EXAM 4 Flashcards
Multiple Myeloma is a malignancy of the ______ cells
plasma
MM can be measured in the ______ and _______
plasma
urine
What are the genetic factors of MM
familial clusters of MM
Multiple genetic mutations
What 2 conditions precede MM?
Monoclonal gammopathy of undetermined significance
Smoldering MM
What is the malignant plasma cell involved in unregulated production of a monoclonal antibody
M-protein
MM cells are in the bone marrow and are further expanded by what 4 “receptors/genes”
IL-6
VEGF
IGF-1
NF-kB
what are the symptoms of MM
bone pain
fatigue
infection
neurologic symptoms
polyuria
N/V
What labs will you see with MM?
elevated M-protein, SCr, B2-microglobulin, C-reactive protein
hypercalcemia
low hemoglobin, albumin
What is the acronym for MM symptoms?
C: hypercalcemia
R: renal insufficiency
A: anemia
B: bone lesions
staging and prognosis of MM includes looking at what labs?
serum B2-microglobulin
albumin
LDH
high-risk chromosomal abnormalities
Initial therapy for MM includes what regimen?
dexamethasone
immunomodulatory drugs
proteasome inhibitors
What is the VRd treatment regimen for MM?
Bortezomib
Lenalidomide
Dexamethasone
Candidates for HSCT in MM look at what eligibility factors?
age
renal function
performance status
comorbidities
MM maintenance therapy consists of what single agent drugs?
Lenalidomide
Bortezomib
High doses of dexamethasone are associated with what risks?
higher risk of infection
CNS toxicity
should be used in caution (especially older patients)
What are the 3 IMiDs for MM?
Thalidomide
Lenalidomide
Pomalidomide
what is the major side effect for IMiDs in MM?
VTE
severe birth defects (REMS program)
what are the 3 proteasome inhibitors for MM?
Bortezomib
Carflizomib
Ixazomib (PO)
Proteasome inhibitors inhibit what “receptor/gene”
NF-kB
Bortezomib has less neurotoxicity if given by what route?
SQ
Carfilzomib has less _____ compared to bortezomib
peripheral neuropathy
Ixazomib has what side effects?
infection (herpes zoster)
What monoclonal antibodies target CD38
Daratumumab
Isatuximab-irfc
What monoclonal antibody targets SLAMF7?
Elotuzmab
what monoclonal antibody targets BCMA and has a REMS program?
Belantamab
REMS program for ophthalmic exam prior to each dose
What drug is an oral inhibitor of histone deacetylase enzymes and has a side effects of QTc prolongation?
Panobinostat
What drug inhibits nuclear export of tumor suppressor proteins and exportin 1
Selinexor
What is the chimeric antigen receptor T-cell therapy drug for relapsed or refractory MM?
idecabtagene vicleucel
What is the VRd dosing regimen?
Lenalidomide PO QD x14 days
Bortezomib SQ days 1,4,8,11
Dexamethasone PO days 1,8,15
repeat Q21 days
What are the bone modifying therapies for supportive care in MM?
zoledronic acid (dose adjustments for renal impairment)
pamidronate (reduced dose for renal impairment)
Denosumab (targets RANK-L, no dose adjustments)
Myelodysplastic syndrome is characteristed by ineffective hematopoiesis with morphologic dysplasia in what cells?
hematopoietic cells
peripheral cytopenias
myelodysplastic syndrome is progressive _________ failure, a result of _________ hematopoiesis
bone marrow
ineffective
neutrophils have reduced ________ and ________ activity despite a normal quantity
bacterial and fungal
Platelets may be normal in quantity but have impaired _________ , _________ , and _________
activation, secretion, and aggregation
IPSS classification of MDS is what chromosome abnormalities?
5q or 20q deletions and chromosome 7 abnormalities
What chromosome abnormalities are part of the IPSS-R system?
trisonomy 8 or 19, 12p or 11q deletions and double abnormalities
myelodysplastic clone is associated with what cellular dysfunctions?
excess secretion of cytokines
defective differentiation
genomic instability
reduced response to regulatory cytokines
MDS is associated with what IMMUNE dysregulations?
impaired immune surveillance
autoimmune reactions
cytopenias related autoimmune T-cell mediated response
What are the 4 prognostic factors for MDS?
cytogenetic abnormalities
% of bone marrow blasts
age
number of cytopenias
What labs will be observed in MDS?
anemia
neutropenia
thrombocytopenia
multiple cytopenias
what are the clinical symptoms of MDS?
fatigue, lethargy, malaise, palpitations, dyspnea on exertion, exercise intolerance
What is treatment for lower-risk MDS?
immunomodulating agents
Growth factors
immunosuppressive therapy
hypomethylating agents
what are the side effects for thalidomide?
fluid retention
peripheral neuropathy
thrombosis
constipation
When is a patient a candidate for growth factors in MDS?
lower-risk MDS and symptomatic anemia who have a serum EPO level of <500
What are the growth factor drugs?
filgrastim
luspatercept
eltrombopag
What are the agents that modulate effector T-cells (immunosuppressive therapies)
antithymocyte globulin (ATG)
cyclosporine
corticosteroids
what are the hypomethylating agents to treat MDS?
azacitidine
decatabine
azacitadine and venetoclax
What are treatment options for higher-risk MDS?
DNA hypomethylating agents: prolong overall survival
allogeneic HSCT: only curative option
immunomodulating agents
intensive chemotherapy
Venetoclax inhibits?
B-cell lymphoma (BCL-2)
What is the intensive chemotherapy for higher-risk MDS?
anthracycline plus cytarabine
bridge therapy to allogeneic HSCT
MDS patients are at risk for?
anemia
infections
colony stimulating factors stimulate _______ production, increasing the circulating ________, _________ the risk of infection
WBC
neutrophils
decreasing
What are the hematopoietic growth factors?
filgrastim
sargramostim
patients with MDS can be treated with transfusions of _______ for anemia, but complications of transfusions include _________
RBC
iron overload
patients with MDS and a ____ deletion generally have _______ prognosis and are ______ likely to respond to __________
5q
favorable
highly
lenalidomide
patients with MDS can receive intensive chemotherapy as bridge therapy to HCST to ______ tumor burden and ______ disease while suitable donor is found
reduce
control
What are some factors associated with the development of Non-Hodgkin lymphoma?
genetic diseases
environmental agents
infectious agents
congenital and acquired immunodeficiency states
a diet high in _______ increases the risk of NHL?
meats and dietary fats
What infections are associated with the development of NHL?
Epstein-Barr
human T-cell lymphotropic virus type 1
H. pylori
Hep C
NHL is derived from proliferation of malignant _______ lymphocytes and their precursors
B or T
in the US most is B-cell origin
Classification of NHL is based on what 3 things?
cell of origin (B or T)
clinical features
morphologic features
Most patients with NHL present with what symptom?
peripheral lymphadenopathy
What are the B symptoms for NHL?
fever
weight loss
night sweats
what is the gold standard for assessment of almost all lymphoma histology types?
PET-CT
Stage I Hodgkin Lymphoma involves how many lymph nodes?
One
Stage II Hodgkin Lymphoma involves?
2 or more lymph nodes on the SAME side of the diaphragm
stage III Hodgkin Lymphoma involves?
lymph node regions on BOTH sides of the diaphragm
stage IV Hodgkin Lymphoma involves?
diffuse or disseminated involvement of one or more extralymphatic organs or tissues with or without lymphnode enlargement
What other factors are used in the staging and prognosis or NHL?
A - no symptoms
B - fever, night sweats, weight loss
X - bulky disease
E - involvement of extra lymphatic tissue on one side of the diaphragm
S - involvement of the spleen
CS - clinical stage
PS - pathologic stage
