Haematological cancers Flashcards
Which gene fusion is commonly seen in CML?
BCR:ABL
Which haematological maligancy is 12 times more likely to affect patients with HIV?
Non-hodgkins lymphoma
What is the broad mechanism of CAR-T cell therapy?
T cells are genetically engineered and a manufacture Chimeric antigen receptor is added which allows T cells to directly present to cell surface antigens
What is the broad mechanism of TIL therapy?
Tumour infiltrating lymphocytes are removed from the patient and expanded and/or engineered prior to infusion back into the patient.
What is the standard of care for diffuse large B cell lymphoma? How would the treatment change if patient above 80 years or significant comorbidity?
R - CHOP, otherwise (R) mini chop.
What is luspatercept used for?
Anaemia in MDS and beta thalassaemia
What is the most common subtype of Hodgkin lymphoma?
Nodule sclerosis
First line treatment of CLL with 17p deletion or TP53 mutation
Ibrutinib or Zanubrutinib
Which mutation in CLL is correlated with a very good clinical outcome
Del 13q 14
Which drugs commonly cause cytokine release syndrome and how would you treat it?
Bispecific T cell antibody, CAR-T.
Give tocilizumab, steroids used in refractory cases.
What is a useful investigation in the context of CAR-T cell therapy neurotoxicity?
EEG
What should be considered in patients with abdo pain and diarrhoea post ablative chemotherapy (arabinoside, cytarabine or idarubin)
Necrotising or neutropenic enterocolitis
What mutation is correlated with improved prognosis in CLL?
Mutated immunoglobulin heavy chain variable regions
Name 4 poor prognostic mutations in CLL
Del17p
High Beta 2 microglobulin (B2M)
TP53 mutation
High ZAP-70 levels
What are the 3 phases of CML?
Chronic- blast levels<10%
Accelerated phase- blast levels 10-19%
Blast phase- blast levels >20%
Dasatanib is a drug used to treat CML. What is its unusual side effect?
Pleural effusions (in 20%)
What is rasburicase
Recombinant urate oxidase used to treat TLS.
Which cell surface marker pattern would you expect to see in Hodgkin Lymphoma?
CD20 negative (65%), CD30 positive (almost always), CD15 positive (80%)
What is the SOC for newly diagnosed DLBCL?
RCHOP
How would you modify the RCHOP regime if patient was >80yo or it’s cardiac dysfunction or frail?
Omit or substitute doxorubicin
Hodgkin lymphoma is usually staged via which classification?
Lugano
What does the A or B classification mean in Lugano classification for HL?
Presence (B) or absence (A) of B symptoms
Broadly speaking define stage III and stage IV HL?
Involved nodes on both sides of the diaphragm in stage 3. Stage 4 is extranodal disease.
What is the management of relapsed or refractory DLBCL?
R-GDP (or R-DHAP and R-ICE) follows by high dose chemotherapy with autologous stem cell transplant
