Phillip Alanis M.D.
LEUKEMIA
ALL (agranular) B lymph>>>>T lymph
General:
MC Leukemia in Kids (0-15), blast crisis- patient will present
with fever, bone pain, infection, bleeding anemia and infection,
Associated with Downs Syndrome. Can present with
mediastinal mass causing SVC-syndrome
KEYS:
TDT - marker of lymphoblast cytoplasm
CALLA - in cells that are CD10+ (early B-cells)
PAS - this detects polysaccharide, ALL blasts have large
vacuoles full of sugars
Rx:
Chemo- Doxorubicin-topo II inhibitor (cardio toxicity)
Has the propensity to hide in the CNS so patients should be treated
prophylactically with intrathecal MTX (folic acid analog) or Ara-C
(pyrimidine analog)
CML (granular)
General:
Ages 30-50. Patients usually asymptomatic and it is found
incidentally. Peripheral increase of WBCs leading to
hyperviscosity syndrome. May develop blast crisis if it goes
on years w/o rx
KEYS:
Philadelphia Chromosome: t(9;22) translocation leading to
over activity of tyrosine kinase (BCR-ABL).
LAP score DECREASED vs. leukemoid rxn
Rx:
Imatinib- tyrosine kinase inhibitor
AML (granular)
General:
Ages 15-30, also a blast crisis so patient will present with
similar symptoms as in ALL, however look for DIC, also
associated with Downs. Very high WBC (50,000-100,000)
KEYS:
Myeloperoxidase- we are in myeloid lineage
LAP score DECREASED vs. leukemoid rxn
t(15;17)-> M3 subtype, if these cells are destroyed the Auer
Rods can wreck havoc on the patient leading to DIC
Rx:
Chemo- Doxorubicin-topo II inhibitor (cardio toxicity),
Prednisone and allopurinol due to high incidence of Tumor
Lysis Syndrome.
M3- All-Trans Retinoic Acid
CLL (agranular) B lymph>>>> T lymph
General:
Old patients >60 yo, Patients are also usually asymptomatic
average survival w/o rx is ~12 years
Well differentiated with elevated WBC (20,000)
Also prone to hyperviscosity syndrome
KEYS:
Smudge Cell- cytoskeleton of cell is fragile
CD 19, CD 20, and CD 21 mature B-cell markers
CD 5 unique as this is usually seen in t-cells
Absolute lymphocyte count > 50
Diffuse Lymphadenopathy
Rx:
If old or Donor = No Rx
If old and symptomatic = Chemo (Chlorambucil alkylation in
dna)
If young and donor = BM Transplant
 Phillip Alanis M.D.

LYMPHOMA B-Symptoms = Fever, night

sweats and/or wt loss
Nontender Lymphadenopathy (
B symptoms)

Excisional Biopsy

+ RS - RS

Hodgkins Non-Hodgkins
Lymphoma Lymphoma

RS cells have 2 Owls Eyes

Extra nodal disease more
Bimodal distribution (15-35 common (Similar to CLL)
and >55)
Staging Spreads Non-contiguously
Associated with EBV
Possible CD20 +
Spreads anatomically
CD 15 x 2 owl eyes= CD 30

Follicular Lymphoma Burkitts Lymphoma

I One group of lymph
Older patient Younger patient
nodes involved
BCL-2 C-myc
II >one group of lymph
t(14;18) leading to t(8;14)
nodes involved on
same side inhibition of apoptosis Starry sky appearance
III >one group of lymph Associated with EBV
nodes involved on
opposite side
IV Diffuse Disease in
Hodgkins Lymphoma Non-Hodgkins Lymphoma
(blood and bone marrow)
Adriamycin/Doxorubicin Rituximab

Bleomycin Cyclophosphamide
A = No B Symptoms
B = Positive B Symptoms Vinblastine Hydroxydoxorubicin

Dacarbazine Oncovorin

Prednisone