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PHRM 864: Therapeutics IV > Hematologic Malignancies > Flashcards

Hematologic Malignancies Flashcards

1
Q

What is Lymphoma?

A
  • Deals with Lymphatic System and the malignant transformation of lymphocytes [B-Cells]
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2
Q

What are the two main types of Lymphomea?

A
  • Hodgkins [Reed-Sternberg Cells]
  • Non-Hodgkinis
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3
Q

What is the pathophysiology of Hodgkins Lymphoma [HL]?

A
  • Reed-Sternburg Cells; B-Cell transcriptions disupted [loss of immunoglobulin & lack of apoptosis]
  • Overexpression of kB
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4
Q

What are some of the risk factors for Hodgkins?

A
  • Epstein-Barr: Changes B Cell DNA
  • Unable to remove the damages B Cells
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5
Q

What are some of the presentations for Hodgkins?

A
  • Painless, Rubbery, enlarged Lymph Node
  • B Symptoms: Fever, Sweaty, Weight Loss
  • ICTHING
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6
Q

What is the way that we can diagnosis for Hodgkin?

A
  • Excisional Biopsy [remove lymph]
  • CT/PET scan
  • Bone Marrow Biopsy
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7
Q

What is Ann Arbor Staging in Hodgkins?

A
  • A = Aysmptomatic
  • B = B Symtpoms
  • Stage I –> IV: how many radiation fields are needed to treat
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8
Q

What are the classifications for Hodgkins?

A
  • Early Stage Favorable: Stage I & II WITHOUT unfavorable factors
  • Early Stage Unfavorable: Stage I & II WITH unfavorable factors
  • Advanced Stage: Stage III & IV
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9
Q

What are some of the unfavorable factors that are used in classifications for Hodgkins?

A
  • Large Adenopathy: infections of glands
  • Multiple nodes
  • B Symptoms
  • Extranadol Involved
  • ESR
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10
Q

What are the risk factors that go into the Internatinoal Prognostic Scre [IPS] for hodgkins?

A
  • Albumin < 4
  • Hemoglobin < 10.5
  • Male
  • Stage IV
  • Age > 45
  • WBC > 15,000
  • Lymphocytes < 600
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11
Q

What are some of the treatment options for Hodgkins?

A
  • CURE with minimizing toxicities and complications
  • Chemo [ABVD or AAVD], Rads, Antuologus Stem Cell Transplant
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12
Q

What is the treatment by stage in Hodgkins?

A
  • Favorable: ABVD + RT
  • Unfavorable: ABVD +RT
  • Stage III/IV: ABVD +/- RT, AAVD
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13
Q

What are the two main chemotherapy regimens that are used in Hodgkins?

A
  • ABVD
  • AAVD
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14
Q

What is in ABVD in Hodgkins?

A
  • Doxorubicin, Bleomycin [Pulmonary Toxicites], Vinblastine, Dacarbazine x28d
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15
Q

What is in AAVD in Hodgkins?

A
  • Doxorubicin, Brentuximab, Vinblastine, Dacarbazine [Myelosuppression & Neruopathy]
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16
Q

What do you do for Relasped Hodgkins?

A
  • High does chemo with AUTOLOGOUS stem cell
  • MAINTENANCE Bretuximab vedotin after
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17
Q

Breifly summarize what to do within Hodgkins disease?>

A
  • Early Stage: Radiation, ABVD [2-4 cycles]
  • Advanced Stage: ABVD or AAVD [6-8 cycles] {AAVD in younger patients with III or IV}
  • Relasped: High dose chemotherapy then stem cell rescue
  • Maintenance: Brentuximab
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18
Q

What is the Pathophysiology of Non-Hodgkins?

A
  • Malignant B or T Lymphocytes that proliferate and replace nomral cells in the lymph nodes or bone marrow
  • 85% B & 15% T
19
Q

What are some of the Risk factors for Non-Hodgkins?

A
  • Epstein-Barr Virus: change B cell DNA
  • H. Pylori
  • Herpes virus 8
20
Q

How is Non-Hodgkins presented?

A
  • Depends on location: B-cell [lymph node, spllen, bone marrow] & T-cell [skin or lungs]
  • Leads to organ destruction [Lymphadenopathy]
21
Q

What are some of the B Symtpoms?

A
  • Fever
  • Sweat
  • Weight Loss
22
Q

What is the way that we are able to dianosis Non-Hodgkins?

A
  • Excisional Biopsy: remove lymph
  • CT/PET scan
  • Bone Marrow Biopsy
  • LUMBER PUNCTURE: not in CNS
22
Q

What are some of the main differences between Hodgkins and Non-Hodgkins?

A
  • Hodgkins: Single group, Waldeyer ring rarely involved, Extranodal RARE
  • Non-Hodgkins: Multiple groups, Waldeyer ring common, Extranodal common
22
Q

What are some of the B-Cell Lymphomas in Non-Hodgkins?

A
  • Indolent [25-40%]: Long survival & Incurable
  • Aggressive [60-75%]: Rapid growth, short survival, CURABLE
  • Highly Aggressive: Doubling Time 18hr, Curable [Burkitt’s]
22
Q

What is the way that we stage Non-Hodgkins?

A
  • Ann Arbor & International Prognostic Index
  • IPI: Age > 60, Abnormal LDH, Performace > 2, Ann Arbor III or IV, Extranodal > 2
23
Q

What are some of the treatments that we can use in Non-Hodgkins?

A
  • Rads, Chemo, Immunotherapy, Autotransplant, CAR-T, BiTE
24
Q

What is Follicular Lymphoma in Non-Hodgkins?

A
  • 2nd most common: 22% [incurable = slow growth]
  • Treat is symptomatic [organ failures, bone marrow failures…]
25
Q

What are some of the treatments for Follicular Lymphoma in Non-Hodgkins?

A
  • 1st line: Bendamustine + Rituximab, R-CHOP
26
Q

What is Richter’s Transformation in Non-Hodgkins?

A
  • When Non-Hodgkins becomes Diffuce Large B-Cell Lymphoma [AGGRESIVE]
  • Will still have follicular & DLBCL
27
Q

What is Diffuse Large B-Cell Lymphoma?

A
  • Genetic abnormalities with MYC, BCL2, BCL6 [two = double-hit; three = triple-hit]
28
Q

What are the multi-agents chemotherapy agents that are used in DLBCL in Non-Hodgkins?

A
  • R-CHOP
  • Pola + R + CHP
29
Q

What is R-CHOP in DLBCL in Non-Hogkins?

A
  • Rituximab [CD20], Cyclophosphamide, Doxorubicin, Vincristine, Prednisone
30
Q

What is in Pola + R + CHP in DLBCL in Non-Hodgkins?

A
  • Polatuzamab Vedotin, Rituximab, Cyclophosphamide, Doxoubicin, Prednisone
  • $400,000!!
31
Q

What is the treatment for DLBCL in Non-Hodgkins?

A
  • Stage I-II: R-CHOP 3 cycles or 6 cycles
  • Stage III-IV: R-CHOP 6 cycles or Pola+R+CHP 6 cycles
32
Q

What is important to know about Hepatitis B in Non-Hodgkins?

A
  • Reactivation that can cause liver failure and death
  • Test HBsAg & HBcAb before Rituximab
  • PRETREAT with entecavir [if +]
33
Q

What is important to know about relapsed DLBCL/Aggressive Non-Hodgkins?

A
  • CURE: salvage chemo [prove chemo works] then autologous stem cell transplant
  • Palliative: Bendamustine + Rituximab + Polatuzumab
  • BiTE: Epcoritamab or Glofitamab
34
Q

What are some of the BiTE that are used in Non-Hodgkins?

A
  • Epocoritamab & Glofitamab
  • Helps move T-cells closer to B-cells [CD3 to CD19] causing b-cell lysis
35
Q

What is Burkitts Lymphoma?

A
  • HIGHLY AGGRESSIVE [DLBCL]
  • Always MYC translocation
  • Starty Sky Apperance
36
Q

What is the Pathophysiology of Multiple Myeloma?

A
  • Abnormal clonal plasma cells that go into the bone marrow causing MM cells to NOT DIE
  • Releases Immunoglobulins [IgG 60%]
37
Q

What is Presentation of Multiple Myeloma?

A
  • C: hyperCalcemia
  • R: Renal dysfunction
  • A: Anemia
  • B: Bone - one or more lesion
38
Q

What is the treatment strategies for Multiple Myeloma?

A
  • Transplant?
  • NO: 3 drugs
  • YES: 3 drugs –> Stem Cell
39
Q

Breif summary of Multiple Myeloma?

A
  • INCURABLE
  • 3 DRUGS BOI
  • High dose chemo then stem cell [Induction–>consolidation–>maintenance]
40
Q

Brief summary of Lymphoma?

A
  • Hodgkins and Non-Hodgkins
  • Hodgkins = ABVD
  • Non-Hodgkins = R-CHOP

PHRM 864: Therapeutics IV (28 decks)

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