Exam 2 - Hematologic Malignancies I Grove

Question 1

B-cells attack invaders ______ the cell while T-cells attack ______ cells

Answer 1

outside; infected

Question 2

Hodgkin lymphoma (HL) is characterized by what kind of cells?

Answer 2

Reed-Sternberg cells

Question 3

what is the backbone of lymphoma tx?

Answer 3

chemotherapy

Question 4

what are the B symptoms? (3 of them)

Answer 4

-fever (> 38 C)
-drenching night sweats
-unintentional weight loss of greater than 10% in past 6 months or less

Question 5

HL presentation (3 things; slide 18)

Answer 5

-painless, rubbery, enlarged lymph nodes
-B symptoms (25-50%)
-itchiness

Question 6

best diagnosis biopsy for HL and NHL

a. excisional biopsy
b. bone marrow biopsy

Answer 6

a. excisional biopsy

Question 7

best biopsy for advanced stage HL

a. excisional biopsy
b. bone marrow biopsy

Answer 7

b. bone marrow biopsy

Question 8

HL classification: early-stage favorable

a. stage I-II without unfavorable factors
b. stage I-II with unfavorable factors
c. stage III-IV

Answer 8

a. stage I-II without unfavorable factors

Question 9

HL classification: early-stage unfavorable

a. stage I-II without unfavorable factors
b. stage I-II with unfavorable factors
c. stage III-IV

Answer 9

b. stage I-II with unfavorable factors

Question 10

HL classification: advanced stage

a. stage I-II without unfavorable factors
b. stage I-II with unfavorable factors
c. stage III-IV

Answer 10

c. stage III-IV

Question 11

look up unfavorable factors (slide 21)

Answer 11

okay

Question 12

what score is used to measure risk factors for stage III to IV HL?

Answer 12

international prognostic score (IPS)

Question 13

goal for HL tx

a. palliative
b. cure

Answer 13

b. cure

Question 14

what is autologous stem cell transplant?

Answer 14

high dose chemotherapy with stem cell rescue

Question 15

what are the two chemo regimens for HL? (slide 25)
what drugs are included in these regimens?

Answer 15

-ABVD = doxarubicin, bleomycin, vinblastine, dacarbazine
-AAVD = doxarubicin, brentuximab vendotin, vinblastine, dacarbazine

Question 16

AAVD should be used in which stages of HL?

Answer 16

stage III/IV

Question 17

T or F: the ABVD regimen has low rates of neutropenia and high infection rates

Answer 17

F (high neutropenia, low infection)

Question 18

relapsed HL tx (2 things to know; slide 27)

Answer 18

-autologous stem cell transplant
-maintenance therapy if high risk relapse with brentuximab vendotin following stem cell transplant

Question 19

how many cycles of ABVD chemo for early stage HL? (range)

Answer 19

2-4

Question 20

how many cycles of ABVD or AAVD for advanced stage HL? (range)

Answer 20

6-8

Question 21

NHL (Non Hodgkin Lymphoma) pathophysiology (2 things to know; slide 33)

Answer 21

-malignant B or T lymphocytes and precursors
-malignant cells proliferate and replace normal cells in lymph nodes and/or bone marrow

Question 22

what percent of NHL is due to B-cells vs T-cells?

Answer 22

B cells: ~85-90%
T cells: ~10-15%

Question 23

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

Answer 23

a. rhinovirus

Question 24

NHL presentation if it is due to B-cells

a. lymph nodes, spleen, bone marrow
b. extra nodal sites (skin and lungs)

Answer 24

a. lymph nodes, spleen, bone marrow

Question 25

NHL presentation if it is due to T-cells a. lymph nodes, spleen, bone marrow b. extra nodal sites (skin and lungs)

Answer 25

b. extra nodal sites (skin and lungs)

Question 26

look at slide 37 for differences between HL and NHL

Answer 26

right on

Question 27

NHL diagnosis for pt with sx or high-risk disease a. excisional biopsy b. CT or PET c. bone marrow biopsy d. lumbar puncture

Answer 27

d. lumbar puncture

Question 28

follicular lymphoma first line tx (2 regimens)

Answer 28

-BR = bendamustine + rituximab -R-CHOP = rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone

Question 29

follicular lymphomas can transform into an aggressive NHL know as _______ _______

Answer 29

Richter's transformation

Question 30

T or F: chemotherapy on Richter's transformation will get rid of all underlying follicular lymphomas

Answer 30

F (yields 40% CR of the DBLCL but still have underlying follicular lymphomas)

Question 31

most common type of NHL

Answer 31

diffuse large B-cell lymphoma (DLBCL)

Question 32

R-CHOP most common toxicities a. diarrhea b. neutropenia c. N/V d. anemia

Answer 32

b. neutropenia

Question 33

HepB and which drug can cause risk of viral reactivation?

Answer 33

rituximab (so check for HBsAg and HBcAb before starting)

Question 34

pre-emptive tx for pt who tests positive for HBsAg or HBcAb prior to starting rituximab a. entecavir b. acyclovir c. valacyclovir

Answer 34

a. entecavir

Question 35

tx for anti-CD20 antibody late neutropenia

Answer 35

gram colony stimulating factors (G-CSF)

Question 36

relapsed DLBCL/aggressive NHL tx options (4 of them)

Answer 36

-autologous stem cell rescue -CAR-T therapy -bendamustine + rituximab + polatuzumab -BiTEs

Question 37

know how CAR-T therapy works (slide 57-59)

Answer 37

fosho

Question 38

two BiTEs for third line aggressive NHL

Answer 38

-eprocitamab -glofitamab

Question 39

BiTEs and CAR-T cell therapy can cause what two unique toxicities? (slide 63)

Answer 39

-cytokine release syndrome (CRS) -immune effector cell-associated neurotoxicity syndrome (ICANS)

Question 40

_____ gene translocation is present in nearly all cases of Burkitt's Lymphoma a. BCL2 b. BCL6 c. MYC

Answer 40

c. MYC

Question 41

multiple myeloma pathophysiology (from internet; 3 things to know)

Answer 41

-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

Question 42

multiple myeloma presentation acronym

Answer 42

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

Question 43

MM tx overview (3 steps)

Answer 43

-induction -consolidation -maintenance

Question 44

what is the first question for MM induction therapy?

Answer 44

is pt a transplant candidate?

Question 45

MM induction therapy: pt should be on a ___ drug regimen if they are NOT a transplant candidate

Answer 45

3

Question 46

MM induction therapy: pt should be on a ___ drug regimen for ___-___ cycles if they are a transplant candidate

Answer 46

3; 3-4

Question 47

what drug class is backbone of MM tx?

Answer 47

steroids

Question 48

look at MM agents for 3 drug regimen (slide 89)

Answer 48

will do

Question 49

monoclonal antibodies daratumumab and isatuximab are anti-_____ mAbs a. CD3 b. CD19 c. CD20 d. CD38

Answer 49

d. CD38

Question 50

target for elotuzumab

Answer 50

SLAMF7

Question 51

look at preferred induction regimens for MM (slide 95)

Answer 51

okay

Question 52

what drugs are in the VRD regimen for MM?

Answer 52

bortezomib lenalidomide dexamethasone

Question 53

look at relapsed/refractory MM tx (slide 101)

Answer 53

okay

Question 54

two CAR-T agents for MM

Answer 54

idecabtagene vicleucel (Abecma) ciltacabtagene autoleucel (Carvykti)

Question 55

CAR-T therapy for MM is indicated after 4 or more prior lines of therapy. What drug classes are on the slide? (slide 102)

Answer 55

-proteasome inhibitor -immunomodulatory agent -anti-CD38 mAb

Question 56

there is an inc risk of HSV infections with ________ ________ or ________ ________

Answer 56

proteasome inhibitor; monoclonal antibody

Question 57

what two drugs can be used for prophylaxis of HSV infections in MM?

Answer 57

acyclovir, valacyclovir

Question 58

VTE is highest in first ___ months of diagnosis of MM

Answer 58

6

Question 59

aspirin 81-325 mg daily can be used for prophylaxis of ___ risk VTE in MM a. high b. low

Answer 59

b. low