Pharm Approach to Hematologic Malignancies

Question 1

Name and describe the three stages of treatment for hematologic malignancies.

Answer 1

Induction - high dose intensive short-term therapy
Consolidation/Post-Remission - intensive therapy over a short term, not as high dose as induction therapy
Maintenance - low dose long-term

Question 2

What are the 3 rules for combination therapy?

Answer 2

1. must be active against the tumor type present
2. two drugs can’t share a mechanism
3. drugs should have different patterns of toxicities

Question 3

What is metronomic therapy?

Answer 3

Daily administration of really low doses of chemotherapy with the idea that instead of eradication, maintain the malignant cell population at very low levels that way it stays sensitive to the drug

Question 4

What are the effects of metronomic therapy?

Answer 4

• appears to have a selective effect on Tregs, which when it quiets them will allow proliferation of other lymphocytes which can attack the cancer
• MC also has an anti-angiogenic effect
• Disadvantage: secondary malignancies

Question 5

Describe treatment for AML.

Answer 5

1. Induction: daunorubicin + cytarabine ± thioguanine
2. Post-remission: cytarabine + radioablation or autologous transplant
3. Maintenance: not commonly used in AML

Question 6

Describe treatment for APL.

Answer 6

1. Induction and Post-remission: ATRA + cytarabine + daunorubicin
2. Maintenance: ATRA + 6-MP + MTX
   * Childhood: ATRA + anthracycline ± cytarabine

Question 7

Describe treatment for ALL.

Answer 7

1. Induction: corticosteroid (prednisone) + vincristine + anthracycline
2. Post-Remission: MTX + 6-MP
   * For t(9;22): Imatinib* ± combination (above)
   * ADEs: GI/nausea, elevated LFTs, cytopenias

Question 8

Describe treatment for CML.

Answer 8

Indefinitely: Imatinib

Second generation: Nilontinib / Dasatinib

Question 9

Describe treatment for CLL.

Answer 9

Option 1. FCR: Fludarabine, cyclophosphamide, rituximab (anti-CD20)
Option 2. Bendamustine (both an antimetabolite and alkylating agent)

Question 10

Describe treatment for Hairy Cell Leukemia.

Answer 10

Cladribine – purine analog
Pentostatin – purine analog
Interferon-alpha-2b – induces cell differentiation and induces host immune response

Question 11

Most drug combinations used to treat Hodgkin lymphoma contain what?

Answer 11

an anthracycline, doxorubuicin, mitotic spindle inhibitor, vincristine, alkylating agent, ± corticosteroid

Question 12

Describe the treatments for low stage and high stage NHL.

Answer 12

• Low stage: COMP – cyclophosphamide, vincristine, MTX, prednisone
• High stage (B cells that express CD20): R-CHOP – rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone; *Also: drugs that deliver radioactivity to the CD20 B cells like Tositumomab and Ibritumomab are used

Question 13

What are some main side effects of treatment for NHL?

Answer 13

• Sterility
• Secondary malignancies
• LV dysfunction (doxorubicin)
• MDS and AML are late complications of myeloablative therapy with SCT

Question 14

Describe treatment for Burkitt lymphoma.

Answer 14

cyclical administration of cyclophosphamide + MTX or vincristine + doxorubicin; possibly cytarabine.
Administer intrathecally for CNS coverage.

Question 15

True or false: almost all the chemotherapy drugs given during pregnancy were associated with congenital birth defects.

Answer 15

False - they were mostly associated with premature births, which carry developmental problems of its own