Nutritional Management of Hematologic Malignancies

Question 1

What are the four main types of leukemia?

Answer 1

• acute lymphoblastic leukemia
• acute myeloid leukemia
• chronic lymphocytic leukemia
• chronic myeloid leukemia

Question 2

True or False: Hodgkin lymphoma is more prevalent than non-Hodgkin lymphoma.

Answer 2

False

Question 3

True or False: Multiple Myeloma (MM) is a type of plasma cell malignancy.

Answer 3

True
* MM accounts for 90% of the plasma cell neoplasms diagnosed

Question 4

What are the two phases of AML treatment and what do they involve?

Answer 4

1. Induction therapy: designed to establish complete remission
2. Consolidation: aims to destroy leukemia cells that survived induction but are undetectable by tests; 3 options are chemo, auto HCT, or allo HCT

Question 5

What are the three stages of ALL treatment and what do they involve?

Answer 5

1. Induction therapy: to achieve complete remission
2. Consolidation: many of same meds used for induction are used for consolidation; high risk patients may have allogenic HCT
3. Long-term maintenance

Question 6

What are the three disease phases of CML treatment and how do they affect treatment?

Answer 6

1. Chronic: includes targeted tyrosine kinase inhibitors (TKIs)
2. Accelerated: clinical trial followed by TKIs as second option
3. Blastic: allogenic HCT is needed

Question 7

What are some treatments used for CLL?

Answer 7

• Chemo
• monoclonal antibodies
• targeted therapies
• HCT (if high risk)
• leukapheresis (prior to chemo if amount of CLL within cells is high)

Question 8

What are some treatments use for MM?

Answer 8

• First line: alkylating agents, immunomodulatory drugs, proteasome inhibitors commonly with steroids
• Radiation for bone pain management
• Auto HCT if at least partial remission after induction (likely with high-dose melphalan for conditioning regimen)

Question 9

What are some common treatments used for NHL?

Answer 9

• Chemo (intrathecal if lymphoma has reached the CNS)
• Targeted therapy
• Immunotherapy (CAR-T is being used for NHL)
• Radiation
• Consolidation with auto or allo HCT +/- radiation for refractory or relapsed lymphomas

Question 10

What are some common treatments used for HL?

Answer 10

• Chemo
• Radiation
• Surgery
• Clinical trial (for recurrent HL)
• HCT (not standard, but may be needed for progressive or relapsed lymphoma)

Question 11

True or False: Bone disease is a major cause of morbidity and mortality among patients with MM.

Answer 11

True
* Nutrition assessment and intervention should include a focus on bone health

Question 12

True or False: Both acute and chronic renal insufficiencies are common in patients with MM.

Answer 12

True
* Renal failure is one of the components used to diagnose MM