Malignant Heme Pharm Flashcards by Kyle Gabrick

What is Post Remission therapy ?

Short Term intense chemotherapy with Cytarabine based regimens.

High dose chemotherapy or chemoradiotherapy with autologous bone marrow rescue.

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What is cytarabine ?

It is a pyrimidine anti-metabolite activated by kinases to ARA-CTP which inhibits the S phase of the cell cycle.

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What are the black box warnings of Arsenic Trioxide ?

AV block, QT prolongation, electrolyte imbalance

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What is differentiation syndrome ?

Fever, Dyspnea, weight gain, pulmonary infiltrates, pleural or pericardial effusions +/- Leukocytosis.

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What would you use to treat Acute Promyelocytic Leukemia ?

ATRA and Arsenic trioxide. for standard treatment

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What is the childhood treatment of APL ?

ATRA + Anthracycline + Cytarabine

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What is the remission and consolidation therapy for APL ?

ARTA in conjunction with standard dose cytarabine and daunorubicin or idarubicin + ARTA without cytarabine

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What is the mantenance therapy for APL ?

ATRA + 6-ercaptopurine + Methotrexate

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What does Arsenic Trioxide do ?

Degrades PML-RAR-Alpha fusion protein.

Cardiovascular Toxicities

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What is the remission induction therapy for ALL ?

Prednisone + Vincristine + Anthracycline

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What is the consolidation therapy for ALL ?

Methotrexate + Mercaptopurine

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What is the CNS Prophylaxis therapy for ALL; sometimes with irradiation

IT Methotrexate + Mercaptopurine

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What is so great about Imatinib ?

It is an oral inhibitor of BCR-ABL tyrosine kinase. The adverse effects induces hepatic enzyme elevation and pancytopenia.

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How would you treat the acute phase of CML ?

Due to the short durability classic chemotherapy is utilized

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When you use Imitinab to treat CML ?

In the chronic phase this is the first line of treatment

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If the binding site for Imitinab has been mutated what drug would you use next ?

Desatinib and Nimotinib

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What are the common treatment regimens for CLL ?

Fludarabine + Cyclophosphoamide

Fludarabine + Rutiximab

Fludarabine + Rutiximab + Cyclophosphoamide

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How would you treat hairy cell leukemia ?

Purine analoges show the best response rate. Cladribine + INF Alfa-2b, Pentostatin

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What are the anti-neoplastic actions of Interferons ?

They will prolonge all the phases of the cell cycle. and induce cellular differentiation

What would you use to treat AML ? (post remission)

ARA-C - pyrimidine analog
Thioguanine - purine analog
Donorubicin- Free radical generator (Cardiotoxicity)
**All three are myelosupressive

What is metranomic dosing ?

Daily administration of lower doses of anti-hematologic malignancy drugs. By administering the drug more frequently you can avoid the proliferative effect some drugs exhibit at low concentrations
**It will circumvent hormesis.

What is Gemtuzomab ?

It is an Anti-CD33 antibody. This will be on cells of myleoid origin. The receptor Ab complex is internalized and releases Calechimycin which induces DNA stand breakage. Accelerated approval for AML relapse.

What is a problem with Gemtuzomab

Initial phase acute toxicity with 10% venoocclusive disease.

Why did we learn about Gemtuzumab ?

It carries an antitumor drug to tumor cells with CD-33. It is a monoclonal Ab carrier of a Chemo drug.

What does Alemtuzumab do in CLL ?

Orphan Drug that binds to CD-52 on mature Lymphocytes, monocytes, and Lymphoid cells. Induces a similar effect to rituximab.

Bendamustin in CLL ?

It is both an anti-metabolite and an an Alkylating agent. It causes DNA cross linking and very durable dsDNA single and double strand breakage. This drug is less susceptible to resistance.

How are interferons used to treat hematologic malignancies ?

1. They exhibit a direst antiproliferative effect on the tumor. 2. Activate the host immune system against the tumor cell (Cytotoxic T and NK cells) 3. Stimulate anti-proliferative cytokines

What is the most common treatment of Hogkin Lymphoma ?

Antracycline ( Doxirubicin ) Mitotic Spindel Inhibitor ( Vincristine ) Alkylating (Cyclophosphoamide ) or Bleomycin. Carbazine Drug and a corticosteroid.

What is the dose limiting toxicity of alkylating drugs ?

Myelosupression. Other classes of agents dont show this uniform response.

Can advanced Hodgkin disease be cured ?

Yes they can be treated with high dose therapy. 60-70% of patients can be cured with combination chemo. If the patient relapses they can rarely be cured with salvage therapy. High dose therapy with Autologous SCT.

What are the adverse effects of high dose therapy ?

They destroy stem cells which will have to be replaced after high dose therapy.

How do you treat Non-HL

COMP therapy. When they express CD-20 you can also employ rituximab

What are the concerns when treating Non-HL ?

Sterility from pelvic irridation using high dose cyclophosphoamide, secondary malignancies, and left ventricular dysfunction.

What are the two anti-CD20 antibodies

Tositumomab Ibritumomab They will not bind to non-lymphoid tissue and have a high incidence of hematologic malignancy.

How do you treat Burkitt Lymphoma ?

Cyclical Regimen of Cyclophosphoamide + methotrexate, Vincristine and Doxorubicin, and possibly cytarabine

During Pregnancy Chemo ?

Class X drugs are Teratogenic will cause death in utero. Other drugs can just cause organ malformation.

What are the adverse effects of Arsenic Trioxide ?

Acute Promyeloctic differentiation syndrome, AV block, cardiac arrhythimas, leukocytosis

What are the adverse effects of ATRA ?

Acute Promyelocytic Leukemia Differentiation syndrome and Leukocytosis

What are the adverse effects of Bleomycin ?

Pulmonary Fibrosis, Boobs on cancer man, and Idiosyncratic reaction ( fever )

What are the adverse effects of carboplatin ?

Anemia and Infection

What are the adverse effects of chlorambucil ?

Bone Marrow suppression, secondary malignancy, pregnancy and infertility

What are the adverse effects of Cladiribine ?

Marrow supression and neurotoxicity

What are the adverse effects of Ifosamide ?

Coma and hemorrhagic cystitis

What are the adverse effects of Doxorubicin, Danuribicin, and Idiorubicin ?

These Anthracyclines generate free radicals and inhibit Topo-2. they can cause heart disease and extravasational necrosis. d

What are the adverse effects of Interferon alpha ?

Contraindicated with autoimmune disease. Cause depression and suicidal thoughts.

What are the adverse effects of methotrexate ?

Ascites, Diahrrhea, exfolative dermititis, pulmonary disease, fibrosis, renal imparment, and tumor lysis syndrome.

What are the adverse effects of vinblastine and vincristine ?

Fatal Neuropathic Toxicity