Lecture 9 Flashcards
Lymphoma and MM
What are the components of the ABVD regimen for treating Hodgkin Lymphoma?
Answer: Adriamycin (Doxorubicin), Bleomycin, Vinblastine, Dacarbazine.
What is the rationale for including Bleomycin in the ABVD regimen?
Answer: Bleomycin causes DNA strand breaks through free radical formation, leading to apoptosis in cancer cells.
What is a major toxicity of Bleomycin and how is it monitored?
Answer: Pulmonary toxicity, including pneumonitis and fibrosis. Monitoring includes baseline and periodic pulmonary function tests (PFTs) and chest X-rays.
What are the potential side effects of Doxorubicin, and how do you monitor for these?
Answer: Cardiotoxicity (e.g., cardiomyopathy, heart failure). Monitor with baseline and periodic echocardiograms or MUGA scans to assess left ventricular ejection fraction (LVEF).
How is Vinblastine administered, and what serious adverse effect should be avoided?
Answer: Vinblastine is administered intravenously. It is fatal if given intrathecally (into the spinal fluid).
What are common side effects of Dacarbazine, and how can they be managed?
Answer: Nausea/vomiting (severe), myelosuppression, and anorexia. Anti-emetics should be given prophylactically, and CBC should be monitored for myelosuppression.
Which medications in the R-CHOP regimen require dose adjustments for liver dysfunction, and why?
Answer: Doxorubicin and Vincristine are metabolized by the liver (CYP3A4), so dose adjustments are necessary in patients with hepatic impairment to avoid toxicity.
What drug interactions should be considered for patients on Bortezomib for multiple myeloma who are also receiving green tea?
Answer: Green tea can interfere with Bortezomib’s anti-cancer effects, and patients should be advised to avoid it.
What is the standard treatment for DLBCL, and what is the rationale for adding Rituximab to the R-CHOP regimen?
A:
The standard treatment is R-CHOP (Rituximab, Cyclophosphamide, Doxorubicin, Vincristine, and Prednisone), administered in 3-6 cycles.
Rituximab is a monoclonal antibody targeting CD20 on B-cells, enhancing the destruction of malignant B-cells. It improves overall survival and response rates compared to CHOP alone.
What are the major toxicities associated with R-CHOP, and how should they be monitored?
A:
Doxorubicin: Cardiotoxicity (monitor with echocardiogram).
Vincristine: Peripheral neuropathy (monitor for sensory and motor symptoms).
Cyclophosphamide: Myelosuppression and risk of secondary malignancies.
Prednisone: Hyperglycemia, mood changes, and insomnia (monitor blood glucose and provide supportive care).
Rituximab: Infusion-related reactions, premedicate with acetaminophen and antihistamines.
What is the ABVD regimen used to treat Hodgkin Lymphoma, and what are the key toxicities?
The ABVD regimen includes Adriamycin (Doxorubicin), Bleomycin, Vinblastine, and Dacarbazine.
Key toxicities:
Doxorubicin: Cardiotoxicity, monitored with echocardiograms.
Bleomycin: Pulmonary toxicity (pneumonitis, pulmonary fibrosis), monitored with pulmonary function tests.
Vinblastine: Peripheral neuropathy and myelosuppression.
Dacarbazine: Severe nausea and vomiting, myelosuppression.
How would you assess and manage hypercalcemia of malignancy in a patient with multiple myeloma?
Assessment: Look for symptoms such as fatigue, confusion, dehydration, polyuria, polydipsia, and arrhythmias. Check serum calcium and correct for albumin if needed.
Management:
Hydration with normal saline to promote renal excretion of calcium.
Bisphosphonates (Zoledronate or Pamidronate) to inhibit bone resorption.
Calcitonin for rapid reduction of calcium levels (short-term effect).
Avoid medications that increase calcium (e.g., thiazides).
What are the criteria for diagnosing multiple myeloma, and what does CRAB stand for?
A:
Diagnosis requires ≥10% clonal plasma cells in bone marrow or biopsy-proven plasmacytoma, along with symptoms or biomarkers of malignancy.
CRAB stands for:
Calcium elevation (>0.25 mmol/L above normal).
Renal impairment (serum creatinine >177 μmol/L).
Anemia (hemoglobin <100 g/L).
Bone lesions (lytic lesions or osteopenia).
What are the commonly used agents in the treatment of multiple myeloma, and what are their associated toxicities?
A:
Bortezomib: Proteasome inhibitor, with toxicities like peripheral neuropathy and thrombocytopenia. Prophylaxis for herpes zoster reactivation is required.
Daratumumab: Monoclonal antibody targeting CD38, with infusion reactions requiring premedication.
Lenalidomide: Immunomodulatory drug with toxicities such as teratogenicity, thrombocytopenia, and an increased risk of DVT/PE.
Dexamethasone: Corticosteroid with risks of hyperglycemia, mood changes, and fluid retention.
What is the role of bisphosphonates in the management of multiple myeloma, and how do you minimize the risk of osteonecrosis of the jaw (ONJ)?
Role: Bisphosphonates (Zoledronate, Pamidronate) reduce bone resorption, preventing fractures and managing hypercalcemia.
Minimizing ONJ Risk:
Ensure a dental exam and complete any necessary dental work before starting therapy.
Avoid invasive dental procedures while on bisphosphonates.
Withhold bisphosphonates before dental extractions and resume once healing is complete.
