CLL Flashcards
One complication of Fludarabine that results in anemia
Severe AIHA/ITP. Must discontinue if it occurs and cannot use it again, as the AIHA will return on rechallenge [also avoid pentostatin, cladribine (all purine nucleoside analogs)]
Name 2 indications for consideration of stem cell transplant in CLL
Tp53
r/r CLL in young
Richter’s
Ibrutinib failure
4 treatment options for a CLL patient with a high comorbidity index.
Ibrutinib or Acalabrutinib + Obinutuzumab Venetoclax +Obinutuzumab Chlorambucil + Obinutuzumab BR Also supportive management
Molecular target of Idelalisib
PI3K inhibition
Molecular target in Brentuximab
CD30 antibody drug conjugate with antimicrotubule agent
Molecular target in Romidepsim
Histone deacetylase inhibitor (HDACi)
What is the difference in mechanism of action between Rituximab and Obinutuzumab?
- Rituximab- Type 1 monoclonal Ab
- More complement AND cytotoxic mediated cell death - Obinutuzumab- Type 2 monoclonal Ab
- More Ab-mediated AND apoptosis
List three severe toxicities with Idelalisib therapy?
BB warning:
- Colitis/diarrhea
- Pneumonitis
- Transaminitis
- Infection (CMV/PJP)
- Intestinal perforation.
Major SE of Acalabrutinib
Cytopenias
Headache
Upper respiratory tract infection
Diarrhea
Serious, potentially life-threatening, toxicities include opportunistic infections, bleeding, arrhythmias, and second primary malignancies.
What things should you monitor when starting someone on Alemtuzumab?
- Increased risk of infection (CMV reactivation!, bacterial, fungal)
- Lymphopenia
- infusion reactions
o CMV, Viral load weekly
O Also monitor clinically for infusion reactions.
o CBC q weekly
o CD4+ lymphocyte count until >/= 200
MOA of Alemtuzumab
Recombinant human IgG-derived monoclonal Ab that binds to antigen CD52 which is found on the surface of B and T lymphocytes, most monocytes, macrophages and NK cells, and certain granulocytes, but not hematopoietic stem cells.
-Causes lysis of CD52-positive cells occurs via complement activation, antibody-dependent cytotoxicity, and apoptosis.
Name 5 side effects of Rituximab?
- Infusion reaction
- Neutropenia
- HBV reactivation
- PML
- TLS- Do not give if WBC >25!
- Infections
Other: renal toxicity if used with cisplastin.
What are 2 potential indications for allo-sct in CLL patients?
- Ritcher’s transformation (DLBCL, HL)
- Tp53
- Relapsed, refractory disease
Use induced intensity conditioning.
What are the 3 most common gr 3/4 toxicities of ibrutinib? How do you treat gr 2 rash?
- Hypertension 29% (Grade 3 is >160/100 or needing >1 drug),
- Infection 16%
- Neutropenia 13-29%
- Anemia 11%
- Afib 8%
Gr 2 rash
- Topical corticosteroids +/- oral antihistamine
- Continue ibrutinib and monitor
Define MBL. Low count vs. High count. Annual risk of conversion to CLL. What two other thing would you counsel the pt on?
Clonal B-cell population with no LAD, cytopenias.
Low count: clonal B cell population <0.5 x 10’9 g/l
High count: 2-5x 10’9 g/l
Risk of progression to CLL:1-1.5%/ yr (new evidence that low count is also at similar risk)
Counsel: 1) increased secondary malignancy
2) increased infxn risk.