Luke 1 Flashcards
What are the main clinical management for haematological malignancies?
- standard treatment for acute leukaemias
- remission induction
- consolidatioin
- maintenance
What is remission induction?
- primary treatment
- 3 to 8 weeks
What is consolidation?
- intensification of treatment to ensure eradication of any resistant cells surviving the induction phase
- can last for 6 to 9 months
What is the maintenance stage?
- continuing treatment
What is the clinical management for children with ALL?
- multidrug therapy
- CNS targeted treatment
- randomised controlled triaks
What are the remission induction chemo for children with ALL?
- vincristine, prednisolone and daunorubicin (doxorubicin)
What determines the intensity of remission chemo for child ALL?
- age
- white cell count at presentation
- response of disease
- measurement of residual disease (MRD)
What are the consolidation chemo for child ALL?
- daunorubicin
- asparaginase
- methotrexate
- cytosine arabinoside
What are the treatments for CNS prophylaxis childhood ALL?
- intrathecal methotrexate
- cranial irradiation
What are the maintenance chemo for child ALL?
- methotrexate
- vincristine
- prednisolone
- 6-mercaptopurine
How long does maintenance therapy for child ALL last?
2-3 years
What can cause non-compliance in maintenance therapy for child ALL?
- maintain high leucocyte count
Can boys or girls tolerate higher mercaptopurine doses and why?
- boys which may be related to their higher risk of relapse
What area of the body is also treated in maintenance therapy for child ALL?
- cranial radiation
- intrathecal chemotherapy
- CNS sanctuary
What are the side effects?
- major short term side effects (bone marrow suppression)
- low neutrophil and platelet count
- allopurinol to prevent kidney damage
Why do you require overshoot for cranial irradiation?
- due to beam penumbra and thickness of skull which stops the beam
What is a common area of relapse for boys?
- testicular diease in 25% of males pre-pubity
What is a common dose for testicular disease?
- 24Gy in 12-15#
- includes the scrotum and spermatic cord
What are the four groups identified at presentation?
- standard risk group (majority of ALL)
- higher risk group (all adults and children with higher leukocyte counts at presentation)
- highest risk
- special risk patients (philadelphia chromosome, slow response to induction treatment)
What is the percentage of ALL relapse and when does it occur?
- 20 to 25%
- occur because leukaemia cells become resistant to drug
What is the first step in treating relapased ALL?
- repeat remission program
- possible increase in drug intensitiy
- late relapse usually achieve 2nd remission quite easily maintained for long period of time
What is the clinical management for adult ALL?
- remission induction
- consolidation
- maintenance
What are the adverse prognostic factors for adult ALL?
- age over 60
- WBC above 30 x 10^9 cells/L
- late achievement of complete response
- Philadelphia chromosome
- B-cell ALL
What are the remission chemo for AML?
- cytosine arabinoside
- daunorubicin
- intensive supportive care
What are the maintenance therapy for AML?
- cytosine arabinoside, daunorubicin WITH - etoposide - 6-mercaptopurine - 5-azacytidine
What are the adverse prognostic factors for AML?
- age over 60
- high WBC
- poor performance status
- patients who developed AML after myelodysplastic syndrome
What is the clinical management CLL?
- no cure
What are the treatments used for CLL?
- chlorambucil/cyclophosphamide
- anthracyclines
- fludarabine and cladribine
- alemtuzumab and tituxan
- prednisolone
What does spleen irradiation cause?
- splenomegaly
What is imatinib?
- an oral tyrosine kinase inhibitor
What are some devices to deliver chemo?
- hickman line
- portacath
What are the two types of stem cell transplantation?
- autologous (own cells)
- allogeneic (donor cells)
What are the two types ways to treat/prepare for transplant?
- chemo
- TBI
What is a TBI dose fractionation?
- 14.4Gy in 8# over 4 days
- 12Gy in 6# over 3 days
What is some TBI patient care?
- administration of pre-treatment medication is essential
- anti-emetics
- 5HT antogonits
What is the clinical management for multiple myeloma?
- asymptomatic patients not treated unless disease progressing
What can multiple myeloma cause?
- cord compression
- bone pain
- whole brain
What is the rt target volume for multiple myeloma?
- depends on pain
- need to consider OAR
- may need an equatorial tattoo
What is the major option for definitive treatment of multiple myeloma?
- chemotherapy aimed at achieving stable response (melphalanor cyclophosphamide)
What are the treatment options for polycythaemia rubra vera?
- venesection (bleed the patient)
- chemotherapy
- radiaiton to spleen
What is venesection?
- reduce blood volume rapidly
- phlebotomy gives quick symptomatic relief by removing 500mL
- further 500mL can be withdrawn 24hrs later
- maintain haematocrit below 45% in men (lower for women)
What chemo is used for polycythaemia rubra vera?
- busulfan
- chlorambucil and melphalan
- hydroxycarbamide
