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Leukemias and Lymphoma

Leukemias are malignancies beginning in a hematopoietic stem cell.

leukemias contain one or more somatic mutations leading to their transformation.

Leukemias are white cells located in the blood or bone marrow

acute leukemias tend to involve blast cells or their equivalents
chronic leukemias are more mature cells

acute myelogenous leukemia (AML) - 40%

chronic myelogenous leukemia (CML) - 15%

acute lymphocytic leukemia (ALL) - 11%

chronic lymphocytic leukemia (CLL) - 30%

other - 4%

pediatrics

Lymphomas are lymphocyte proliferations which originate in a solid tumour of the reticuloendothelial system.They can begin in the lymph nodes, spleen, liver, or bone marrow.

lymphoma staging:

Stage I: single nodal region or lymphoid structure

Stage II: 2 or more node regions, on the same side of diaphragm

Stage III: nodes on both sides of diaphragm

Stage IV: extralymphatic involvment

A: no B symptoms

B: fever, night sweats, >10% weight loss in past 6 months

Monoclonal gammopathy

monoclonal protein = paraprotein

may be in serum or urine
intact Ig or light chain
caused by clonal expansion of plasma cells or B lymphocytes

MGUS (monoclonal gammopathy of unknown significance)

fairly common
relatively low M protein
no lytic lesions or problems with bone marrow
no immunosuppression
asymptomatic, other than rare peripheral neuropathy

multiple myeloma

Waldenstrom's macroglobulinemia

IgM, with marrow infiltration of lymphoplasmacystoid cells
can cause hyperviscosity syndrome: fatigue, HA, decreased LOC, visual change, Raynaud's