Malignant haematology management basics Flashcards
What are the 2 main categories of cancer therapy?
- Surgery/Radiotherapy - Limited role
- Systemic treatment - General role
What is the function of surgery in haematological malignancy?
Surgery helps in diagnosis of tumour masses and plays a limited role in treating most haematological malignancies
What is the function of radiotherapy in haematological malignancy?
Radiotherapy plays a relatively limited role on its own, however, is useful for localised, low-grade lymphomas and extramedullary myeloma
At times, this can be used as palliative or symptom control
What is the main form of systemic cancer therapy?
Chemotherapy
How does chemotherapy generally work?
This is a non-specific treatment that inhibits DNA of cells in the S-phase of the cell cycle
They do this by damaging DNA, which stimulates p53 to initiate either DNA repair or apoptosis
What are some haematological malignancies that can be cured by conventional chemotherapy?
Burkitt lymphoma
ALL
Lymphoma
Some AML sub-types
What are the 2 main categories of conventional chemotherapy?
- Phase specific
- Non-phase specific
What are the 3 main classes of phase specific chemotherapy?
- Anti-metabolites (E.g. methotrexate)
- Cytotoxic antibiotics (E.g. Anthracyclines)
- Mitotic spindle poisons (E.g. Vinca alkaloids, vincristine and vinblastine)
What is an example of an anti-metabolite chemotherapy agent?
Methotrexate
What is a example of a cytotoxic antibiotic chemotherapy agent?
Anthracyclines
What are some examples of mitotic spindle poison chemotherapy agents?
Vinca alkaloids
Vincristine
Vinblastine
What is the main class of non-phase specific chemotherapy agent?
Alkylating agents
What are some examples of alkylating agent chemotherapy agents?
Cyclophosphamide
Chlorambucil
Melphalan
How do anti-metabolite and cytotoxic antibiotics work?
They impair DNA structure and health
What phase of the cell cycle do mitotic spindle poisons target?
The M-phase of the cell cycle
How do alkylating agents work?
Impair DNA structure and covalently adduct with DNA
What are some general side effects of chemotherapy?
- Bone marrow suppression
- Mucocytosis
- Infections
- Cardiomyopathy
- Thrombocytopenia
What is a side effect of vinca alkaloids?
Neuropathy
What is a side effect of anthracyclines?
Cardiomyopathy
What are some side effects of alkylating agents?
Infertility
Secondary cancer
What mutation can result in a low response of a cancer to chemotherapy?
Tp53 mutant disease
How does Tp53 reduce chemotherapy prognosis and effect?
Tp53 mutant disease results in the loss of the check-point regulator, meaning that DNA damage is not sensed and cell cycle arrest and/or apoptosis not initiated
What are some uses of steroids in cancer therapy?
They can also be used a single agent in the emergency management of life-threatening complications of lymphoid malignancy at diagnosis
What are some forms of personalised cancer therapy?
Monoclonal antibody chemotherapy delivery
Chimeric antigen receptor T-cell (CAR-T)
Bi-specific antibodies
