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Thera IX > 19 Lymphoma Kasravi > Flashcards

19 Lymphoma Kasravi Flashcards

1
Q

What are the signs and symptoms of Non-Hodgkin’s Lymphoma (NHL)?

A

“B” Symptoms (20%) - Fever, Weight loss, Drenching night sweats. Lymphadenopathy (65%) - Peripheral (most commonly cervical), 20% mediastinal. Fatigue, pruritus, malaise. Bone marrow involvement (33%). Extranodal

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2
Q

What is use in the Ann Arbor Staging of Non-Hodgkin’s Lymphoma (NHL)?

A

“B” symptoms. Bulky disease (tumor mass > 10cm in greatest diameter, localized (stage I or II) w/ bulky disease are treated as advanced disease (stage III or IV)

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3
Q

What are used to categorize patients in the different risk categories for Non-Hodgkin’s Lymphoma (NHL)?

A

Age > 60. Stage III or IV. >2 extranodal sites. Performance status > 2. LDH > norma

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4
Q

What are the characteristics of Low grade NHL?

A

Cure if rare. Median overall survival (5-8 years). Prognosis depends on (age, bulk of disease)

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5
Q

What are the different treatment options for Low Grade NHL?

A

Observation. Radiation for localized. Chemotherapy for disseminated

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6
Q

What are the ADRs with Prednisone?

A

Insomnia (take dose QAM). Hyperglycemia. Increase appetite. Indigestion, gastritis

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7
Q

What dosage forms does Prednisone come in?

A

Oral solution: 1mg/mL. Concentrate oral solution (5mg/mL). Tablet: 1, 2.5, 5, 10, 20, 50mg. Take with food

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8
Q

What are the ADRs with Cyclophosphamide (Cytoxan)?

A

Hemorrhaghic cystitis (at high dose) - MESNA, hydration. Alopecia, Myelosuppression (leukopenia), infertility

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9
Q

What is the Emetogenicity like for Cyclophosphamide (Cytoxan)?

A

High

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10
Q

What is the dose adjustment like for Cyclophosphamide (Cytoxan)?

A

Hepatic: no official recommendation. Renal < 10: 75% dose

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11
Q

What dosage form does Cyclophosphamide (Cytoxan) come in?

A

Injectable, oral tablet 25, 50mg

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12
Q

What is Fludarabine (Fludara) indicated for?

A

CLL (NHL not FDA approved, but commonly used)

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13
Q

What are the ADRs with Fludarabine (Fludara)?

A

Myelosuppression (leukopenia, thrombocytopenia). Increased risk for opportunistic infection d/t decreased CD4 counts, pneumonia. Fever, fatigue, edema

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14
Q

What is the Emetogenicity like for Fludarabine (Fludara)?

A

Very low

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15
Q

What is dose adjustment like for Fludarabine (Fludara)?

A

CrCl 30-70: 20% dose reduction. CrCl < 30: not recommended

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16
Q

How is Fludarabine (Fludara) administered?

A

Infusion over 30-60 minutes

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17
Q

What are the ADRs with Mitoxantrone (Novantrone)?

A

Discoloration of urine, saliva, tears, and sweat (blue-green for 24 hrs post). Cardiotoxicity (CHF, decreased cardiac function (LVEF)

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18
Q

What is the Emetogenicity like for Mitoxantrone (Novantrone)?

A

Moderate

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19
Q

What is the dose adjustment like for Mitoxantrone (Novantrone)?

A

Hepatic (no official recommendations). T.bili 1.5-3.0: 50% dose reduction. T.bili > 3.0: 75% dose reduction

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20
Q

What is a caution with Mitoxantrone (Novantrone) use?

A

Vesicant (management): DMSO, cold. Classified as an irritant

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21
Q

What is Chlorambucil (Leukeran) used for?

A

CLL, HD, NHL

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22
Q

What are the ADRs with Chlorambucil (Leukeran)?

A

Rash, myelosuppression (DLT). Transient increase in LFTs, hyperuricemia. Less common: hepatotoxicity, seizure, drug fever, pulmonary fibrosis

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23
Q

What is the Emetogenicity of Chlorambucil (Leukeran)?

A

Very low

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24
Q

How should Chlorambucil (Leukeran) be taken?

A

On empty stomach. BA decreased by 10-20% when taken with food

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25
Q

What are the treatment options for Aggressive NHL?

A

Localized: chemo +/- radiation. Disseminated: combination chemotherapy. R-CHOP: 1st line

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26
Q

What does R-CHOP stand for?

A

R: Rituximab (Rituxan). C: Cyclophosphamide (Cytoxan). H: Hydroxyl Daunorubicin. O: Vincristine (Oncovin). P: Prednisone

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27
Q

How is Rituximan (Rituxan) dosed in R-CHOP?

A

375mg/m2 IVPB day 1

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28
Q

How is Cyclophosphamide (Cytoxan) dosed in R-CHOP?

A

750mg/m2 IVPB day 3 (or day 1)

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29
Q

How is Hydroxyl Daunorubicin dosed in R-CHOP?

A

50mg/m2 IVP day 3 (or day 1)

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30
Q

How is Vincristine (Oncovin) dosed in R-CHOP?

A

1.4mg/m2 (max 2mg) day 3 (or day 1)

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31
Q

How is Prednisonse dosed in R-CHOP?

A

100mg/day PO days 3-7 (or days 1-5)

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32
Q

How often is R-CHOP repeated?

A

Repeat cycle every 21 days

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33
Q

What is the MOA of Rituximab (Rituxan)?

A

Monoclonal antibody. Anti-CD20. Chimeric (mouse/human)

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34
Q

What is Rituximab (Rituxan) used for?

A

NHL, RA, CLL

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35
Q

What are the infusion related reactions with Rituximab (Rituxan)?

A

Fever, chills/rigors, angioedema, flushing, HTN. Can premedicate with APAP

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36
Q

What is a BBW for Rituximab (Rituxan)?

A

Tumor Lysis Syndrome (high tumor burden (usually with 1st dose)). Fatal infusion reaction

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37
Q

How is Rituximab (Rituxan) prepared?

A

In D5W or NS, final concentartino 1-4mg/mL

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38
Q

What are the ADRs with Doxorubicin (Adriamycin)?

A

Myelosuppressive (Leukopenia). Urine/saliva/tear discoloration - red/orange. Cardiotoxicity

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39
Q

What is the Emetogenicity like with Doxorubicin (Adriamycin)?

A

Dose dependent. 20-60mg: moderate

40
Q

What does Doxorubicin (Adriamycin) need to be dose adjusted?

A

AST/ALT 2-3x ULN: 75% of dose. >3x or T.bili 1.2-3: 50% of dose. T.bili 3.1-5: 25% of dose

41
Q

What caution should be taken with Doxorubicin (Adriamycin)?

A

Vesicant (management): DMSO or Totect, cold

42
Q

What are the ADRs with Vincristine (Oncovin)?

A

Peripheral neuropathy (DLT). Constipation (DLT)

43
Q

What is Vesicant management like for Vincristine (Oncovin)?

A

Hyaluronidase (Amphadase, Wydase, Vitrase). Warm preferred over cold

44
Q

When does Vincristine (Oncovin) required dose adjustment?

A

Hepatic

45
Q

What is a warning with Vincristine (Oncovin)?

A

DO NOT remove covering until the moment of injection. For intravenous use only. FATAL if given intrathecally

46
Q

What are the ADRs with Etoposide (Toposar, VePesid) - salvage therapy?

A

Hypotension if infused too rapidly. Myelosuppression (leukopenia > thrombocytopenia). Alopecia, asthenia, fever

47
Q

What is the Emetogenicity with Etoposide (Toposar, VePesid)?

A

Mild

48
Q

What does stability of Etoposide (Toposar, VePesid) depend on?

A

Concentration dependent

49
Q

When does Etoposide (Toposar, VePesid) need dose adjustment?

A

Renal, Hepatic

50
Q

What do you need to do when administering Etoposide (Toposar, VePesid)?

A

Use in-line filter with high doses d/t high likelihood of precipitation

51
Q

What are the ADRs with Cytarabine (Cytosar, ARA-C) - salvage therepy?

A

Ocurlar (use opthalmic corticosteroids - Prednisolong (Pred-Forte)). Fever, rash, hyperuricemia. Myelosuppression. Acute increase LFT, mild jaundice. Neurotoxicity - high dose

52
Q

What is the Emetogenicity of Cytarabine (Cytosar, ARA-C)?

A

High

53
Q

What are the ADRs with Cisplatin (CDDP, Platinol)?

A

Neurotoxicity: Peripheral neurotoxicity is dose- and duration-dependent. Myelosuppression. Nephrotoxicity, ototoxicity

54
Q

What is the Emetogenicity like for Cisplatin (CDDP, Platinol)?

A

High

55
Q

What is the stability of Cisplatin (CDDP, Platinol) like?

A

Stable in saline only

56
Q

When does Cisplatin (CDDP, Platinol) need dose adjustment?

A

Renal only

57
Q

What is done for Cisplatin (CDDP, Platinol) as a vesicant?

A

In high dose. Sodium thiosulfate and cold

58
Q

What needs to be monitored while on Cisplatin (CDDP, Platinol)?

A

Renal function, electrolytes, CBC, hearing test, neuro exam

59
Q

What are the ADRs with Ifosfamide (IFEX) - salvage therapy?

A

Alopecia. Confusion, hallucination (avoid with BZD). Myelosuppression. Metabolic acidosis. Hemorrhagic cystitis, hematuria (ALWAYS give Mesna)

60
Q

What is the Emetogenicity of Ifosfamide (IFEX)?

A

Moderate

61
Q

What does Ifosfamide (IFEX) need dose adjustment?

A

Renal if significant impairment. Hepatic: 75% dose reduction if AST > 300 or T.bili < 3

62
Q

What is the MOA of Mesna (Mesnex)?

A

Mesna oxidized to dimesna in blood. Reduced in the kidney back to mesna yielding a free thiol group. Binds to and inactivates acrolein

63
Q

What are the ADRs with Carboplatin (Paraplatin)?

A

Myelosuppression (dose related and dose limiting)

64
Q

What is the Emetogenicity of Carboplatin (Paraplatin)?

A

Moderate

65
Q

What are the DDIs with Carboplatin (Paraplatin)?

A

Nephrotoxic drugs. AGs increase risk of ototoxicity

66
Q

What are the ADRs with Bendamustine (Treanda)?

A

Myelosuppression (DLT), rash, HA, increased bilirubin, peripheral edema, TLS

67
Q

What is the stability of Bendamustine (Treanda) like?

A

Concentration dependent. Stable in NS

68
Q

What should be administered before Bendamustine (Treanda) use?

A

Premedicate to prevent hypersensitivity (APAP, antihistamine +/- corticosteroid)

69
Q

What is the pathogenesis of Hodgkin’s Disease (HD)?

A

Bimodal age distribution (15-45 and > 50. More common in caucasian). Presence of Reed-Sternberg (large size, binucleated, cellular origin characteristic of macrophage and lymphocyte)

70
Q

What is Stage I HD?

A

Involvement of single lymph node region or single extralymphatic site

71
Q

What is Stage II HD?

A

Involvement of two or more lymph node regions on same side of diaphragm; may include localized extralymphatic involvement on same side of diaphragm

72
Q

What is Stage III HD?

A

Involvement of lymph node regions on both sides of diaphragm; may include spleen or localized extranodal disease

73
Q

What is Stage IV HD?

A

Diffuse extra-lymphatic disease (e.g. in liver, bone marrow, lung, skin)

74
Q

What is the treatment strategy for Stage IA or IIA HD (with favorable prognostic factors)?

A

Radiation. Radiation +/- chemotherapy

75
Q

What is the treatment strategy for Stage IB or IIB HD (with bulky disease)?

A

Chemotherapy + Radiation. Combination chemotherapy

76
Q

What is the treatment strategy for Stage III or IV HD?

A

Chemotherapy +/- radiation

77
Q

What is the treatment strategy for HD relapse?

A

SCT (stem cell transplant). Salvage therapy

78
Q

What is the gold standard treatment option for HD?

A

ABVD (used to be MOPP)

79
Q

What does MOPP stand for?

A

M: Mechlorethamine (Mustargen). O: Vincristine (Oncovin). P: Procarbazine (Matulane). P: Prednisone

80
Q

What does ABVD stand for?

A

A: Doxorubicin (Adriamycin). B: Bleomycin (Blenoxane). V: Vinblastine (Velban). D: Dacarbazine (DTIC). Days 1 and 15 every 28 days for 6-8 cycles

81
Q

What needs to be done before Bleomycin (Blenoxane) administration?

A

Test dose. Monitor vital signs, wait 1 hr prior to giving dose

82
Q

What are the ADRs to look out for with Bleomycin (Blenoxane)?

A

Pulmonary fibrosis (cough, dypsnea, increased toxicity with O2 treatment up to 1 year after). Monitor PFT. Acute frebrile reaction. Dermatological SE

83
Q

What is the emetogenicity like for Bleomycin (Blenoxane)?

A

Very low

84
Q

When does Bleomycin (Blenoxane) need to be dose adjusted?

A

Renal

85
Q

What is the maximum cumulative lifetime dose of Bleomycin (Blenoxane)?

A

400 units

86
Q

What are the ADRs with Vinblastine (Velban)?

A

Myelosuppressive (Leukopenia)

87
Q

What is the Vesicant management for Vinblastine (Velban)?

A

Hyaluronidase (Amphadase, Wydase, Vitrase). Warm/cold

88
Q

When does Vinblastine (Velban) need dose adjustment?

A

Hepatic

89
Q

What is a warning with Vinblastine (Velban)?

A

DO NOT remove covering until the moment of injection. For intravenous use only. FATAL if given intrathecally

90
Q

What are the ADRs with Dacarbazine (DTIC)?

A

Myelosuppressive. Irritant (possible vesicant). Infusion related reaction (painful, dexamethasone as premedication, hot pack)

91
Q

What is the Emetogenicity of Dacarbazine (DTIC)?

A

High

92
Q

How does MOPP compare to ABVD?

A

MOPP involved with more: Hematological toxicity, Infection risk, Neuropathy, Secondary leukemia, Infertility

93
Q

What is the MOA of Brentuximab Vetodin (Adcetris)?

A

Antibody drug conjugate (Anti-CD30) with 3 components: 1) CD30-specific chimeric IgG1 antibody - cAC10. 2) Microtubule-disrupting agent - MMAE. 3) Protease cleavable dipeptide linker

94
Q

What are the common ADRs with Brentuximab Vetodin (Adcetris)?

A

Rash, BMS, fatigue, peripheral neuropathy

95
Q

What are the serious ADRs with Brentuximab Vetodin (Adcetris)?

A

Anaphylaxis, PML, pulmonary toxicity, SJS

96
Q

What are the potentially fatal late complications of HD treatment?

A

Acute myelomonocytic leukemia. Diffuse, high-grade NHL. Solid tumors (mostly lung and breast cancer). Bacterial sepsis post splenectomy or spleen irradiation

97
Q

What are the serious late complications of HD treatment?

A

Myocardial damage secondary to radiation/anthracyclines. Lung fibrosis d/t radiation plus bleomycin. Sterility in men and women. Growth abnormalities in children and adolescents. Opportunistic infections

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