APL and Supportive Care Flashcards
APL
Acute Promyelocytic Leukemia
APL arises from
single translocation like CML
pathogenesis APL
oncologic emergency secondary to rapidly evolving clotting abnormalities and risk for fatal hemorrhage
treatment of APL
All-trans retinoic acid
Arsenic tri-oxide
mechanism ATRA for APL
directly addresses maturation block
mechanism arsenic tri-oxide for APL
Induces degradation of chimeric protein
Induces apoptosis at higher doses by uncertain (and possibly multiple) mechanisms
3 kinds of nausea
Anticipatory
Acute
Delayed (>24 hrs)
2 pathways for nausea-vomiting
peripheral pathway - GI tract release 5HT onto vagal afferent (acute phase)
central pathway - (chronic, delayed) area postrema to vagus nerve w/ substance P
what cancers known for thrombotic diathesis
Pancreas, Breast, Prostate, Bladder, Lung and CNS cancers all well known for thrombotic diathesis
what clotting markers are consistently correlated w/ poor survival
Elevated D-dimer, elevated INR, and other measures of hypercoagulability
most active agent for management of DVT in cancer
Low-molecular weight heparin
clots and therapeutic warfarin
Clots often continue to form in setting of “therapeutic” warfarin
(distinctly inferior way – need LMWH)
tx management of dvt in cancer
Cancer patients should get at least 2 weeks of LMWH, and ideally stay on LMWH until thrombogenic stimulus (e.g. chemotherapy) is removed.
which cancers almost universally affect bone
breast and prostate
bone directed treatment extends survival in what cancers
Myeloma and Breast and Renal Cell (NOT in Prostate)
classic agents for anti-resorptive therapy of bone
bisphosphonate
most potent and most used anti-resorptive therapy of bone at present
zoledronic acid
treatment of constipation: gentle and does not generate gas
polyethylene glycol (miralax)
______ to prevent tearing (with constipation) is quite important
mineral oil
need to replace ____ w/ diarrhea
electrolyte
what do you need to remember with both diarrhea and constipation
fiber
what is extremely useful in tx of diarrhea
tincture of opium
what are useful for quite useful for secretory diarrhea unresponsive to other measures
somatostatin analogues
myelosuppression tx: now available as a recombinant therapeutic peptide
Granulocyte Colony Stimulating Factor (G-CSF)
SE G-SCF
In young people getting only moderately myelosuppressive therapy, the long-acting form causes BAD low back pain. Snee this in the ED.
anemia tx: now available as a recombinant therapeutic peptide
Epo
therapeutic outcome with Epo
Unfortunately, pushing Hgb above 10 is consistently associated with WORSE outcome
BAD
Use of EPO restricted to
The use of EPO for cancer patients is pretty much restricted to transfusion-dependent marrow failure
Two agents FDA approved for refractory ITP
eltrombopag
romiplostim
No routine use of these agents at the moment for chemo-induced thrombocytopenia
