Hematologic Malignancies
Core concepts
Understand leukaemia, lymphoma, myeloma, and myelodysplastic syndrome. Acute leukaemia: AML (cytogenetics, FLT3, IDH, APL with ATRA/DIC), ALL (Ph+, CNS prophylaxis). Chronic: CML (BCR-ABL, TKIs), CLL (BTK/BCL-2 inhibitors). Lymphoma: Hodgkin (Reed–Sternberg, ABVD, PET-adapted), non-Hodgkin (DLBCL, follicular, mantle, Burkitt), Ann Arbor staging, IPI. Myeloma: CRAB criteria, M-protein, free light chains, proteasome inhibitors/IMiDs/anti-CD38, autologous transplant. MDS: cytopenias, blast percentage, hypomethylating agents. Know transplant (autologous vs allogeneic), GvHD, tumour lysis syndrome, febrile neutropenia, and CNS prophylaxis. Recognise molecular monitoring (BCR-ABL, MRD).
Traps
Questions test which translocation defines which disease (t(15;17) APL, t(9;22) CML/Ph+ ALL, t(8;14) Burkitt, t(14;18) follicular). Distinguish Hodgkin vs NHL treatment paradigms. Do not give ATRA without confirming APL; do not miss DIC in APL. Watch tumour lysis syndrome prophylaxis in high-burden disease.
Worked example / rule of thumb
A young patient with pancytopenia, circulating blasts, and t(15;17): start ATRA immediately (do not wait for confirmation) plus arsenic trioxide/chemotherapy; monitor for DIC and differentiation syndrome. Rule of thumb: APL is a medical emergency - ATRA first, confirm later.