Day 2- Blood and Marrow Cancer Flashcards
What is Romiplostim used for?
What is Eltrombopag used for?
What are the signs and symptoms of anemia?
Must be registered in NEXUS to distribute.Used for thrombocytopenia.
chronic thrombocytopenia. BBW of hepatoxicity.
Big one is FATIGUE, chest pain, tachycardic, palpitations, weakness, shortness of breath.
What does it mean if someone has <80 MCV?
What does it mean if someone has 80-100 MCV?
What does it mean if your mch is >100?
Microcytic(iron deficiency).
Anemia of chronic disease, hemolytic anemia, mixed anemia.
Vitamin B12 or Folate deficiency.
What is the best indicator of iron deficiency or overload?
If you have high TIBC does that mean you have iron deficiency?
What things to know about oral iron?
Ferritin.
Yes.
Treatment for 3-6 months. Side effects are GI related. Interacts with PPI’s, H2RA’s, Antacids, Cholesteryamine, Fluoroquinolones, Levothyroxine, tetracyclines, methyldropa. Best absorbed on an empty stomach.
When should a patient take IV iron?
What things to watch for with IV iron?
What is iron dextrans black box warning?
Significant blood loss who refuse transfusion, dialysis, can’t take pills.
Usually well tolerated.
Must give test dose prior to administration.
When can you use ferric gluconate?
When can you use iron sucrose?
When can you use Ferumoxytol?
When on hemodialysis(IV only).
Only approved for IV use. Common.
patients with CKD 2 doses.
When can you use Ferric Carboxymaltose?
If you have an elevated MCV do you need to check BOTH Vitamin b12 and folic acid?
What are some signs and symptoms of Vitamin B12 deficiency?
Can’t tolerate oral iron or have CKD.
Yes.
Glossitis(silver tongue), Neuropathies, Neuropsychiatric issues.
What is pernicious anemia?
How do you treat folate deficiency?
What is the difference between Epoetin and darbepoetin?
Autoimmune disorder where intrinsic factor is affected. More common in whites of norther Europe. Most common B12 deficiency. Treat with parenteral therapy, can also give nasal therapy.
Folic acid.
Epoetin has more indications(HIV, surgery).
What is in your pretreatment assessment for ESA and goal for treatment?
What are ESA’s BBW?
Who do you give ESA’s in malignancys?
Iron supplementation will be needed especially for CKD’s. Obtain lab values(Ferritin >100, TSAT >20%). 10-12.
Cardiovascular events, CKD(hgb levels higher than 11 lead to CV events), Cancer.
CKD, patients undergoing palliative therapy, select patients who refuse transfusions.
Does having sickle cell trait protect you against malaria?
How do you cure SCA?
What else can you give to treat SCA?
YES
Allogeneic bone marrow transplant. Up to 10% mortality so only reserved for patients <17 years.
Hydroxyurea. Induces fetal HbG which reduces Hb S. Opioids and NSAIDS for pain control, Hydration and blood transfusions, thromboembolytic prophylaxis.
What are the 3 stages of CML?
What translocation leads to a constitutively active tyrosine kinase?
What is the goal of CML?
Chronic–> Accelerated–> Blast Crisis and Death.
BCR-ABL.
Keep them in chronic phase.
What is the only way to cure CML?
What are the 3 first line treatments for CML?
What are your 2nd line therapies for CML?
Allogeneic transplant.
Imatinib, Dasatinib, Nilotinib.
Bosutinib, Ponatinib is only one that targets (T315I) or bone marrow transplant. After that you can do clinical trial or interferon-alpha.
Can you possibly use hydroxyurea in CML cytoreductive therapy?
What do you do in low/intermediate risk CLL without significant symptoms?
What are your significant symptoms in CLL?
YES
Observation.
Fatigue, Night Sweats, Weight loss, Fever, End organ damage, progressive disease.
How do you treat symptomatic CLL with del(17p)/TP53 mutations?
What about without that mutation?
What is the difference between 1,2 and 3,4 for CLL?
Irbutinib.
FCR OR Obinutuzumab plus chlorambucil, irutinib in older patients with poor performance status.
Lymphocytosis + lymphadenopathy or organomegaly in 1,2 or lymphocytosis + anemia or thrombocytopenia.
If a patient is younger than 60 what is your induction treatment for AML?
How do you treat a patient older than 60 with AML? If they can handle intensive chemo.
How to do CR obtained consolidation in patients younger than 60 with AML?
Standard 7+3(Cytarabine days 1-7 and Anthracycline 1-3). OR HiDAC + anthracycline.
Give them Standard 7+3(Cytarabine 1-7 and Anthracycline 1-3). If they can’t handle intensive chemo give them Azacytiabine, Dectiabine, Low-dose cytarabine.
HiDAC for 3-4 cycles. If >60 use same agent in induction. After either stop treatment or hematopoietic stem cell transplant.
How do you treat non CR AML?
How do you treat people who can tolerate the stuff with APL?
How about people who can’t tolerate the stuff with APL?
Re-induction with 7+3 or HiDAC, clinical trial, bone marrow transplant, supportive care.
ATRA + anthracycline + Cytarabine. For consolidation give ATRA + anthracycline and then for maintenance give ATRA +/- 6-MP +/- PO methotrexate for 1-2 years.
ATRA + Arseneic Trioxide for induction and consolidaiton, same maintenance as who can tolerate.
