HEME Flashcards
How did we reduce bortezomib-associated PN?
Subcutaneous!! (Weekly dosing has same amount as biweekly, but patients could tolerate higher doses)
What combinations of daratumimab can be used first-line in transplant eligible patients?
Dara-VRd
Dara-VTd
What’s the mechanism of daratumimab?
Anti-CD 38
What’s the difference between KRd and VRd
KRd had higher composite of cardiac/renal/pulmonary side effects. VRd had more PN
Why do we use low-dose dexamethasone?
Low-dose dex (weekly) had improved OS from less infectious complications and lower rate of VTE than high-dose dex (pulse dosing)
What line of treatment is selinexor approved in?
5th+
How many drugs should be used for transplant eligible initial treatment? What about non-transplant?
3-4
2-4
What anticoagulant prophylaxis is used for patients on IMIDs at high risk for VTE per the IMPEDE?
Warfarin (goal 2-3)
Dateparin 5000IU
Enoxaparin 40U daily
Apixaban 2.5 mg BID
What are the BBWs for pabinostat?
Cardiac arrhythmia, ischemia
Diarrhea
What combination is pabinostat approved with?
Vd
What treatment line is pomalidomide approved in?
NOT first
Used with dexamethasone
What is the MOA of isatuximab?
Anti-CD38
What is supportive care required for daratumimab?
Antiviral for at least 3 months after treatment
Premedications with corticosteroid, APAP, and antihistamine
Type and screening prior to initiation
What’s in PACE?
Cisplatin
Doxorubicin
Cyclophosphamide
Eroposide
What supportive care is needed with PACE?
Antifunfal and antibacterial ppx during periods of neutropenia
GF support
Antiviral if getting bortezomib with it (VT-PACE)
What is the weekly dose of bortezomib? And what is biweekly dose?
Weekly = 1.5 mg/m2 Biweekly = 1.3 mg/m2
What are high risk genetic mutations for MM?
Del 17p
T(14;16)
T(4:14)
What are requirements for “active” MM?
BMPC at least 10%
+ something clinical (CRAB)
OR BMPC at least 60%, FLCR >100 or <0.01, or focal marrow lesion at least 5 mm
T/F: Transplant should be the goal following induction for patients with MM
False - equal outcomes with transplant vs maintenance, so patient specific…
Maintenance therapy approved for MM?
Lenalidomide
Bortezomib
Ixazomib (only transplant eligible)
Lenalidomide+bortezomib
What is the microglobulin protein level considered high risk?
> 5.5! (<3.5 is low risk)
For non-transplant MM patients, what regimens are approved with daratumimab?
Dara-Rd
Dara- velcade- melphalan - prednisone
Dara-CyBorD
What’s the MOA of belantomab mafodotin ?
ADC targeting BMCA w/MMFA (microtubule inhibitor)
What are ADEs of blenrep?
Ocular toxicity! REMS program requires eye appts before each dose and ocular lubricants QID throughout treatment
For MM, which bone modifying agent is preferred??
No preference - pamidronate, Zometa, or Xgeva
What is the dose of Xgeva for bone metastases?
120mg SC monthly
When is furosemide used in management of MHC?
Only AFTER fluid has been restored. Used to continue hydration without overload
Which of the IMIDs has the highest risk of secondary malignancies?
Lenalidomide
Which of the IMIDs has the highest risk of PN?
Thalidomide
Which of the IMIDs cause the most myelosuppression?
Lenalidomide and pomalidomide
Which of the IMIDs has the most renal toxicity?
Lenalidomide
What is the recommendation for treatment of VTE in patient with platelet count 25-50K?
Enoxaparin half dose
Which patient population should avoid DOACs?
Gastric or gastroesophageal lesions
Fondaprinux is contraindicated when?
CrCl < 30
