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Disease

AML M0
AML M1
AML M2
M3
M4
M5
M6
M7
FLT3
KIT
WIlms Tumor
NPM1
CEBPA
ALL

Other Name

Acute Promyelocytic
(APML)
Acute Myelomonocytic
Acute Monocytic
Acute Erythroleukemia
Acute Megakaryocytic

Catagory

Predominant Cell

AML
AML
AML
AML

Myeloblast
Myeloblast
Myeloblast

AML
AML
AML

Myeloblast, Monocytes
Monocytes
Dysplastic Erythroid,
myeloblasts

AML
AML
mut
AML
mut
AML
mut
AML
mut
AML
mut
ALL

w
w
w
w
w

gene
gene
gene
gene
gene

Lymphocytes, smudge
cells

CML

CML

Mature Myeloid lineage


cells
B cells

Adult T Cell leukemia

ATLL

CLL

13
4
11
5

B cells

CLL

PLL
HCL
TPLL

t(8:21)
t(15:17)

Chrom
Chrom
Chrom
Chrom

CLL

B Cell prolymphocytic leukemia


Hairy Cell Leukemia
T cell prolymphocytic leukemia

Genetic
Change

Prolymphocytes

CD4

T cell Large Granular lymphocyte


leukemia
Sezary Syndrome

CLL

Granular Lymphocytes
T cell

MZL/MALToma

NHL

post gernminal center


memory B cells

philadelphia
chrom
t(9:22)

Splenic Marginal Zone Lymphoma


Nodal Marginal Zone Lymphoma

NHL
NHL

Follicular Lymphoma

NHL

Mantle Cell Lymphoma

NHL

LBCL- Centroblastic

NHL

LBCL- Immunoblastic

NHL

LBCL- Tcell rich

NHL

Anaplastic LBCL

NHL

Thymic LBCL

NHL

Primary CNS Lymphoma

NHL

Primary Effusion Lymphoma


Diffuse LBCL

NHL
NHL

Burkitt Lymphoma

NHL

B cells

Angioimmunoblastic Large Cell


Lymphoma

NHL

Plasma cells,
lymphocytes, eosinophils

Mucosis Fungoides

NHL

Hepatosplenic T cell Lymphoma


Lymphocyte Predominance HL

NHL
HL

Mixed Cellular HL

HL

lots of lymphocytes w
some tissue macrophages
RSC

Lymphocyte Depleted HL

HL

RSC

Monocytoid B

deletion
7q21
t(14:18) bcl2
and cmyc
t(11:14)
cyclinD

B cells w mixed in T cells

cMyc
t(8:14)

trisomy 8

Nodular Sclerosing HL

HL

Nonspecific Follicular Hyperplasia

Benign

Toxoplasmosis Lymphadenitis

Benign

Syphilis Follicular Hyperplasia

Benign

Granulomatous Lymphadenitis

Benign

Kikuchi Disease

Benign

Sacoidosis

Benign

Cat Scratch

Benign

Lymphogranuloma venerum

Benign

HIV related Hyperplasia

Benign

Infectious Mono

Benign

Post Vaccinial Lymphadenitis


Dilantin Hypersensitivity

Benign
Benign

warthin finkeldey cells


(multiple nuclei
eosinophilic intranuclear
inclusions)

Viral Lymphadenitis

Benign

Rheumatoid Arthritis

Benign

SLE
Castlemans

Benign
Benign

Rosai-Dorfman

Benign

Histiocytes

Kimuras

Benign

Histiocytes

Whipples

Benign

Foamy Macrophages

Virus Associated Hemophagic Syndrome

Benign

Bland Macros

Dermatopathic Lymphadenitis

Benign

pigment laden macros


B cells

FAS(CD95)
caspase 10

RBC, granulocytes, plts

Jak2

Autoimmune Lymphoproliferative
Syndrome

ALPS

Benign

Mycocutaneous Syndrome

Kawasaki Disease

Benign

P Vera

MPD

Russel bodies

Areas
found
Marrow
Marrow
Marrow
Marrow
Marrow
Marrow
Marrow

Markers

Key morphology

Few Granules
Few Granules
FISH test
Auer Rods,
Hypergranular
Non specific esterase Vacuoles in cytoplasm
Blue cytoplasm

Marrow
Marrow
Marrow
Marrow
Marrow
Marrow
TdT+, CD19+, CD10

Prognosis

BM, spleen

CD20, no CD5
TRAP stain
CD3

ATRA

H pylori

general vague
symptoms

Bad

Bad
Bad
Bad
Good
Good
No auer rods, almost no Good: 2-10 yo,
cytoplasm, dense
diploidy. Bad: very
chromatin
young, philly chrom

Anemic, Bone pain,


hepatosplenomegaly
none,
asymptomatic, vague
alkylating,
symptoms
fludarbabine

basophilic myeloid cells managed, never


cured

imatinab

splenomegaly, purpura,
anemia, priapism,
fatigue

look like they have hair


Hepatosplenomegaly,
lymphadenopathy, skin
lesions
clover leaf and flower
nuclei

CD3, no CD4 or CD8

Clinical Presentation

Good

Periphery, LN Cd20, Cd23, Cd5

stain for LAP

Therapy

Large, granules
criboform nuclei

skin lesions,
lymphadenopathy,
hypercalcemia
Red patches all over

marrow,
blood

villous projections
neutrophil infiltation in
marginal zones
bulging follicles

aggressive
CVP,
Rituximab

small cells
indented cells
immunodeficiecy,
autoimmune
comorbidities

aggressive

large vesicular nucleus,


nuclear huf
difuse with interstitial
fibrosis
Large bizzare cells
Resp distress, can
impinge on vena caa
Seizures, mental status
change

HIV pts
HIV pts HHV8
aggressive
CD10 BCL6

Lipid vacuoles, large


macrophages, Starry
sky
prominent vascularity

criboform nuclei
sinusoidal infiltration
Cd15 neg, CD30 neg, popcorn cells, pufy
CD20+
nuclei on RSC
heterogenous cellular
infiltrates
very few lymphocytes

R-CHOP

aggressive

B symptoms present
when disease is
advanced

not too aggressive


unless let go
aggressive
Great

skin lesions

Rituximab
ABVD,
Stanford 5
ABVD,
Stanford 5

lower
cervical,
supraclavicul
ar,
mediastinal
LN

Lacunar RSC,
collagenic fibrous
bands

unilateral
posterior LN

follicular hyperplasia,
histiocytes, pink pufy
macrophages, maybe a
cyst

Good

ABVD,
Stanford 5

coughing, vena cava


compressed

Variation in sizes of
follicles, tingible body
macrophages

surrounds blood
vessels, histiocytes,
capsule, spirochetes

macrophages w C
shaped nuclei,
monocytes w round
nuclei

bartonella

chlamydia

Fever

ateroid bodies,
schaumen bodies
(laminar concretions)
calcium oxalate
crystals
follicular hyperplasia,
granuloma w
pallisading
macrophages
follicular hyperplasia,
granuloma w
pallisading
macrophages
from hyperplasia to
involution to depletion
resembles lymphoma

will have abnormal liver


function test
resembles mono
fever, rash,
eosinophilia

monocytes and
lymphocytes with
macrophages (looks
like burkitts)

S100

interfollicular
plasmacytosis
Necrotic Debris
Onion skin and
lollipops, sheets of
plasma
cells
Sinus histiocytes

fevers, neutrophilia,
high ESR
fevers, neutrophilia,
high ESR
malabsorbtion in GI,
weight loss, tetani,
seizures, bruising

Sinus histiocytes
Trooheryma whippelii Foamy macros

CD5 B cells

Bland macros, ingest


rbc, neutrophils, plts
pigment laden macros,
paracortical expansion
paracortical follicular
hyperplasia

anemia, petichiae, look


like leukemia
lymphoma like/
mycosis fungoides like
lymphadenopathy,
splenomegaly,
hypergammaglobuline
mia
conjunctivitis, coronary

absence of follicles

artery necrosis and


thrombi
too many RBC

Phlebotomy

asymptomatic to
splenomegaly,
hyperviscocity, buddchairi syndrome,
pruritis

Age

Sex

Prevalence

Adult
Adult
Adult
Adult

Other

t(11:17) ATRA resistant

Adult
Adult
Adult
Adult
Tyr Kinase receptor
Tyr Kinase receptor

Children

adult

Men

70 Men

Most
common
leukemia in
Adults

Rule out HIV, mono,


pertussis

Rare

men

Huge in Japan and


carribean. HTLV1
related
rare
leukemia form of
mycosis fungoides

Richter Transformation: Turns into LBCL

older

females

50-60

white peeps

most
common

Rare

ALK+ means good


prognosis

30s women

Most
common
Need Intrathecal
Chemo, therapy results
in sterility

adult
young

black males
40s

over 50
older

Men
least
common HL

young

women

common

Sarcoid, kikuchi, cat


scratch, venerum
young

women

middle age

men

increases risk of
lymphoma
in young childrenheart attack
adult

males

rare

Drug

Subclass

Class

Mechlorethamin N Mustards
e

Alkylating

Alkylates Guanine,
cross links strands

Cyclophosphami N Mustards
de

Alkylating

Metabolites damage
DNA

Ifosfamide

N Mustards

Alkylating

Chlorambucil

N Mustards

Alkylating

Busulfan
Carmustine

Alkyl
Alkylating
Sulfonates
Nitrosoureas Alkylating

Cisplatin

Metal Salt

Oxaliplatin
Doxorubicin

Bleomycin
Methotrexate

MOA

Stage
Effective
Not CCS

MOR

Tx for

Decrease
Permeability

HL

Not CCS

Decrease
Permeability,
increase repair

BL, Breast

Metabolites damage
DNA

Not CCS

Decrease
Permeability,
increase repair

BL, Breast

Metabolites damage
DNA

Not CCS

Decrease
Permeability,
increase repair

Leukemia/Ly
mphoma

Not CCS
crosslinks and
alkylates especially
in replicating cells

Not CCS

CML
Unknown

Alkylating

HL, NHL,
Brain,
leukemia

Form covalent bond G1, S, resting increase


in DNA strands
glutathione
Metal Salt
Alkylating
Form covalent bond G1, S, resting increase
in DNA strands
glutathione
Anthracyclin Cytotoxic AB Intercalation of DNA, S, G2
Very little
es
Bind to cell
membranes,
generate ROS

Solid Tumors

Cytotoxic AB Scission of DNA by


G2
ROS
Folate Antag Antimetabolit inhibits dihydrofolate S
es
reductase, results in
polyglutamation, cell
functions fail

HL,
testicular,
Lung
Lots and Lots

drug efflux
nonprolif cells
immune, enzyme
changes

Solid Tumors
Lots and Lots

Mercaptopurine Purine
Analog

Antimetabolit purine analog added S


es
to DNA, and syn
terminated

Cannot transform
drug to active
form

Cytarabine

Antimetabolit Inhibits DNA pol


es

change in enzyme Leukemia

Pyrimadine
Analog

Leukemia

5-Flurouracil

Pyrimadine
Analog

Antimetabolit inhibits thymidylate


es
synthetase (stops
DNA syn)

cells lose ability to Solid Tumors,


convert 5FU to
Colon CA
5GdUMP

Vincristine

Vinca
Alkaloid

Plant Derived freeze cells in


metaphase by
binding tubulin

drug efflux

Rapidly
dividing
tumors

Vinblastine

Vinca
Alkaloid

Plant Derived freeze cells in


metaphase by
binding tubulin

drug efflux

Rapidly
dividing
tumors

Etoposide

Topoisomera Plant Derived Blocks TopoII, DSB


se II Inhib
prevalent
Taxanes
Plant Derived Bind tubulin,
promote
polymerization, cell
dies, cant break it
down
Enzymes
Plant Derived destroys asparagine
Estrogens
Hormones
Binds estrogen
receptors but does
not create a signal

S, G2

P-glycoprotein

G2, M

P-glycoprotein

Not CCS
Not CCS

ALL
Breast

LH

Not CCS

Prostate

Paclitaxel

Asparaginase
Tamoxifen

Leuprolide

Hormones

Binds GnRH, inhibits


LH, FSH release

Breast,
Ovarian

ADR

Notes

Myelosuppression
, Pain at injection,
N/V
alopecia, N/V,
Hemorrhagic
Cystitis

Taken Orally,
P450 metab

Neurotox

Taken Orally,
P450 metab

Hematologic Tox

Pulmonary
Fibrosis
Hemapoeietic
Depression,
Renal Tox

Imatinib
used more

Nephrotox (renal
tube dmg)
Nephrotox (renal
tube dmg)
Cardiotox

PULMONARY
FIBROSIS
Lots of drug
interations

Weak acid,
should
alkalize urine

Bone marrow
suppression
NEUROTOX

Bone marrow
suppression
2ndary leukemia
NEUTROPENIA

Hyperglycemia
menstrual
abnormalities

Drug
MOA
Target
Thrombin
Heparin
Potentiates antithrombin III
Antithrombin III
Bivaliruden Reversible Thrombin inhibitor
Lepirudin
Inhibts thrombin (irreversible
Argatroban Blocks thrombin related rxn
(Fibrin, V, VIII, XIII)
Warfarin
Vit K antagonist

thrombin
Free and Clotted
thrombin
Vit K

Dabigatran Inhibts thrombin


Thrombin
Aspirin
Irreversible COX binding
Clopidogrel Irreversible block of ADP
ADP receptors
receptors on Plt
Ticlopidine Irreversible block of ADP
AdP receptors
receptors on Plt
Prasugrel
Blocks P2Y12 receptor, no Plt P2Y12 ADP
activation or aggregation
receptor
Ticagrelor
reversible P2Y12 block
P2Y12 ADP
receptor
Dipyridamo Increases cAMP, prevents
phosphodiesterase
le
aggregation
Prostacycli Increases cAMP, prevents
stims adenylate
n
aggregation
cyclase

Streptokina activates plasminogen into


se
plasmin
Urokinase
activates plasminogen into
plasmin
TPA
activates plasminogen into
plasmin, cleaves fibrin
crosslinks

plasminogen

Aminocapro binds plasminogen and


id
plasmin, prevents fibrin
breakdown

plasminogen,
plasmin

Admin
Used for
Topical Powder Burns
IV
DVT, PE
IV
percutaneous
coronary angioplasty
IV
Pts with HIT
IV
Pts with HIT

Side effects
Random hemorrhage
Random hemorrhage
Random hemorrhage
Random hemorrhage

PO

Afib

Random hemorrhage

PO
PO
PO

Hip and Knee


surgery
Afib

Random hemorrhage

PO
PO

Acute Cerebral
ischemia
Angioplasty

bleeding, n/v, diarrhea,


neutropenia
TTP, bleeding

PO

CV

Resp distress, absnormal


cardiac rhythm

PO

prothetic heart
valves

TTP

PO

plasminogen

CVA

plasminogen,
fibrin

CVA

IV, PO

myopathy necrosis

Monitoring

Other

PTT
Very short T1/2
PTT

PT

Very narrow
therapeutic range

used in combo with


warfarin

Systemic activator
systemic activator
Clot specific

stops body from


breaking down
formed clots, does
not inhibit new clots