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WBC, R-CHOP rituximab cyclophosphamide doxorubicin vincristine …
WBC
Leukemia
Acute
ALL
common ALL ag (CALLA; CD10)
Term deoxynucleotidyl transf
mainstay tr of ALL
daunorubicin
vincristine
prednisone
<13 y.o "ALL" my children
POOR prognosis
<1 y.o or >10 y.o
Phili [t(9;22)] +
WBC# >50k
CNS involv at dx
additional tr for
prevent of leukastasis:::
leukapheresis+hydroxyurea
CNS infilt:::
intrathecal MTX for
AML
Auer rods [M3]
MPO
Esterase[M4, M5]
mainstay tr of AML
cytosine arabinoside(AraC)
daunorubicin or idarubicin
13-40 y.o "A"cute "M"id "L"ife
staging based on #of node involved
POOR prognosis
age >60 y.o
elvated LDH
additional tr
M3 promyelocytic:::
ATRA
LP showing blastic cell:::
it MTX
prevent of leukastasis:::
leukapheresis+hydroxyurea
blasts
similar in clinical presentations
rapid onset and progression
anemia(pallor, fatigue)
t.penia(petechia, purpura, bleeding)
ineff&immat wbc(recur infec)
DIC
HSM, bleeding gums,
skin and CNS infiltration
1st test CBC and PBS
most accurate BMbx and flow cytometry
Chronic
CML
40-60 y.o
SM, LUQ,early satiety, weight loss, anorexia, fever chills
3 phases
chronic; infection and bleeding
acceler; transition toward crisis,
incr basophil and t.penia
crisis; resemble like acute leukemia
most accur; Phili t(9;22)
WBC# >100k,
may look like leukomoid rx.
incr LDH, B12, uric acid levels
mainstay tr.
chronic; TK inh.(imatinib) and if young BMT
crisis; same as acute leukemia
2nd gen TK inh.(dasatinib, nilotinib)+BMT
CLL
age >60 y.o
fatigue, malaise, infection,
LAP, HM, SM
CBC, PBS,
Most accurate flow cytom [CD5]
granulocytopenia, anemia, t.penia
mainstay tr.
fludarabine chlorambucil
tr. palliative
Hairy
40-60y.o male predomin
pancytopenia, BM infilt, SM
weakness, fatigue, petechia, bruising,
atypical infection like MAC
abdom pain, early satiety, weight loss
CBC with smear TRAP stain
Tartrate-resistant acid-phosphatase
showing hairy cells
most accur flow cytom hairy cells
main tr.
cladribine
altern tr. pentostatin, splenectomy, IFNa
mature
Lymphoma
Hodgkin
Reed-Sternberg CD15+ CD30+
predom B cell dz
assoc w/ EBV
bimodal distrib 30 y.o and 60 y.o
enlarged nontender lymph-nodes
b symptoms
pruritus and HSM
alcohol-ind pain at nodal sites
usually above diaph, if below think dissem
excisional bx
reed sternberg cell CD15+ and CD30+
owl eye appearance
staging based on #of node involved
usually chemo+rad
ABVD
st IV 5-yr surv%65
Non-Hodgkin
NO
Reed-Sternberg
CD15-- CD30--
B-cell
Follicular
painless waxing and waning adenopathy
localized
cure only radiation
Diffuse large B
MC NHL in adults
single rapidly growing mass
high cure w/ R-CHOP
Burkitt
starry-sky appearance on bx
jaw lesion on Africa
abdominal mass in Americas
assoc w/ EBV
assoc w/ t(8;14) transloc
aggressive chemo
Mantle
cd5+ rarest form
T-cell
Adult T cell
may progress to ALL
presents w/ cutaneous lesion
caused by HTLV
assoc w/ IV-DA
Mycosis Fungoides
T-cell lymph of skin
cutaneous eczema like lesion and pruritus
cerebriform lymphoid lesions on bx
may progress to sezary syndrome of Tcell leukemia
R-CHOP
rituximab cyclophosphamide doxorubicin vincristine
prednisone
ABVD
adriamycin
bleomycin
vinblastine
dacarbazine
NHL
only 10% localized
more likely to involve extranodal tissue
CNS involvement is more likely