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Acute and Chronic Blood Cancers

Acute and Chronic Blood Cancers. Dilan Patel UT Memphis College of Medicine 2/24/14. Chronic Lymphocytic Leukemia. Patient Population and Presentation Disease of the elderly Assess constitutional B symptoms Smoldering and rarely kills by itself Pathophysiology B-cell mediated

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Acute and Chronic Blood Cancers

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  1. Acute and Chronic Blood Cancers Dilan Patel UT Memphis College of Medicine 2/24/14

  2. Chronic Lymphocytic Leukemia • Patient Population and Presentation • Disease of the elderly • Assess constitutional B symptoms • Smoldering and rarely kills by itself • Pathophysiology • B-cell mediated • Different flavors of disease • Chromosome 17p deletion suggests poor prognosis

  3. CLL Staging • Rai system used in United States • Stage 0: Lymphocytosis • Stage I: Lymphocytosis and lymphadenopathy • Stage II: Lymphocytosis with splenomegaly, possible hepatomegaly • Stage III: Lymphocytosis and anemia • Stage IV: Lymphocytosis and thrombocytopenia

  4. CLL Diagnosis and Treatment • Diagnosis • Flow cytometry • Treatment • Watchful waiting • Chemotherapy backbone of chlorambucil, cyclophosphamide, fludarabine • Targeted therapy • Rituximab/obinutuzumab • Ibrutinib • Idalisib

  5. Chronic Myeloid Leukemia • Essential elements • WBC count elevated, often over 200k • Spill marrow elements into peripheral blood • Characteristic t(9,22) translocation • Targeted therapy with imatinibmesylate • IRIS study: STI571 versus IFN and hydroxyurea • Can progress to acute myeloid leukemia • Poster child for personalized medicine

  6. Acute Lymphoblastic Leukemia • Patient population • Predominantly children with adults having worse prognosis • Pathophysiology • Genetic disease with multiple prognostic markers • Require bone marrow biopsy to diagnose • Treatment • High dose combination chemotherapy • Protocol developed at St. Jude Children’s Research Hospital • Targeted therapy

  7. Acute Myeloid Leukemia • FAB classification • M0-M1: High grade dysplasia • M2: Hard to define • M3: APL with t(15,17) • DIC kills due to brain bleeding • M4: Myelomonocytic • Eosinophilicoften with inversion of chromosome 16 • M5: Monocytic • Previous malignancy association • M6: Erythrocytic • M7: Megakaryocytic with worst prognosis

  8. Acute Promyelocytic Leukemia • Clinical suspicion essential to save patient • Present as aleukemic leukemia with pancytopenia • Death from DIC • Bleeding into brain most common • Early treatment with ATRA • Lo-Coco et al. NEJM 2013 • Tallman Blood 2011

  9. A 65 y/o Hispanic male w/PMHx of alcoholic liver disease, heavy smoking history, DM type II, and possible IV drug use presents with headaches, fever, chills, muscle weakness, and dyspnea. On PE, vitals significant for fever, tachycardia, and tachypnea, chest exam suggests rales bilaterally, no murmurs or S3 gallop, and multiple petechiae on arms and legs. CBC indicates pancytopenia. CT brain suggests possible intracranial bleed. Flu test positive. GCS of 7. Patient admitted to the ICU, intubated, and mechanically ventilated. Which genetic defect is most likely contributing to the patient’s condition? • Inversion 16 • t(9;22) • t(15;17) • t(8;14)

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