Hematology (Grove)

Question 1

Hodgkin’s lymphoma treatment goal

Answer 1

Cure; use high dose chemo followed by autologous stem cell transplant

Question 2

Risk factors for hodgekin’s lymphoma

Answer 2

viral exposure (Epstein-Barr virus), impaired immune function (solid organ transplant, HIV)

Question 3

Hodgkin’s lymphoma chemo regimen

Answer 3

ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine) (cardiotoxicity and pulmonary toxicity) or AAVD (6 cycles)

Question 4

Which type of non-Hodgkin’s lymphoma is the most prevalent?

Answer 4

B cell (85%)

Question 5

How to diagnose NHL and HL

Answer 5

excisional biopsy

Question 6

follicular lymphoma treatment

Answer 6

type of NHL
slow growing; treat symptoms only

Question 7

what is Richter’s transformation?

Answer 7

transformation of slow-growing NHL into an aggressive NHL

Question 8

what is the median time from diagnosis of low-grade NHL to transformation to DLBCL (diffuse large B Cell Lymphoma)?

Answer 8

~5 years

Question 9

what is the treatment for DLBCL

Answer 9

R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, presnisolone)

Question 10

What is the treatment for DLBCL in high risk patients

Answer 10

Pola + R + CHP

Question 11

What should be done before initiating rituximab (anti CD-20) in a patient with NHL?

Answer 11

check a hepatitis B surface antigen and hep B core antibody

Question 12

How to pre-treat for HepB reactivation in NHL

Answer 12

entecavir 0.5mg daily

Question 13

NHL treatment options

Answer 13

1st: rituximab, 2nd: CAR-T, 3rd: Bispecific t-cell engagers

Question 14

What is the treatment for cytokine release syndrome?

Answer 14

Tocilizumab (anti IL-6)

Question 15

What is ICANS?

Answer 15

Immune effector cell-associated neurotoxicity syndrome

mainly presents as confusion/ altered mental status

Question 16

How to treat ICANS?

Answer 16

corticosteroids!

Question 17

multiple myeloma patho

Answer 17

abnormal plasma cells infiltrating the bone marrow (m-protein)

Question 18

Multiple Myeloma (MM) presentation

Answer 18

C- calcium >11.5mg/dL (constipation, altered mental status)
R- renal dysfunction SCr > 2 mg/dL or CrCl < 40 mL/min
A- anemia <10g/dL (or 2g/dL below normal)
B- bone; one or more osteolytic lesions

Question 19

multiple myeloma treatment

Answer 19

3 drug regimen, then stem cell transplant if possible

Question 20

3 drug regimen for MM

Answer 20

thalidomide derivative, steroids, proteasome inhibitor (bortezomib) (causes apoptosis of cancer cells)

Question 21

MM treatment goals?

Answer 21

incurable; prolong survival with stem cell rescue. use 3 drug regimen

Question 22

What are the chronic leukemias?

Answer 22

chronic myeloid Leukemia (CML)
chronic lymphocytic leukemia (CLL)

Question 23

patho of CML

Answer 23

Philadelphia chromosome (BCR-ABL) oncogene

Question 24

CML presentation

Answer 24

• leukocytosis (as high as 1 mil WBCs causing leukostasis) = medical emergency
• can cause stroke and/or organ dysfunction

Question 25

CML treatment

Answer 25

- tyrosine kinase inhibitors - cure with stem cell transplant - TKIs: Imatinib, Ponatinib (for T315A mutation)

Question 26

Imatinib considerations

Answer 26

- need to be compliant! - metabolized CYP3A4 - nausea and rash

Question 27

Dasatinib considerations

Answer 27

avoid acid reducers may cause fluid retention

Question 28

Nilotinib considerations

Answer 28

may cause metabolic syndrome and QTC prolongation

Question 29

Bosutinib considerations

Answer 29

may cause diarrhea and GI toxicity

Question 30

Ponatinib considerations

Answer 30

may cause ischemia, vascular occlusion, and hypertension

Question 31

chronic lymphoid leukemia patho

Answer 31

loss of apoptosis and lymphocyte accumulation

Question 32

CLL treatment principles

Answer 32

only treat if symptomatic - tx reserved for stage III or IV disease

Question 33

CLL treatment

Answer 33

BTK inhibitor (___BRUTinib) (indefinite) and venetoclax x 1 year

Question 34

AML presentation

Answer 34

pancytopenia, bone pain, gum hypertrophy

Question 35

AML diagnosis

Answer 35

- through bone marrow biopsy - greater than 20% blasts (immature cells)

Question 36

AML treatment principles

Answer 36

induce remission and prevent relapse (do a bone marrow biopsy before and after treatment)

Question 37

venetoclax considerations

Answer 37

tumor lysis syndrome

Question 38

ALL treatment considerations

Answer 38

can hide in brain or testes (can cause testes to enlarge)

Question 39

ALL CNS treatment

Answer 39

intrathecal methotrexate or cytarabine