2.9 advantages in treatment of haem cancers Flashcards
What imaging do we use to predict patients with HL will respond to standard chemo?
interm PET scanning
how does radiotherapy work?
DNA damage
initiates apoptosis
- single treatment in early disease
- combo with chemo in extensive disease
long term toxicity of radiotherapy
pulmonary fibrosis
cardiomyopathy
malignancy- breast, lung
premature atherosclerosis
need to fractionate dose and reduce field size
Treatment for DLCL (diffuse large b-cell lymphoma)
CHOP regimen
cyclophosphamide
doxorubicin
vincristine
prednisolone
late effects of chemotherapy
cardiomyopathy infertility premature gonadal failure secondary MDS leukaemia
Hodgekin’s lympthoma
A= absence of B= presence of more of: -fever >38 -night sweats -weight loss >10% body wt in 6 months
How do you cure early stage hodgkin’s disease
cured with chemotherapy- 6 cycles or
radiotherapy- mantle or inverted Y fields alone
or combined
how do you differentiate between metabolically active tissue and fibrosis
PET
if PET becomes negative after 2 of 6 planned ABVD (chemo and radio) there is a 90% chance of never relapsing
TRUE
enhances natural immunity
interferon alpha
this biological modifier alters the microenvironment of HL
thalidomide
lenalidomide
this enhances levsl of anti-proliferative molecules by blocking degradation (protesome inhibitor)
velcade
what cancers can you use interferon alpha for?
chronic phase CML hairy cell leukaemia renal carcinoma melanoma some lymphomas
what are the side effects of interferon A?
flu life
depression
neurological
where does thalidomide work?
anti-VEGF, blocks IL6 anti-TNFa
anti-IFN-y
side effects of thalidomide
teratogenic
somnolence
neurological
thromboembolism
lenalidomide less toxic and greater efficacy
how does velcade-bortezomib work?
blocks ubiquitination of proteins before destruction by proteosome
results in accumulation of I-kb, so reduced NK-kb
molecular targetting
imatinib
monoclonal antibody therapy
rituximab
negative prognostic indicators of high grade NHL
older >60
bulky disease
poor WHO performance status
which b-cell malignacies have the highest expression of CD20?
hairy cell
large cell
burkitts lymphoma
marginal zone
how does MabThera work?
helps killer leukocytes and complement bind the CD20 on malignant B-cells
are monoclonal antibodies curative in low grade NHL?
No, but promising.
what is the new gold standard for high grade NHL treatment?
rituximab plus CHOP
