Malignant haematology management basics

Question 1

What are the 2 main categories of cancer therapy?

Answer 1

• Surgery/Radiotherapy - Limited role
• Systemic treatment - General role

Question 2

What is the function of surgery in haematological malignancy?

Answer 2

Surgery helps in diagnosis of tumour masses and plays a limited role in treating most haematological malignancies

Question 3

What is the function of radiotherapy in haematological malignancy?

Answer 3

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

Question 4

What is the main form of systemic cancer therapy?

Answer 4

Chemotherapy

Question 5

How does chemotherapy generally work?

Answer 5

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

Question 6

What are some haematological malignancies that can be cured by conventional chemotherapy?

Answer 6

Burkitt lymphoma
ALL
Lymphoma
Some AML sub-types

Question 7

What are the 2 main categories of conventional chemotherapy?

Answer 7

• Phase specific
• Non-phase specific

Question 8

What are the 3 main classes of phase specific chemotherapy?

Answer 8

• Anti-metabolites (E.g. methotrexate)
• Cytotoxic antibiotics (E.g. Anthracyclines)
• Mitotic spindle poisons (E.g. Vinca alkaloids, vincristine and vinblastine)

Question 9

What is an example of an anti-metabolite chemotherapy agent?

Answer 9

Methotrexate

Question 10

What is a example of a cytotoxic antibiotic chemotherapy agent?

Answer 10

Anthracyclines

Question 11

What are some examples of mitotic spindle poison chemotherapy agents?

Answer 11

Vinca alkaloids
Vincristine
Vinblastine

Question 12

What is the main class of non-phase specific chemotherapy agent?

Answer 12

Alkylating agents

Question 13

What are some examples of alkylating agent chemotherapy agents?

Answer 13

Cyclophosphamide
Chlorambucil
Melphalan

Question 14

How do anti-metabolite and cytotoxic antibiotics work?

Answer 14

They impair DNA structure and health

Question 15

What phase of the cell cycle do mitotic spindle poisons target?

Answer 15

The M-phase of the cell cycle

Question 16

How do alkylating agents work?

Answer 16

Impair DNA structure and covalently adduct with DNA

Question 17

What are some general side effects of chemotherapy?

Answer 17

• Bone marrow suppression
• Mucocytosis
• Infections
• Cardiomyopathy
• Thrombocytopenia

Question 18

What is a side effect of vinca alkaloids?

Answer 18

Neuropathy

Question 19

What is a side effect of anthracyclines?

Answer 19

Cardiomyopathy

Question 20

What are some side effects of alkylating agents?

Answer 20

Infertility
Secondary cancer

Question 21

What mutation can result in a low response of a cancer to chemotherapy?

Answer 21

Tp53 mutant disease

Question 22

How does Tp53 reduce chemotherapy prognosis and effect?

Answer 22

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

Question 23

What are some uses of steroids in cancer therapy?

Answer 23

They can also be used a single agent in the emergency management of life-threatening complications of lymphoid malignancy at diagnosis

Question 24

What are some forms of personalised cancer therapy?

Answer 24

Monoclonal antibody chemotherapy delivery
Chimeric antigen receptor T-cell (CAR-T)
Bi-specific antibodies