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444-Oncology and Neurology > Lymphoma and MM > Flashcards

Lymphoma and MM Flashcards

1
Q

what is lymphoma

A

group of lymphoproliferative disorders originating in lymphocytes/ lymphatic tissue

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2
Q

what is the defining feature of hodgkin’s lymphoma

A

reed-sternbery cell

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3
Q

describe hodgkin’s lymphoma

A

B cell only, aggressive

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4
Q

3RF for hodgkin’s lymphoma

A

prolonged EBV infection, family Hx, (siblings of same sex), HIV

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5
Q

nonhodgkin’s lymphoma RFs

A

HIV, FHx (first degree), EBC, H pylori, MALD, burkitt, weakened immune sx, autoimmune disease

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6
Q

types of NHL

A

B (DLBCL), T, or NK/T cell
can be indolent or aggressive

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7
Q

diagnosis of B cell lymphoma rquires

A

Excisional lymph node biopsy of preferably largest regionally involved lymph node
For extranodal lymphomas = use sizable biopsy from organ of origin
Fine needle biopsy inadequate for initial diagnosis

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8
Q

when the excised lymph node is examined by the pathologist, what will they look for?

A

phenotyping- CD20 on B cells
gene rearrangements
EBV

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9
Q

what additional workup may be done for lymphomas besides lymph node examination

A

CT/PET
IPI score
lab chemistries
testing for comorbidities- pregnancy, HIV, EBV, hep B, pulmonary and ECHO/MUGA test if bleomycin or anthracyclines

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10
Q

stage of lymphoma if Single lymph node region (I) or one extralymphatic organ

A

1

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11
Q

stage of lymphoma if local extralymphatic extension plus lymph nodes, same side of diaphragm

A

2

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12
Q

stage of lymphoma if 2 or more lymph node regions, same side of diaphragm

A

2E

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13
Q

stage of lymphoma if local extra lymph extensions

A

3E

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14
Q

stage of lymphoma if lymph node regions on both sides of the diaphragm either alone

A

3

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15
Q

stage of lymphoma if Diffuse involvement of one or more extralymphatic organs or sites

A

4A (if no B sx)

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16
Q

stage of lymphoma if Diffuse involvement of one or more extralymphatic organs or sites with unexplained weight loss >10% from baseline within 6 mths of staging, unexpected fever >38C, or drenching night sweats

A

4B

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17
Q

list the 3 B sx

A

unexplained weight loss >10% from baseline in 6mths
unexpected fever >38C
drenching night sweats

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18
Q

what is treatment for DLBCL

A

RCHOP
rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone

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19
Q

rituximab 3 sus MOA

A

binds CD20 and cells die either by being recognized by effector cells, complement activation, or direct cell death

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20
Q

most common rituximab AE + what to do to prevent it

A

infusion reaction
premedicate with acetaminophen, diphenhydramine or loratidine, hydrocortisone, ranitidine or famotidine
hold ACEi/ARBs 24hrs pre

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21
Q

how should rituximab therapy be initiated

A

first dose should always be given IV, if no AEs, next dose can be given SQ
if first dose was not complete due to AEs, must have one full IV dose before SQ possible

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22
Q

what is the difference between IV and SQ rituximab

A

IV is dosed by 375mg/m2, SQ is a fixed flat dose of 1400mg

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23
Q

cyclophosphamide AEs

A

hemorrhagic cystisis
N/V- HEC with doxorubicin in RCHOP
myelosuppression, alopecia, fertility suppression

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24
Q

cyclophosphamide MOA

A

Alkylating agent- nitrogen mustard type: binds to DNA + cross links DNA and RNA = no protein synthesis

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25
doxorubicin MOA
Anthracycline: inhib TP2 and prevents relegation of DNA during replication Damages DNA and cell membranes by producing free radicals
26
doxorubicin AEs
cardiotoxicity - late onset: reduced LVEF or CHF (more common) - early onset: acute transient ECG changes to arrhythmia myelosuupression HEC with cyclophosphamide in RCHOP alopecia discoloration of urine
27
what must be done before initiating doxorubicin in RCHOP
ECHO or MUGA- LVEF must be =>50%
28
vincristine MOA
Vinca alkaloid - binds to tubulin (protein on spindle) and prevents mitosis IV admin only (fatal if intrathecal)
29
vincristine AEs
Neurotoxicity Peripheral neuropathy Autonomic neuropathy- constipation (may require stool softeners and laxatives prophylactically)
30
what to monitor for prednisone in RCHOP
blood glucose- diabetics esp mood changes insomnia- may require zopiclone on prednisone days GERD- take with food
31
what is included in supportive care for RCHOP
antinauseants infection prevention (entecavir or tenofovir for HepB prophylxis) prophylaxis for tumor lysis syndrome
32
factors reducing chances of cure in hodgkin's lymphoma
Stage IV, ≥3 extranodal sites Age ≥45yrs old Male gender Albumin <40 High WBC count (≥15) Lymphocytopenia (lymphocytes <8% or <0.6%) Hg <105
33
factors that reduce ability to tolerate intense chemo in hodgkin's
≥60yrs old ECOG >2 HIV +
34
2 treatments for hodgkin's
Esc-BEACOOP ABVD
35
what is Esc-BEACOOP for HL (BLEHCOPP)
bleomycin etoposide doxorubicin cyclophosphamide vincristine procarbazine prednisone
36
what is ABVD (DBVD)
doxorubicin bleomycin vinblastine dacarbazine
37
the A in HL treatments stand for
doxorubicin
38
bleomycin MOA
Causes DNA strand scission through formation of an intermediate metal complex
39
bleomycin AEs
respiratory effects- pulmonary tests + CXR before and periodically derm effects mucositis and stomatitis loss of appetite
40
vinblastine MOA
vinca alkaloid that binsd to tubulin and prevents mitosis
41
AEs of vinblastine
less neurotoxicity than vincristine more myelosuppression
42
which is more myelosuppressive 1. vincristine 2. vinblastine
2
43
which is more neurotoxic 1. vincristine 2. vinblastaine
1
44
dacarbazine MOA
Prodrug for MTIC -cytotoxicity thought to be due to methylcarbonum ions that attach nucleophilic groups in DNA
45
dacarbazine N/V severity
HEC
46
procarbazine MOA
Alkylating agent- MOA not clear, could be free radical damage
47
what to watch out for with procarbazine
MAOi activity = avoid high tyramine content foods and alcohol- disulfaram reaction avoid sympathomimetic drugs
48
procarbazine AEs
infertility (ovarian failure, azoospermia), bone marrow suppression, secondary malignancies
49
T or F: MM is curable with transplant
F- incurable
50
what is CRAB in MM
calcium >2.75 renal function (Cr >176) anemia bone lesions or osteopenia with compression fractures
51
what is a common symptom of MM
hypercalcemia
52
hypercalcemia is an oncologic emergency when
it causes sig phys dysfxn like: dehydration, mental status changes, cardiac arrhythmias, renal insuff or failure
53
what is a normal serum Ca level
2.2-2.6
54
what is important to consider when reading a pt's calcium level
most labs report Ca as total calcium both bound and unbound those with hypoalbuminemia may have high unbound, but total still looks normal use corrected calcium for estimation of phys active calcium
55
corrected calcium equation
Corrected calcium (mmol/L) = measured calcium (mmol/L) + ([40-albumin (g/L)]x0.02)
56
tx of hypercalcemia
hydration with NS bisphosphonates (promotes Ca elimination + inhibits further Ca release from bone) calcitonin (promotes excretion of Ca)
57
malignant expansion of plasma cells usually in bone marrow, monoclonal protein (M-protein) in serum or urine.
multiple myeloma
58
what is the marker in multiple myeloma
CD38 o nplasma cells
59
is MM aggressive or indolent
aggressive
60
what type of cell does MM affect
plasma cells
61
what type of cells does lymphoma affect
lymphocytes
62
what is the M protein
monoclonal protein secreted by malignant plasma cell- can be produced uncontrollably + not functional
63
what is the problem in MM with having too many malignant plasma cells
crowding of bone marrow = pancytopenia bone damage from bone marrow crowding- increased osteoclast function and decreased osteoblast function = bone weakening and hypercalcemia no normal plasma cell functioning = inefctions
64
what is the issue in MM with haaving too many monoclonal proteins
too many proteins in bloodstream = kidney damage = cast nephropathy, anemias increased serum viscosity
65
what is the diagnostic criteria for MM
M protein in serum and/ or urine Clonal bone marrow plasma cells or plasmacytoma Presence of myeloma sx
66
what is the ß2M (Beta-2-microglobulin)
protein on membrane of nucleated cells that becomes elevated with high cell turnover. Elevated levels = poor prognostic factor in MM
67
which of the following is not a goal of therapy with MM 1. cure 2. disease control 3. improve QoL 4. prolong survival
1
68
treatment for MM typically include ________ for transplant eligible pts
induction, consolidation, autologous transplant, maintenance
69
what is the treatment for MM if pt is not eligible for transplant
pharmacotherapy to reduce tumor burden
70
4 drugs for transplant ineligible MM pts
bortezomib dexamethasone daratumumab lenalidomide
71
bortezomib MOA
reversible inhibitor of the 26S proteasome- inhibition alters regulatory proteins = cell cycle arrest + apoptosis Can be given IV or SC, fatal if given intrathecally
72
AEs of bortizomib
herpes zoster reactivation (all pts should be given HSV/VZV prophylaxis with acyclovir or valacyclovir), neuropathy, thrombocytopenia, constipation/ diarrhea
73
bortezomib interacts with
green tea- lowered bortezomib's antiproliferative effect of myeloma cells
74
dexamthasone MOA in MM
cytotoxic to myeloma cells likely via apoptosis Pulse dosing (ex 40 mg po once weekly)
75
daratumumab MOA in MM
monoclonal abx that targets CD38
76
daratumumab AEs and how to deal
infusion rxn in 50% = premedicate with antihistamines, acetaminophen, corticosteroids, H2 acid inhibitors
77
lenalidomide MOA
thalidomide derivative = immunomodulatory, antiangiogenic, and antineoplastic characteristics via multiple mechs
78
lenalidomide AEs
teratogenic, DVT/PT, edema, thrombocytopenia and neutropenia Requires renal dosing adjustment if kidney fxn poor
79
T or F: with the REVAID program, pharmacists must counsel with every rx, even a refill for thalidomide derivatives
T
80
what do BPs do in MM
prevent hypercalcemia by enhancing Ca elimination and preventing further skeletal release of Ca less vertebral fractures, skeletal related events, pain
81
bisphosphonate AEs
osteonecrosis of jaw precipitated by dental work involving manipulation of mandibular and maxillary bones
82
how to minimize risk of ONJ with BPs
Prior to initiating therapy with bisphosphonates, a comprehensive dental evaluation should be performed and all invasive dental procedures be completed. Annual dentist visits and maximal preventive care. Avoid dental extractions if possible.
83
what to do if a pt on BPs with MM needs a dental extraction
hold BPs 1mth before procedure and resume after recovery
84
all _______ pts should receive prophylaxis for shingles with acyclovir or valacyclovir
bortezomib
85
what is used to mobilize stems cells into peripheral blood for an autologous stem cell transplant
filgrastim or chemo or both

444-Oncology and Neurology (22 decks)

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