New and Future Treatments for Blood Cancer

Question 1

What does chemotherapy do?

Answer 1

Damages DNA of cancer cells as they divide
Recognize cells damaged beyond repair and kills via apoptosis
Involves protein in cell - p53

Question 2

Why do lymphoma/ CLL and acute leukaemia respond well to chemo and RT?

Answer 2

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

Question 3

What are the immediate effects of chemo?

Answer 3

Hair loss
Nausea and Vomiting
Neutropenic infection
Tiredness +++

Question 4

What are the long term effects of chemo?

Answer 4

Heart damage
Lung damage
Cancers

Question 5

What is the supportive treatment of chemo?

Answer 5

Promt treatment of neutropenic fever 
Broad spectrum antibiotics 
Red cell and platelet transfusion 
Growth factors (gCSF) 
Prophylactic antibiotics and antifungals

Question 6

What are examples of antifungals used as prophylactic agents in those who are on chemo?

Answer 6

Itraconazole

Posaconazole

Question 7

What are monoclonal antibodies?

Answer 7

Immune treatment which affect only cells which posses the target protein
More effective than chemo alone

Question 8

What is an example of a monoclonal antibody used in haem malignancy?

Answer 8

Rituximab; targets CD20 region on B cells

Question 9

What ir R-CHOP?

Answer 9

Rituximab 
Cyclophosphamide
Hydroxydaunorubicin 
Vincristine (Oncovin) and
Prednisolone

Question 10

In what condition is R-CHOP used?

Answer 10

Non-hodgkin’s lymphoma

B cell NHL

Question 11

What is the protein present on hodgkin’s cells?

Answer 11

CD30

Question 12

What is an example of a monoclonal Ab used to target CD30?

Answer 12

Brentuximab

Question 13

In what condition is biological treatment well established?

Answer 13

Multiple Myeloma

Question 14

What is a proteasome inhibitor?

Answer 14

Proteasome will breaks down protein into amino acids for recycling
Blocking this allows for toxic accumulation of proteins in the cell resulting in apoptosis

Question 15

In what condition are proteasome inhibitors used?

Answer 15

Low grade NHL (Waldenstrom’s)

Mantle cell NHL

Question 16

What are side effects of proteasome inhbitors?

Answer 16

Nerve damage

Low platelets

Question 17

What are IMIDs?

Answer 17

Derivatives of thalidomide e.g. lenalidomide

Question 18

‘What are side effects fo IMIDs?

Answer 18

Nerve damage
Risk to foetus
Effect on blood count
Can result in other cancer

Question 19

In what condition are tyrosine kinase inhibitors (imatinib, nilotinib) used?

Answer 19

CML; targets philadelphia chromsome

Question 20

In what conditions are ibrutinib used (targets malignant B cells)?

Answer 20

CLL

NHL

Question 21

What is the results of the translocation of 9 to 22 in philadelphia chromosome?

Answer 21

Produces oncogene BCR-ABL
Affects signal transduction - activates gene transcription, interrupts mitochondrial processing of apoptosis and the degradation of inhibitory proteins

Question 22

What are side effects of tyrosine kinase inhibitors?

Answer 22

Diarrhoea
Fluid in lungs
Neutropenia
Generally tolerated very well

Question 23

What are side effects of idelalisib (used in CLL with p53 mutation)?

Answer 23

Diarrhoea
Rash
Fatigue
Liver abnormality
Fever

Question 24

What are side effects of ibrutinib (used in mantle cell NHL)?

Answer 24

Fever
Low platelets
Anaemia
SOB

Question 25

What is an example of a checkpoint inhibitor?

Answer 25

Nivolumab

Question 26

What will nivolumab bind to?

Answer 26

PD-1 receptor

Question 27

In what conditions is nivolumab used?

Answer 27

Malignant melanoma

Lymphoma; esp hodgkins

Question 28

What is an allogenic bone marrow transplant?

Answer 28

Transplant from a matched donor

Question 29

What are the side effects of a bone marrow transplant?

Answer 29

GvHD

Question 30

What is the graft vs leukaemia effect?

Answer 30

T cells from donor results in immune attack on the cancer