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PHM703 Heme/Onc/Crit Care > Exam 3 - Multiple Myeloma > Flashcards

Exam 3 - Multiple Myeloma Flashcards

1
Q

List risk factors for multiple myeloma (MM)?

A

non-Hispanic Blacks, radiation/chemical exposure, obesity, immune suppression, genetics

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2
Q

Explain the progression order for MM?

A

monoclonal gammopathy of undetermined significance (MGUS) -> smoldering MM -> MM

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3
Q

Explain the acronym SLMCRAB?

A

Sixty (minimum % of bone marrow plasma cells), Light chains, MRI (>1 focal lesion 5mm+), Calcium (>1 mg/dL), Renal (CrCL < 40 or SCr > 2), Anemia (hemoglobin >2), Bone (1+ ostelytic lesion on imaging)

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4
Q

What is supportive care treatment for MM? (5)

A

bisphosphonate therapy or denosumab (in renal impairment), erythropoietin or blood transfusions for anemia, IVIG for serious recurrent infections, acyclovir for HSV, levofloxacin for newly diagnosed

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5
Q

What is treatment (triplet regimen) for MM?

A

triplet regimen: RVd; lenalidomide (Revlimid), bortezomib (Velcade), dexamethasone

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6
Q

What is added-on in the quadruplet regimen for MM?

A

daratumumab

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7
Q

Which type of transplant should be given to MM patients?

A

ONLY AUTOLOGOUS

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8
Q

What is the MOA of daratumumab?

A

anti-CD38 1gG1-kappa human MoAB

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9
Q

What is another drug in the class of daratumumab?

A

isatuximab

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10
Q

What are pre-medications for daratumumab?

A

dex/methylprednisolone, acetaminophen, diphenhydramine/hydroxyzine, montelukast

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11
Q

What is the post-medication for daratumumab?

A

methylprednisolone

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12
Q

What are AEs of daratumumab? (3)

A

HSV/HepB reactivation, infusion-related reactions, lab interferences

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13
Q

What is the MOA of bortezomib?

A

proteasome S20 subunit inhibitor (leads to apoptosis)

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14
Q

What is a clinical pearl for bortezomib?

A

SQ preferred over IV due to dose limiting AEs

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15
Q

What are AEs of bortezomib? (3)

A

HSV reactivation, thrombocytopenia, peripheral neuropathy (bor > ixa > car)

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16
Q

What are clinical pearls for carfilzomib?

A

given IV, rare cardiac and pulmonary toxicity

17
Q

What are clinical pearls for ixazomib?

A

given oral, taken on empty stomach, GI toxicity

18
Q

What is the MOA of lenalidomide?

A

immunomodulatory drug; anti-angiogenic upregulation of pro-apoptotic factors, decreased production of cytokines, enhance T/NK-cell proliferation and activity

19
Q

What are other drugs in the class of lenalidomide? (2)

A

thalidomide, pomalidomide

20
Q

What are AEs of lenalidomide?

A

birth defects, hematologic toxicity, thrombotic events, somnolence, secondary malignancy risk, rash and skin toxicities, diarrhea, peripheral neuropathy

21
Q

Explain the recommendations by the REMS program for MM therapies?

A

due to embryo-fetal risk, confidential surveys and highly effective birth control (IUD, pills, tubal ligation, vasectomy, etc.) and additional birth control (condom, diaphragm, cervical cap, etc.) MUST be used by patient, as well as proper administration and disposal of drugs

22
Q

List risk factors for VTE from MM treatment?

A

prior VTE, high dose steroids, obesity, central/tunneled catheter, fracture, immunomodulatory drugs (IMiDs)

23
Q

What are anticoagulation prophylactics for MM treatment-related VTE? (3)

A

enoxaparin 40 mg qd, apixaban 2.5 mg bid, aspirin 81 mg qd

24
Q

What are AEs of dexamethasone?

A

insomnia, mood changes, increased appetite/weight gain, HTN, edema, GI

25
Q

What is a requirement for utilizing CAR-T or BiTEs therapies?

A

failing 4 lines of therapy

26
Q

What is the MOA of elotuzumab?

A

IgG anti-SLAMF7 moAb, activates NK cells against myeloma cells

27
Q

What are pre-medications for elotuzumab?

A

dexamethasone, acetaminophen, diphenhydramine, famotidine

28
Q

What are AEs of elotuzumab? (3)

A

HSV reactivation, thrombocytopenia, infusion-related reactions

29
Q

What are the bispecific T-cell engagers? (3)

A

teclistimab, talquetamab, elranatamab

30
Q

What is the MOA of teclistimab and elranatamab?

A

T-cell activation and subsequent lysis of BCMA+ MM cells

31
Q

What are AEs of teclistimab and elranatamab? (3)

A

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

32
Q

What is the MOA of talquetamab?

A

T-cell activation and subsequent lysis of GPRC5D+ MM cells

33
Q

What are AEs of talquetamab? (4)

A

same as teclistimab and elranatamab w/ skin/nail toxicities, taste change, weight loss

PHM703 Heme/Onc/Crit Care (18 decks)

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