Oncology
Hematologic Malignancies
Oncology

Hematologic Malignancies

Leukemias, lymphomas, multiple myeloma — key distinguishers.

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Leukemias

TypeDemographicsFeaturesTreatment
ALLKids (peak 2–5); also elderlyBone pain + fevers + lymphadenopathy + blasts; CNS spread; tdT+, Philadelphia chromosome worstMulti-agent chemo with CNS prophylaxis; CR rates >90% in kids
AMLAdults; t(15;17) APL: Auer rods + DICAnemia, thrombocytopenia, blasts >20% with Auer rodsCytarabine + anthracycline; APL → ATRA + arsenic
CLLElderlySmudge cells; lymphocytosis; warm AIHA; hypogammaglobulinemiaObserve early; ibrutinib or chemoimmunotherapy for symptoms
CMLAdults 40–60Philadelphia chromosome (BCR-ABL t(9;22)); leukocytosis with left shift; basophilia + splenomegalyImatinib (tyrosine kinase inhibitor) — dramatic response
Hairy cell leukemiaMiddle-aged menPancytopenia + splenomegaly; TRAP+ cells with hair-like projectionsCladribine (single course)

Lymphomas

TypeFeaturesTreatment
HodgkinPainless cervical LAD + B symptoms (fever, night sweats, weight loss) + Reed-Sternberg cells (owl eyes); EBV association; bimodal ageABVD chemo ± RT; usually curable
Non-Hodgkin (NHL)Many subtypes; nodal or extranodal; B-cell most; t(14;18) follicular = BCL-2; Burkitt = starry sky + t(8;14) c-MYCR-CHOP for DLBCL; rituximab if CD20+
Mycosis fungoidesCutaneous T-cell lymphoma; patches/plaques/tumors; Sezary syndrome = leukemic phaseTopical, phototherapy, systemic

Plasma cell dyscrasias

DiseaseFeaturesTreatment
Multiple myelomaCRAB: hyperCalcemia + Renal failure + Anemia + Bone lesions (lytic, 'punched out'); M-spike on SPEP; Bence Jones proteins (light chains in urine); rouleauxBortezomib + dexamethasone ± lenalidomide; auto stem cell transplant
MGUSAsymptomatic M-spike <3 g/dL; 1%/yr → MMObservation
WaldenströmIgM hyperviscosity (blurry vision, headache, mucosal bleeding); lymphoplasmacytic lymphomaPlasmapheresis acute; rituximab

High-yield pearls

  • Auer rods = AML (especially M3 APL — risk of DIC)
  • Philadelphia chromosome: GOOD in CML (imatinib responds), BAD in ALL
  • Reed-Sternberg cells = Hodgkin
  • Burkitt 'starry sky' + t(8;14) c-MYC; tumor lysis risk → IV fluids + allopurinol + rasburicase
  • Tumor lysis syndrome: hyperK + hyperphosphatemia + hyperuricemia + hypocalcemia + AKI
  • Smudge cells + lymphocytosis in elderly = CLL
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