcohol or pain in your lymph nodes after drinking alcohol --Classic Hodgkin disease (HD) accounts for about 95% of all cases --Reed-Sternberg Cells --abnormal type of B lymphocyte --Reed-Sternberg cells are much larger than normal lymphocytes --The enlarged lymph nodes in classic HD usually have a small number of Reed-Sternberg cells and a large number of surrounding normal immune cells. It is mainly these other immune cells that account for the enlarged lymph nodes. Classic HD has 4 subtypes: Nodular sclerosis Hodgkin disease: This is the most common type of Hodgkin disease in developed countries, accounting for about 60% to 80% of cases. It is most common in teens and young adults, but it can occur in people of any age. It tends to start in lymph nodes in the neck or chest. Mixed cellularity Hodgkin disease: This is the second most common type (15% to 30%) and is seen mostly in older adults (although it can occur at any age). It can start in any lymph node but most often occurs in the upper half of the body. Lymphocyte-rich Hodgkin disease: This subtype accounts for about 5% of Hodgkin disease cases. It usually occurs in the upper half of the body and is rarely found in more than a few lymph nodes. Lymphocyte-depleted Hodgkin disease: This is the least common form of Hodgkin disease, making up less than 1% of cases. It is seen mainly in older people. The disease is more likely to be advanced when first found, in lymph nodes in the abdomen as well as in the spleen, liver, and bone marrow.

Chronic Myelomonocytic Anemia (AMML)

Sx: Fatigue or no energy (anemia) Pinhead-sized red spots under the skin (petechiae) Bruising and bleeding with no clear cause (thrombocytopenia) Frequent infections (leukopenia) Discomfort, a feeling of fullness or a "dragging" feeling on the upper left side of your stomach (caused by an enlarged spleen) Dx: --Persistent high levels of monocytes in the blood (greater than 1,000 microliters of blood) --No evidence of a Philadelphia chromosome (seen in a similar disease known as "chronic myeloid leukemia" (CML). --This can be determined based on a blood test looking for a particular abnormality known as a BCR/ABL fusion gene. --Less that 20 percent of blast cells in the blood and bone marrow --Abnormal changes in any of the cells that develop into red blood cells, certain white blood cells or platelets (precursor cells)