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Pete 3 > Luke 1 > Flashcards

Luke 1 Flashcards

1
Q

What are the main clinical management for haematological malignancies?

A
  • standard treatment for acute leukaemias
  • remission induction
  • consolidatioin
  • maintenance
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2
Q

What is remission induction?

A
  • primary treatment

- 3 to 8 weeks

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3
Q

What is consolidation?

A
  • intensification of treatment to ensure eradication of any resistant cells surviving the induction phase
  • can last for 6 to 9 months
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4
Q

What is the maintenance stage?

A
  • continuing treatment
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5
Q

What is the clinical management for children with ALL?

A
  • multidrug therapy
  • CNS targeted treatment
  • randomised controlled triaks
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6
Q

What are the remission induction chemo for children with ALL?

A
  • vincristine, prednisolone and daunorubicin (doxorubicin)
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7
Q

What determines the intensity of remission chemo for child ALL?

A
  • age
  • white cell count at presentation
  • response of disease
  • measurement of residual disease (MRD)
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8
Q

What are the consolidation chemo for child ALL?

A
  • daunorubicin
  • asparaginase
  • methotrexate
  • cytosine arabinoside
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9
Q

What are the treatments for CNS prophylaxis childhood ALL?

A
  • intrathecal methotrexate

- cranial irradiation

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10
Q

What are the maintenance chemo for child ALL?

A
  • methotrexate
  • vincristine
  • prednisolone
  • 6-mercaptopurine
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11
Q

How long does maintenance therapy for child ALL last?

A

2-3 years

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12
Q

What can cause non-compliance in maintenance therapy for child ALL?

A
  • maintain high leucocyte count
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13
Q

Can boys or girls tolerate higher mercaptopurine doses and why?

A
  • boys which may be related to their higher risk of relapse
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14
Q

What area of the body is also treated in maintenance therapy for child ALL?

A
  • cranial radiation
  • intrathecal chemotherapy
  • CNS sanctuary
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15
Q

What are the side effects?

A
  • major short term side effects (bone marrow suppression)
  • low neutrophil and platelet count
  • allopurinol to prevent kidney damage
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16
Q

Why do you require overshoot for cranial irradiation?

A
  • due to beam penumbra and thickness of skull which stops the beam
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17
Q

What is a common area of relapse for boys?

A
  • testicular diease in 25% of males pre-pubity
18
Q

What is a common dose for testicular disease?

A
  • 24Gy in 12-15#

- includes the scrotum and spermatic cord

19
Q

What are the four groups identified at presentation?

A
  1. standard risk group (majority of ALL)
  2. higher risk group (all adults and children with higher leukocyte counts at presentation)
  3. highest risk
  4. special risk patients (philadelphia chromosome, slow response to induction treatment)
20
Q

What is the percentage of ALL relapse and when does it occur?

A
  • 20 to 25%

- occur because leukaemia cells become resistant to drug

21
Q

What is the first step in treating relapased ALL?

A
  • repeat remission program
  • possible increase in drug intensitiy
  • late relapse usually achieve 2nd remission quite easily maintained for long period of time
22
Q

What is the clinical management for adult ALL?

A
  • remission induction
  • consolidation
  • maintenance
23
Q

What are the adverse prognostic factors for adult ALL?

A
  • age over 60
  • WBC above 30 x 10^9 cells/L
  • late achievement of complete response
  • Philadelphia chromosome
  • B-cell ALL
24
Q

What are the remission chemo for AML?

A
  • cytosine arabinoside
  • daunorubicin
  • intensive supportive care
25
Q

What are the maintenance therapy for AML?

A 
- cytosine arabinoside, daunorubicin
WITH 
- etoposide
- 6-mercaptopurine
- 5-azacytidine
26
Q

What are the adverse prognostic factors for AML?

A
  • age over 60
  • high WBC
  • poor performance status
  • patients who developed AML after myelodysplastic syndrome
27
Q

What is the clinical management CLL?

A
  • no cure
28
Q

What are the treatments used for CLL?

A
  • chlorambucil/cyclophosphamide
  • anthracyclines
  • fludarabine and cladribine
  • alemtuzumab and tituxan
  • prednisolone
29
Q

What does spleen irradiation cause?

A
  • splenomegaly
30
Q

What is imatinib?

A
  • an oral tyrosine kinase inhibitor
31
Q

What are some devices to deliver chemo?

A
  • hickman line

- portacath

32
Q

What are the two types of stem cell transplantation?

A
  • autologous (own cells)

- allogeneic (donor cells)

33
Q

What are the two types ways to treat/prepare for transplant?

A
  • chemo

- TBI

34
Q

What is a TBI dose fractionation?

A
  • 14.4Gy in 8# over 4 days

- 12Gy in 6# over 3 days

35
Q

What is some TBI patient care?

A
  • administration of pre-treatment medication is essential
  • anti-emetics
  • 5HT antogonits
36
Q

What is the clinical management for multiple myeloma?

A
  • asymptomatic patients not treated unless disease progressing
37
Q

What can multiple myeloma cause?

A
  • cord compression
  • bone pain
  • whole brain
38
Q

What is the rt target volume for multiple myeloma?

A
  • depends on pain
  • need to consider OAR
  • may need an equatorial tattoo
39
Q

What is the major option for definitive treatment of multiple myeloma?

A
  • chemotherapy aimed at achieving stable response (melphalanor cyclophosphamide)
40
Q

What are the treatment options for polycythaemia rubra vera?

A
  • venesection (bleed the patient)
  • chemotherapy
  • radiaiton to spleen
41
Q

What is venesection?

A
  • 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)
42
Q

What chemo is used for polycythaemia rubra vera?

A
  • busulfan
  • chlorambucil and melphalan
  • hydroxycarbamide

Pete 3 (11 decks)

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