monoclonal

Question 1

what is hybridoma?

Answer 1

• hybrid cells produced by the fusion of short-live B cell and an immortal myeloma cell.
• Used to continuously produce a single type of antibody respond to specific antigen

Question 2

Characteristic of hybridomas

Answer 2

• unlimited life span
• unique cell surface antigens allow specific antibody target
• used in monoclonal antibody production
• murine characteristics
• highly pure and uniformed antibody

Question 3

what is antibodies?

Answer 3

Immunoglobulins produced by B lymphocytes or plasma cells in response to an antigen

Question 4

what is antigens?

Answer 4

large molecule recognized as foreign by the immune system

Question 5

what is epitopes?

Answer 5

binding site

Question 6

characteristic of IgG?

Answer 6

Reacts to foreign substance
- form Ag-Ab
- enhances phagocytosis
- protect fetus and newborn

Question 7

Identify the specific type of cancer Cd206 and CD20

Answer 7

• CD206 applies to Tilmanocept
• CD20 relates to the protein on the surface of B-cell lymphoma

Question 8

how antibody localization?

Answer 8

tumors grows > blood flow decrease especially to the interior > venous flow is slow > antibodies travel through interstitial spaces and attach to cell close to the capillaries > antibodies that become attached tend to stay attached

Question 9

Monoclonal antibody Production step

Answer 9

• antigen inject to mouse (cancer specific not patient specific)
• Wait 4-6 weeks: B lymphocyte cells to produce antibodies in response to antigen
• Scarifice the mouse and remove the spleen
• isolate B lymphocytes from its spleen
• Fuse B-lymphocytes with myeloma cells to create a hybridoma
• Grow hybridoma in HAT medium (Hypoxanthine, aminopterin, thymidine)
• check secretion from different test tube to has the highest specificity
• best antibody mass produced in growth media for each specific cancer

Question 10

What is monoclonal antibodies?

Answer 10

highly specified to an individual epitope on an antigen. the serum obtained consists of one antibody type

Question 11

what is poly clonal antibodies?

Answer 11

large amount which are non-specific. Able to recognize multiple site. some may react to more than one antigen

Question 12

HAMA reaction?

Answer 12

• mouse antibodies inject to human > immune system develops antibodies against the foreign mose protein in the Fc region
• no HAMA reaction with 1st dose ( no antibodies present)
• 2nd injection > immune recognized the mouse protein as foreign > mounts an immunological response > causes binding to the newly injected mouse antibody > leaves less antibody available to bind with the desired tumor antigen > increased liver concentration > cleared more rapidly from the vascular space

Question 13

Symptom of HAMA reaction

Answer 13

mild: fever, hives
severe: shortness of breath, hypotension
fatal: anaphylaxis

Question 14

monoclonal antibody terminology

Answer 14

• omab: murine (0% human)
• ximab: chimeric (65% human)
• zumab ( >90% human)
• umab (100% human)

Question 15

indication zevalin

Answer 15

not 1st line therapy
Relapsed (come back), refractory (not responding to treatment), transformed ( lower grade to higher graded), follicular ( abnormal B-lymphocyte)

Question 16

Contraindication zevalin

Answer 16

• 25% involvement bonemarrow
• impaired bone marrow: stemcell bonemarrow transplant, > 25% active marrow, < 100000 platelet count, < 1500 neutrophil count
• Type 1 reaction or anaphylactic reaction to murine

Question 17

Patient preparation to zevalin

Answer 17

• Screen HAMA
• must receive infusion of COLD rituximab 4 hrs prior to blocks any CD20

Question 18

Theranostic term?

Answer 18

Zevalin loosely
combine diagnose and therapy

Question 19

Theranostic dose and imaging

Answer 19

• diagnostic: lowdose 5mCi In-111 Zevalin 67hr tp, 173/247 keV look at distribution patterns of tracer. labeled antibody molecule find specific antigen and location of the tumor
• therapeutic: higher energy Y90 zevalin 32mCi, 64.1 hr tp, beta 2.281 MeV done 7-9 days after diagnostic imaging

Question 20

Zevalin Rp

Answer 20

used for chemotherapy in Non- Hodgkin’s lymphoma chimeric MAb to CD20.
5 mCi over 10 min infusion with 10ml saline.
adverse reactions w/n 48 hrs

Question 21

Zevalin imaging

Answer 21

large FOV SPECT/CT MEPH collimator
energy window 15-20% at 171 and 245 keV
Anterior and posterior CAP at 2-24 hrs and 48-72 hr
WB scan 7cm/min

Question 22

Normal uptake zevalin

Answer 22

liver, spleen, kidney, bladder and bowel.

Question 23

Assess distribution of zevalin

Answer 23

blood poool activity decrease

Question 24

When treatment of zevalin cannot be done

Answer 24

if increased activity in lung, liver, heart, urinary tract or bowel

Question 25

Altered distribution of zevalin

Answer 25

Uptake in the area of the tumor is not considered altered distribution
Altered distribution of zevalin is seen in intense localization in bone marrow, reticuloendothelial uptake.
Abnormal increased uptake in organs. lung uptake greater than liver. kidney uptake greater than liver, fixed areas of uptake in bowel greater than liver

Question 26

Treatment zevalin

Answer 26

7-9 days after imaging
pre-treat with rituximab 4hr before zevalin injection

Question 27

Dose treatment zevalin

Answer 27

0.4 mCi/kg (max 32mCi) of Y90 zevalin beta emitter

Question 28

indication of neuroendocrine tumor’s

Answer 28

pituitary adenomas
pancreatic islet cell neoplasms
pheochromocytoma
neuroblastoma
paragangliomas
gastrinomas
small cell lung cancers
detection and localization of meningiomas
carcinoid and other tumor benefit from octreotide therapy
diagnosis of rejection in cardiac transplant

Question 29

Patient prep octreotide therapy

Answer 29

unlabeled octreotide medication stopped 3 day before
well hyrated 1 day before and 24hrs after
- bowel prep and enema
prep for insulinoma
- recent CT film

Question 30

octreoscan dose

Answer 30

6 mCi In111- pentetreotide with 10ml saline

Question 31

octreoscan imaging

Answer 31

at 4 and 24 hours post inj optional 48hrs
energy 173, 247 (20% window)
WB anterior and posterior 3cm/min with MEPH collimator
CAP statics 10-15 minutes each. lateral for head if imaged
Spect at 4 hrs 64 image with 30sec/frame

Question 32

normal uptake in octreoscan

Answer 32

liver, spleen, kidneys, unrinary bladder and bowel

Question 33

Ga68 dotatate info

Answer 33

Ge68/Ga68 generator
ge Tp 271 days
Ga Tp 68 min

Question 34

Indication Ga68 dotatate

Answer 34

use in somatostatin receptor positive neuroendocrine tumors