Cancer 1: Intro to Cancer Flashcards

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1
Q

what is leukemia ?

A

A blood cancer which arises due to failure of haematopoietic differentiation

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2
Q

What characterises CLL?

A
Clonal disorder of mature CD5+/CD19+ B cells
Tumour in bone marrow, blood & 2o lymphoid tissue
Immune dysfunction
Infection
Autoimmunity
BM failure
Highly variable outcomes.
Incurable with current treatments
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3
Q

How would a patient present with CLL?

A
often discovered on blood test - may be asymptomatic 
enlarged LN
repeat infections 
night sweats and fever 
enlarged sleep 
weight loss 
anaemia
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4
Q

how is CLL diagnosed ?

A

Traditionally CLL diagnosed using the Matutes scoring system

CLL when patients B cells express 4 or 5 of these Antigens such as CD5 CD23 and CD19

Cells small lymphocytes with very little cytoplasm

Smudge cells key indication of blood film.

The problem with the matutes system is that it is difficult to always be sure as non-hodgkin lymphoma’s in leukaemic phase could have a similar phenotype.

Therefore a new system has been bough in:

Clonal so they all express either the kappa or lambda light chain

Important to remember they are CD5/CD19 positive B cells and CD5 is usually a T cell Antigen.

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5
Q

what are the 3 compartments in which CLL reside?

A

LN: Survival
Proliferation
Protective niche ‘hiding place’

BM: Survival
Proliferation
Protective niche ‘hiding place’

Peripheral blood: Survival
No proliferation
More susceptible to apoptosis

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6
Q

What is the prognosis of CLL?

A

CLL is a very heterogenous disease
Some patients need little or no treatment
Some patients will die rapidly without medical intervention

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7
Q

What is the rule of thirds?

A

1/3 have aggressive disease
1/3 later disease progression
1/3 never need treatment.

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8
Q

What are the requirements of a good prognostic marker?

A

Marker(s) that will predict whether patients will respond to treatment
Preferably cheap and easy to perform
must be reproducible
Marker(s) should tell us something about the biology of the disease and preferably represent a tractable therapeutic target.

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9
Q

Describe the staging system for CLL?

A

Binet staging A/B/C
A requires no treatment
B requires treatement only if symptomatic
C requires treatment

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10
Q

why is clinical staging not enough?

A

extremely variable clinical course
clinical stage poorly prognostic for early stage (~70%) and for younger patients
new therapeutic approaches now available - MoAbs, biologics, combinations

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11
Q

describe the role of the IGHV mutation status

A

the B cell receptors do not undergo somatic hypermutation and therefore are moRE promiscuous and have better prognosis if you have the mutation

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12
Q

give some examples of some flow cytometry markers?

A

CD38
CD49d
ZAP70

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13
Q

what is standard treatment for CLL?

if fit without mutation

A

Chemo + antibodies
if they are fit without a 17p del
FCR/ BR/FR/PCR

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14
Q

what is standard treatment for CLL?

if older/unfit without mutation

A

chemo +antibodies

BR

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15
Q

what are the goals of novel therapies

A

develop targeted treatment for toxic cells.
recruit the immune system to fight
help improving the effect of existing disease
induce longer remission

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16
Q

what does ibrutinib help with?

A

blood lymphocytes and lymph nodes decrease

17
Q

list some side effects of ibrutinib

A
thrombocytopaenia 
nuetropenia 
diarrhoea
anaemia 
fatigue 
MSK pain 
URTI
Rash 
nausea 
fever
18
Q

how does CART therapy work?

A

1) T cell collection
2) T cell transfection
3) T cell adoptive transfer
4) Patient monitoring
disease response monitoring using CT scans.

19
Q

how does CART therapy work on a molecular level?

A

target surface molecules

enables redirection of engineered T cell subsets