Hematology (Grove) Flashcards
Hodgkin’s lymphoma treatment goal
Cure; use high dose chemo followed by autologous stem cell transplant
Risk factors for hodgekin’s lymphoma
viral exposure (Epstein-Barr virus), impaired immune function (solid organ transplant, HIV)
Hodgkin’s lymphoma chemo regimen
ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine) (cardiotoxicity and pulmonary toxicity) or AAVD (6 cycles)
Which type of non-Hodgkin’s lymphoma is the most prevalent?
B cell (85%)
How to diagnose NHL and HL
excisional biopsy
follicular lymphoma treatment
type of NHL
slow growing; treat symptoms only
what is Richter’s transformation?
transformation of slow-growing NHL into an aggressive NHL
what is the median time from diagnosis of low-grade NHL to transformation to DLBCL (diffuse large B Cell Lymphoma)?
~5 years
what is the treatment for DLBCL
R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, presnisolone)
What is the treatment for DLBCL in high risk patients
Pola + R + CHP
What should be done before initiating rituximab (anti CD-20) in a patient with NHL?
check a hepatitis B surface antigen and hep B core antibody
How to pre-treat for HepB reactivation in NHL
entecavir 0.5mg daily
NHL treatment options
1st: rituximab, 2nd: CAR-T, 3rd: Bispecific t-cell engagers
What is the treatment for cytokine release syndrome?
Tocilizumab (anti IL-6)
What is ICANS?
Immune effector cell-associated neurotoxicity syndrome
mainly presents as confusion/ altered mental status
How to treat ICANS?
corticosteroids!
multiple myeloma patho
abnormal plasma cells infiltrating the bone marrow (m-protein)
Multiple Myeloma (MM) presentation
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
multiple myeloma treatment
3 drug regimen, then stem cell transplant if possible
3 drug regimen for MM
thalidomide derivative, steroids, proteasome inhibitor (bortezomib) (causes apoptosis of cancer cells)
MM treatment goals?
incurable; prolong survival with stem cell rescue. use 3 drug regimen
What are the chronic leukemias?
chronic myeloid Leukemia (CML)
chronic lymphocytic leukemia (CLL)
patho of CML
Philadelphia chromosome (BCR-ABL) oncogene
CML presentation
- leukocytosis (as high as 1 mil WBCs causing leukostasis) = medical emergency
- can cause stroke and/or organ dysfunction
CML treatment
- tyrosine kinase inhibitors
- cure with stem cell transplant
- TKIs: Imatinib, Ponatinib (for T315A mutation)
Imatinib considerations
- need to be compliant!
- metabolized CYP3A4
- nausea and rash
Dasatinib considerations
avoid acid reducers
may cause fluid retention
Nilotinib considerations
may cause metabolic syndrome and QTC prolongation
Bosutinib considerations
may cause diarrhea and GI toxicity
Ponatinib considerations
may cause ischemia, vascular occlusion, and hypertension
chronic lymphoid leukemia patho
loss of apoptosis and lymphocyte accumulation
CLL treatment principles
only treat if symptomatic
- tx reserved for stage III or IV disease
CLL treatment
BTK inhibitor (___BRUTinib) (indefinite) and venetoclax x 1 year
AML presentation
pancytopenia, bone pain, gum hypertrophy
AML diagnosis
- through bone marrow biopsy
- greater than 20% blasts (immature cells)
AML treatment principles
induce remission and prevent relapse (do a bone marrow biopsy before and after treatment)
venetoclax considerations
tumor lysis syndrome
ALL treatment considerations
can hide in brain or testes (can cause testes to enlarge)
ALL CNS treatment
intrathecal methotrexate or cytarabine
