Exam 2 - Hematologic Malignancies I Grove Flashcards
B-cells attack invaders ______ the cell while T-cells attack ______ cells
outside; infected
Hodgkin lymphoma (HL) is characterized by what kind of cells?
Reed-Sternberg cells
what is the backbone of lymphoma tx?
chemotherapy
what are the B symptoms? (3 of them)
-fever (> 38 C)
-drenching night sweats
-unintentional weight loss of greater than 10% in past 6 months or less
HL presentation (3 things; slide 18)
-painless, rubbery, enlarged lymph nodes
-B symptoms (25-50%)
-itchiness
best diagnosis biopsy for HL and NHL
a. excisional biopsy
b. bone marrow biopsy
a. excisional biopsy
best biopsy for advanced stage HL
a. excisional biopsy
b. bone marrow biopsy
b. bone marrow biopsy
HL classification: early-stage favorable
a. stage I-II without unfavorable factors
b. stage I-II with unfavorable factors
c. stage III-IV
a. stage I-II without unfavorable factors
HL classification: early-stage unfavorable
a. stage I-II without unfavorable factors
b. stage I-II with unfavorable factors
c. stage III-IV
b. stage I-II with unfavorable factors
HL classification: advanced stage
a. stage I-II without unfavorable factors
b. stage I-II with unfavorable factors
c. stage III-IV
c. stage III-IV
look up unfavorable factors (slide 21)
okay
what score is used to measure risk factors for stage III to IV HL?
international prognostic score (IPS)
goal for HL tx
a. palliative
b. cure
b. cure
what is autologous stem cell transplant?
high dose chemotherapy with stem cell rescue
what are the two chemo regimens for HL? (slide 25)
what drugs are included in these regimens?
-ABVD = doxarubicin, bleomycin, vinblastine, dacarbazine
-AAVD = doxarubicin, brentuximab vendotin, vinblastine, dacarbazine
AAVD should be used in which stages of HL?
stage III/IV
T or F: the ABVD regimen has low rates of neutropenia and high infection rates
F (high neutropenia, low infection)
relapsed HL tx (2 things to know; slide 27)
-autologous stem cell transplant
-maintenance therapy if high risk relapse with brentuximab vendotin following stem cell transplant
how many cycles of ABVD chemo for early stage HL? (range)
2-4
how many cycles of ABVD or AAVD for advanced stage HL? (range)
6-8
NHL (Non Hodgkin Lymphoma) pathophysiology (2 things to know; slide 33)
-malignant B or T lymphocytes and precursors
-malignant cells proliferate and replace normal cells in lymph nodes and/or bone marrow
what percent of NHL is due to B-cells vs T-cells?
B cells: ~85-90%
T cells: ~10-15%
which is NOT an infection that is a risk factor for NHL?
a. rhinovirus
b. Epstein-Barr virus
c. Human T-cell lymphotropic virus type 1
d. Human herpes virus 8
e. helicobacter pylori
a. rhinovirus
NHL presentation if it is due to B-cells
a. lymph nodes, spleen, bone marrow
b. extra nodal sites (skin and lungs)
a. lymph nodes, spleen, bone marrow
NHL presentation if it is due to T-cells
a. lymph nodes, spleen, bone marrow
b. extra nodal sites (skin and lungs)
b. extra nodal sites (skin and lungs)
look at slide 37 for differences between HL and NHL
right on
NHL diagnosis for pt with sx or high-risk disease
a. excisional biopsy
b. CT or PET
c. bone marrow biopsy
d. lumbar puncture
d. lumbar puncture
follicular lymphoma first line tx (2 regimens)
-BR = bendamustine + rituximab
-R-CHOP = rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone
follicular lymphomas can transform into an aggressive NHL know as _______ _______
Richter’s transformation
T or F: chemotherapy on Richter’s transformation will get rid of all underlying follicular lymphomas
F (yields 40% CR of the DBLCL but still have underlying follicular lymphomas)
most common type of NHL
diffuse large B-cell lymphoma (DLBCL)
R-CHOP most common toxicities
a. diarrhea
b. neutropenia
c. N/V
d. anemia
b. neutropenia
HepB and which drug can cause risk of viral reactivation?
rituximab (so check for HBsAg and HBcAb before starting)
pre-emptive tx for pt who tests positive for HBsAg or HBcAb prior to starting rituximab
a. entecavir
b. acyclovir
c. valacyclovir
a. entecavir
tx for anti-CD20 antibody late neutropenia
gram colony stimulating factors (G-CSF)
relapsed DLBCL/aggressive NHL tx options (4 of them)
-autologous stem cell rescue
-CAR-T therapy
-bendamustine + rituximab + polatuzumab
-BiTEs
know how CAR-T therapy works (slide 57-59)
fosho
two BiTEs for third line aggressive NHL
-eprocitamab
-glofitamab
BiTEs and CAR-T cell therapy can cause what two unique toxicities? (slide 63)
-cytokine release syndrome (CRS)
-immune effector cell-associated neurotoxicity syndrome (ICANS)
_____ gene translocation is present in nearly all cases of Burkitt’s Lymphoma
a. BCL2
b. BCL6
c. MYC
c. MYC
multiple myeloma pathophysiology (from internet; 3 things to know)
-plasma cells become cancerous and multiply uncontrollably
-these plasma cells and MM cells accumulate in bone marrow
-abnormal M protein is produced and causes various complications
multiple myeloma presentation acronym
CRAB = hypercalcemia, renal dysfunc, anemia, bone lesions
C = calcium > 11.5
R = renal; SCr > 2 mg/dL or CrCl < 40 mL/min
A = anemia; Hgb < 10 g/dL or 2 g/dL below normal
B = bone; one or more osteolytic lesions or pathologic fracture
MM tx overview (3 steps)
-induction
-consolidation
-maintenance
what is the first question for MM induction therapy?
is pt a transplant candidate?
MM induction therapy: pt should be on a ___ drug regimen if they are NOT a transplant candidate
3
MM induction therapy: pt should be on a ___ drug regimen for ___-___ cycles if they are a transplant candidate
3; 3-4
what drug class is backbone of MM tx?
steroids
look at MM agents for 3 drug regimen (slide 89)
will do
monoclonal antibodies daratumumab and isatuximab are anti-_____ mAbs
a. CD3
b. CD19
c. CD20
d. CD38
d. CD38
target for elotuzumab
SLAMF7
look at preferred induction regimens for MM (slide 95)
okay
what drugs are in the VRD regimen for MM?
bortezomib
lenalidomide
dexamethasone
look at relapsed/refractory MM tx (slide 101)
okay
two CAR-T agents for MM
idecabtagene vicleucel (Abecma)
ciltacabtagene autoleucel (Carvykti)
CAR-T therapy for MM is indicated after 4 or more prior lines of therapy. What drug classes are on the slide? (slide 102)
-proteasome inhibitor
-immunomodulatory agent
-anti-CD38 mAb
there is an inc risk of HSV infections with ________ ________ or ________ ________
proteasome inhibitor; monoclonal antibody
what two drugs can be used for prophylaxis of HSV infections in MM?
acyclovir, valacyclovir
VTE is highest in first ___ months of diagnosis of MM
6
aspirin 81-325 mg daily can be used for prophylaxis of ___ risk VTE in MM
a. high
b. low
b. low
