New and Future Treatments for Blood Cancer Flashcards
What does chemotherapy do?
Damages DNA of cancer cells as they divide
Recognize cells damaged beyond repair and kills via apoptosis
Involves protein in cell - p53
Why do lymphoma/ CLL and acute leukaemia respond well to chemo and RT?
Lymphocytes commonly undergo apoptosis in normal lymph node
Lymphoma and CLL cells can be triggered to undergo apoptosis readily with chemo/ radiotherapy
Acute leukaemia have very quickly dividing cells
What are the immediate effects of chemo?
Hair loss
Nausea and Vomiting
Neutropenic infection
Tiredness +++
What are the long term effects of chemo?
Heart damage
Lung damage
Cancers
What is the supportive treatment of chemo?
Promt treatment of neutropenic fever Broad spectrum antibiotics Red cell and platelet transfusion Growth factors (gCSF) Prophylactic antibiotics and antifungals
What are examples of antifungals used as prophylactic agents in those who are on chemo?
Itraconazole
Posaconazole
What are monoclonal antibodies?
Immune treatment which affect only cells which posses the target protein
More effective than chemo alone
What is an example of a monoclonal antibody used in haem malignancy?
Rituximab; targets CD20 region on B cells
What ir R-CHOP?
Rituximab Cyclophosphamide Hydroxydaunorubicin Vincristine (Oncovin) and Prednisolone
In what condition is R-CHOP used?
Non-hodgkin’s lymphoma
B cell NHL
What is the protein present on hodgkin’s cells?
CD30
What is an example of a monoclonal Ab used to target CD30?
Brentuximab
In what condition is biological treatment well established?
Multiple Myeloma
What is a proteasome inhibitor?
Proteasome will breaks down protein into amino acids for recycling
Blocking this allows for toxic accumulation of proteins in the cell resulting in apoptosis
In what condition are proteasome inhibitors used?
Low grade NHL (Waldenstrom’s)
Mantle cell NHL
What are side effects of proteasome inhbitors?
Nerve damage
Low platelets
What are IMIDs?
Derivatives of thalidomide e.g. lenalidomide
‘What are side effects fo IMIDs?
Nerve damage
Risk to foetus
Effect on blood count
Can result in other cancer
In what condition are tyrosine kinase inhibitors (imatinib, nilotinib) used?
CML; targets philadelphia chromsome
In what conditions are ibrutinib used (targets malignant B cells)?
CLL
NHL
What is the results of the translocation of 9 to 22 in philadelphia chromosome?
Produces oncogene BCR-ABL
Affects signal transduction - activates gene transcription, interrupts mitochondrial processing of apoptosis and the degradation of inhibitory proteins
What are side effects of tyrosine kinase inhibitors?
Diarrhoea
Fluid in lungs
Neutropenia
Generally tolerated very well
What are side effects of idelalisib (used in CLL with p53 mutation)?
Diarrhoea Rash Fatigue Liver abnormality Fever
What are side effects of ibrutinib (used in mantle cell NHL)?
Fever
Low platelets
Anaemia
SOB
What is an example of a checkpoint inhibitor?
Nivolumab
What will nivolumab bind to?
PD-1 receptor
In what conditions is nivolumab used?
Malignant melanoma
Lymphoma; esp hodgkins
What is an allogenic bone marrow transplant?
Transplant from a matched donor
What are the side effects of a bone marrow transplant?
GvHD
What is the graft vs leukaemia effect?
T cells from donor results in immune attack on the cancer
