Leukemia Lymphoma Therapeutics Flashcards
ALL regimen
ALLL
L-asparaginase Prednisone Doxorubicin Vincristine - CNS toxicity, constipation 6-MP
Gleevec Ph+
ALL intrathecal chemotherapy for CNS involvement
CNS prophylaxis
Cytarabine
Methotrexate
Thiotepa
AML
7C3D
Gingival hyperplasia
Skin involvement - leukemiacutis
Disseminated IV coagulopathy (DIC)
> 20% blasts
7 and 3 induction
7 days continuous cytarabine
3 days anthracycline (Ida/daunorubicin)
Need IV antibiotics for AE neutropenia
High dose cytarabine for consolidation
AE: cerebral toxicity handwriting, conjunctivitis
M3 APML
Differentiation syndrome (pulmonary infiltrate, pleural effusion, weight gain, hypotension ) treat with steroids
15;17 translocation
Promyelocytic
DIC bleeding
Induction: all-trans retinoic acid (ATRA) to promote growth to normal differentiation
Dexamethasone, anthracycline to inhibit differentiation syndrome (too much new WBC)
Consolidation: ATRA and cytarabine
Refractory: arsenic trioxide
ATRA AE: also teratogenic, can cause sterility
Bone marrow failure signs
Neutropenia: infection
Anemia: fatigue
Thrombocytopenia: bleeding
ALL, AML, CLL
AML bone marrow monitoring
1) diagnosis
2) 7 days after end of treatment to see aplastic marrow (wiped out)
3) look for bone marrow to recover WBC count
CML
9;22 translocation
Bcr-abl codes for tyrosine kinase that turns on proliferation
B symptoms: weight loss, fever, night sweat
Chronic accelerates to blast
Gleevec and other tyrosine kinase inhibitors
If T315I mutation use ponatinib
L-asparaginase
Give after MTX to maximize MTX activity
May increase vincristine toxicity
AE: anaphylaxis, decreased liver fibrinogen, neurologic confusion agitation
Pegylated 2 week dosing
CLL
FIB
ROC
Proliferating malfunctioning lymphocytes
B symptoms
Lymphadenopathy
Cytogenetic 17p poor prognosis
Watch if elderly and asymptomatic
Palliation if symptomatic
Fludarabine - need prophylactic abx
Ibrutinib PO regimen
Bendamustine, Rituximab
Obinutuzumab or ofatumumab, chlorambucil
Rituximab
Targets CD20
More useful in lymphoma than CLL
Myelodysplastic syndrome (MDS)
MAD
Less than 20%blast pre-leukemia state
Filgrastim CSF
Hypomethylate: turn on tumor suppressor gene
5-Azacitadine or
Decitabine
AE: myelosuppression, NV
Hodgkin Lymphoma
Neck, mediastinum
B symptoms - fever, night sweats, weight loss
Bimodal age distribution, bcl-2
Reed sternberg cell
Limited non-bulk - radiation
Extensive - chemo ABVD Adriamycin (doxorubicin) Bleomycin Vinblastine Dacarbazine
Relapse - Brentuximab - target Hodgkin CD30
Non-Hodgkin lymphoma
CD 20 positive
Low grade asymptomatic - watch and wait
Treat if massive bulk, symptomatic
CHOP avoid anthracycline if cardio toxicity
Cyclophosphamide
Hydroxy (doxorubicin)
Oncovin (vincristine)
Prednisone
Rituximab targets CD 20 for all NHL
RCHOP
Can use Rituximab for maintenance
