Haematology Flashcards
Explain the mechanism of tumour lysis syndrome
Massive lysis of tumour cells releases potassium, phosphate and nucleic acids into the blood.
Nucleic acids get catabolised into uric acid
Uric acid precipitates in renal tubules and causes renal vasoconstriction and inflammation causing AKI.
Hyperphosphataemia causes hypocalcaemia (risk seizures, tetany) and calcium phosphate crystallises in kidneys to cause AKI.
What is the genetic mutation in APML?
T(15;17)
PML/RARA fusion protein
What is the genetic mutation of CML?
T(9;22)
Bcr-abl fusion protein
Treatment for CML?
Imatinib
Single genetic abnormality “stupid cancer”
Block with TKI (binds to atp binding domain in Brc-abl tyrosine kinase)
Very good prognosis
Ponatinib is new Gen - covers resistance mutation eg T153I
Treatment for diffuse large B cell lymphoma?
Treat at Dx due to bad prognosis
R-CHOP
Stage 1 can give 4 cycles RCHOP 2 ritux
Molecular subtypes incl. rearrangements of MYC and BCL2/6 indicates high grade and should get more intensive treatment
Salvage chemo/autologous transplant for relapse
CD19 CAR-T if failed two lines of therapy
What does R CHOP stand for
Side effects
Rituximab
Cyclophosphamide
Doxorubicin
Vincristine
Prednisolone
Neutropenia
Peripheral neuropathy
Nausea
Constipation (vincristine)
Cardiac toxicitiy (doxo)
Diagnostic features and treatment for Hodgkins lymphoma
Reed Sternberg binucleate cells with inflammatory response
Treat at Dx - 88% cure rate with treatment, 90% mortality in 2 years if untreated
Bimodal distribution
Chemo:
> ABVD
> Escalated BEACOPP
- more intense, better for advanced disease
Immunotherapy:
> PD1
> anti CD30 antibody drug conjugate (Brentuximab)
CLL diagnostic features and treatment
Smudge cells
Elderly pt
Often asymptomatic
CD5 CD19 co expression
Loss of tp53 has worse prognosis
17p deletion poor (has p53 gene on it)
Can see ITP or AIHA
Treat when getting symptoms and worsening cytopenias
Chemo:
> fludaravine, cyclophosphamide, ritux
Venetoclax or ibrutinib
Obintumumab and venetoclax
What are the functions of thrombin
What are the drugs given prior to BMT?
What are the drugs used for GVHD prophylaxis?
What organisms must be covered with prophylaxis post BMT?
