Study Deck 1 Flashcards
Glucarpidase use indication
High dose MTX with kidney dysfunction
CXCR4 mutation
Waldenstroms Macroglobulinemia
medication used in adrenocortical tumors (adjuvant with chemo)
Mitotane
Chemo assocaited with steatohepatitis/risk before hepatic resection in colon ca
Irinotecan
Time between bevacizumab and hepatic resection
at least 28 days, ideally 6-8 weeks given long half life (20 days)
Monosomy 7 management after induction AML
Transplant for consolidation
Criteria for high risk ET
Age >60, hx of thrombosis or major bleeding, platelet count > 1.5 million
CD19+, CD22+, CD11c, CD103, CD123
Hairy Cell Leukemia
Difference between classic vs variant Hairy Cell
CD200+ in classic, BRAF V600E mutation uniformly positive in classic
Treatment of recurrent ovarian cancer-platinum resistant
Bevacizumab + Liposomal doxorubicin (or paclitaxel, or topotecan)
Treatment after recurrent ovarian cancer after CR or PR with platinum
Olaparib, Rucaparib, Niraparib (regardless of BRCA mutation status)
Inotuzumab toxicity
11% pts with veno-occlusive disease
Ponatinib toxicity
Arterial thrombotic disease
Nodular lymphocyte Hodgkin Lymphoma lacks this expression seen in classic HL
CD30
Most common testicular malignancy in men over age 60
primary testicular lymphoma
Tx of primary cutaneous follicular lymphoma (presents as non tender nodules, no ulceration)
respond well to radiation- EBRT for localized disease
Post ASCT maintenance for del17p MM
Bortezomib (improved PFS and OS)
Salvage treatment of Hpylori+ Gastric MALT lymphoma
Ibrutinib
When can bone marrow eval be omitted in MGUS/Myeloma workup?
IgG M spike and normal FLC ratio
Tazemetostat
EZH2 mutation, refractory follicular lymphoma
Oxaliplatin is an irritant or vesicant? Not given with…
Irritant, not given with NS or chloride containing fluids
Paclitxel hypersensitivity
Due to solvent- cremophor
Vandetanib
use in medullary thyroid cancer
Testing in melanoma pt not responsive to immunotherapy
check for ckit exon 11 or 13- option of imatinib or dasatinib
ISS staging for myeloma
Stage 1: B2 <3.5 and albumin > 3.5, Stage III: B2 >5.5
Cholangiocarcinoma transplant criteria
no lymphadenopathy, no intrahepatic or extrahepatic mets, max 3 cm lesion
Important CYP2D6 substrates
Tamoxifen and many anti-depressants
Cord compression Surgery vs Radiation
Surgery comes first, earlier walking (patchell study)
Adjuvant treatment for 1p/19q del oligodendroglioma
adjuvant PCV (procarbazine, lomustin, Vincristine) + EBRT
Tx for platinum refractory cervical cancer
Topotecan/paclitaxel/bevacizumab
HCC concern- cutoff for further imaging
10mm= 1 cm
Lonsurf use in advanced gastric cancer
TAGS trial, median OS 5.7vs 3.6 months
Geriatric adjuvant stage III colon cancer
Oxaliplatin does not necessarily have to be added to a 5-FU based regimen in elderly patients with stage III colon cancer
relapsed primary CNS lymphoma treatment
rechallenge with high dose MTX
when to consider adjuvant chemoRT instead of chemo for pancreatic cancer
subset analysis with benefit if R1 resection and + LN
treatment of ETV6-NTRK B-cell all
larotrectinib or crizotinib
patient with medullary carcinoma/collecting duct tumor, check what test
Hgb electrophoresis for sickle trait
Major side effect with panobinostat
high incidence of diarrhea
increased isolated PTT, normal hemophilia markers, no inhibitor
Factor 11 def- severe def is less than 20%. If inhibitor develops, use rFactor 7
Chemo response with Stage II colon cancer and MSI status
MSI-H Stage II- do not benefit from adjuvant chemo
Radiation treatment for limited stage SCLC
45Gy in 3 weeks (1.5 Gy BID) > 45 Gy in 5 weeks, OS benefit from CONVERT study (2017).
Dermatofibrosarcoma Protuberans (DFSP), metastatic treatment
Imatinib (ORR almost 50%), usually response if t (17,22)- fusion protein with PDGF
RAI indications for papillary thyroid cancer
Gross extrathyroidal extension, primary tumor >4 cm, postop Tg >5-10 ng/ml
Hereditary iron loading disorder
Classic Ferroportin disease, mutation in FPN- marked iron accumulation in Kupffer cells (vs HFE- hepatocytes)
How to modify RBCs for igA deficiency
Washed RBC
What Cr Cl to avoid Rivaroxaban
less than 30
GFR dosing for Cisplatin
> 60- 100% dose, 45-59- 75% of dose, <45-> consider carboplatin
pT2 and no nodes after cystectomy for urothelial cancer
No adjuvant therapy
Mantle Cell lymphoma markers
t(11,14), cyclin D1 overexpression, SOX11. Favorable if SOX 11 +
Imerslund Grasbeck Syndrome
Inherited, autosomal recessive- mutation R protein= B12 deficiency due to intestinal mucosa absorption issue, also proteinuria
ALK agent with best CNS activity
Alectinib
Panabinostat mechanism of action and tox
r/r MM progressed on bortezomib and imid, HDAC inhibitor
Black box for cardiotoxicity and diarrhea
Second line option with Elotuzumab aftr progression on imid and Pi
Elo-Pom-Dex, reminder that ELO inhibits SLAMF7= NK cell function
Sensorineural Hearing loss + Renal and GI malformations +Short stature+ also early onset of head and neck squamous cancer
Fanconi Anemia, Dx- chromosome breakage analysis
Bone marrow failure syndrome with elevated erythrocyte deaminase levels
Diamond-Blackfan= mutation in RPS19 (ribosomal)
Neutropenia + pancreatic insufficiency
Scwamann-Diamond
Monocytopenia + Mycobacterial Infections
GATA2 deficiency
Lab monitoring/side effect with cabozantinib
triglyceride eleccation
Immunotherapy option first line met NSCLC -benefit regardless of PDL1
Nivo/Ipi (CHECKMATE 227)
Bosutinib drug interaction that lowers plasma concentrations
PPI
response in MMR rectal cancer
poor response to neoadjuvant chemotherapy, so neoadjvuant chemo rads done
AML induction for good risk (t8,21, inv 16, NPM1+/FLT-, CEBPA x2)
7+3+GO
Not fit AML options
VEN+HMA, Glasdegib +LDAC
Splenomegaly, lymphocytosis, no lymphadenopathy, +HCV
Splenic marginal zone
Severe aplastic anemia vs very severe
Severe: BM cellularity <30%, 2 of 3 PB criteria- ANC 400-200, plt <20, Retic <40,000. Very severe= ANC <200
Bilirubin cutoff for not using irinotecan
2
management of isolated ovarian lesions <8 cm in premenopausal women
US to see if high risk features, can then do OCP to see if regrression
management of residual mass >3 cm after adjuvant treatment for seminoma
PET scan > if +-> resection or biopsy. If residual seminoma on that-> adjuvant chemo (VIP, TIP)
diagnosis of inv16 in bone marrow specimen
automatic classification as AML
Mast cell leukemia with CKIT D816V, resistance to
imatinib
RBC surface protein combination NOT susceptible to Parvo B19
Patients that are homozygous for pp are not susceptible to parvovirus B 19 infection.
what levels of ferritin and transferrin prompt hemachromatosis eval
Transferrin >45%, Ferritin >200
Platelet based bleeding disorders + Family hx of AML/MDS
RUNX1
AML with propensity for CNS dx and extramedullary hematopoiesis
M4
Follicular lymphoma transformation rate
3% a year
lymphoma with popcorn cells, CD19+, CD20+ , CD45, PAX5,, negative CD15 and NCD30
nodular lymphocyte predominant HL
RBC surface antigen associated with development of cold agglutinin disease in mycoplasma
Big I antigen
tx for adjuvant stage Ib1, B2 and IIA1 cervical cancer
adjuvant chemo with platinum, consideration of vaginal brachytherapy
commonly associated dialysis related amyloidosis
synovial joint space
treatment option for TNBC neoadjuvant not candidates for anthracycline
carboplatin/docetaxel
high risk head and neck squamous cancer
cisplatin 100 mg/m2 + 70 gy (7 weeks)
adjuvant chemotherapy for high risk uterine carcinosarcoma
ifosfamide/paclitaxel
Raloxifene vs Tamoxifen in reducing risk of bca
raloxifene is not as effective as tam, but less toxic (less thromboembolic events, less uterine cancer)
ALK mutation resistance to alectinib and brigatinib
G1202R
Timeline of ATRA differentiation syndrome
usually starts 7-12 days after-can be early (within 1 week), or late (up to 3 weeks later)
Major proteins regulated by VHL
HIF1a and HIF2a
Cowden’s syndrome
mutation in PTEN, predisposed to endometrial cancer, thyroid cancer, macrocephaly
BRCA woman and screening
Annual Breast MR Age 20 age 30-75- annual mammo + MRI. BSO age 35-40 (BRCA 2 onset ovarian ca 8-10 y after BRCA 1)
CK20 pos, Merkel Cell treatment first line-advanced disease
Avelumab
treatment for metastatic cutaneous squamous cell carcinoma
Cemiplimab- anti= PD1
Plasmacytoid urothelial carcinoma mutation
CDH1 mutation- aggressive variant
GIST mutation- best prognosis and poor prognosis
Best prognosis- ckit exon 11, resistance- PDGFR exon 18 D842V (resistance to imatinib, sunitib, regorafenib). C-kit exon 9 and wild type also resistance to imatinib- can try higher dose
Safe drugs during pregnancy
doxorubicin, cyclophosphamide
treatment of inflammatory breast cancer after clinical response
Sentinel LN biopsy not recommended even if complete response, usually total mastectomy + axillary dissection
MLH1 promoter methylation and Lynch syndrome
rarely associated, more likely sporadic if methylation
mutation associated with heriditary pancreatitis and risk of pancreatic adenocarcinoma
PRSS1
Use of dexrazoxane
can use if anthracycline working but concern for cumulative dosing
Use of pembrolizumab in late line esophageal cancer
third line, CPS >1
Key feature distinguishing fatty liver of pregnancy and HELLP
both can have high liver enzymes and thrombocytopenia, fatty liver tends to have hypoglycemia
First line treatment of metastatic cervical cancer
Cisplatin, Paclitaxel, Bevacizumab
Most common somatic mutations in uveal melanoma
GNAQ and GNA11
Mutation germline with cutaneous ad uveal melanoma
BAP1
second line endometrial cancer- testing needed
MMR IHC- found up to 30% of endometrial cancer
Adjuvant treatment of uterine confined leiomyosarcoma
high chance of recurrece but adjuvant chemo or radiation not associated with improved outcomes
Synovial sarcoma treatment
Sensitive to high dose ifosfamide
Treatment of osteogenic osteosarcoma
Intense chemo with MAP-> surgery-> additional MAP. NO ROLE OF RADIATION IN CURATIVE SETTING
Treatment of osteosarcoma older than 40
Cisplatin/Doxorubicin- avoiding MAP chemo (high dose methotrexate)
Complete staging for ovarian cancer
Laparotomy + omentectomy + peritoneal biopsies + LN sampling
what to do if some residual disease on Day 14 marrow of AML
80% of AML patients with day 14 marrow residual leukemia (>5%) could convert to morphological CR without re-induction on a repeated day 28 marrow.
worsening pain- management for already on opiods with pancreatic cancer
celiac plexus block
AML induction in those with impaired cardiac function
use fludarabine instead of dauno/ida- can still use combo with cytarabine for curative intent
Adjuvant treatment GBM
RT + Temozolomide for 6 weeks, then adjuvant 6 cycles TEM + TTF (TTF addition adds 4.9 months for median survival)
Workup of CML
Bone marrow still needed given need % blasts in marrow, cytogenetics- to distinguish phases of CML
opioid for renal dysfunction
fentanyl does not have active metabolites excreted by kidneys. also can use hydromorphone and methadone
treatment of post-radiation angiosarcomas
mastectomy/surgery with wide margins
chemotherapy effective as late line agent for dedifferentiated liposarcomas
eribulin
TKI effective in advanced soft tissue sarcomas
pazopanib
most common malignancy in testes in age >60
NHL
first line tx for multicentric castlemans
siltuximab + dex
Bone marrow biopsy criteria for M spike
M protein 1.5 g/dl or higher, any non-IgG MGUS, abnormal FLC ratio (>1.65)
localized DLBCL in gastric area tx
avoid surgery in general, chemo with RCHOP
bilateral adrenal hemorrhage
may be associated with heparin induced thrombocytopenia
Cd1a + S100 + PDL1+
Langerhans Cell Histiocytosis
agranular/hypogranular platelets and impairment to arachidonic acid/thromboxane pathway, + development of myelofibrosis
Gray platelet syndrome- NBEAL2 mutation
mechanism of action of luspatercept, use
inhibits SMAD signaling, binding and trapping TGFB- promotes late erythropoiesis. Use most for transfusion dependent MDS- works best in MDS + ring sideroblasts
Use of post transplant cyclophosphamide
associated with lower incidence of GVHD
CDKN2A mutation
dysplastic nevus syndrome, autosomal dom
Cervical cancer risk factors
HPV infection, smoking, OCP (prolonged OCP use >5y)
mechanism of HPV genes and tumorogenesis
16,18 HPV-> E6 And E7 inactivate Rb1 and p53
HPV vaccine age
2 doses at age 11 or 12 (0, 6-12 months later)
Minimally invasive vs radical hysterectomy for early invasive cervical cancer
minimally invasive surgery was INFERIOR, radical hysterectomy is standard
Indication for post operative chemoradiation for cervical cancer
High Risk= +pelvic nodes, positive surgical margins, positive parametria= CHEMORADS
first line metastatic cervical cancer
cisplatin, paclitaxel, + bevacizumab
Adjuvant chemotherapy vs chemoradiation for endometrial cancer
modest OS benefit with + radiation, consider mainly for stage III disease AND using chemo+rads for serous type (copy number high)
2nd line treatment for endometrial cancer (non mSI-H)
Lenvatinib + Pembrolizumab (ORR 37%)
new treatment for epithelioid sarcoma
IL1 overxpression-> EZH2, tx- Tazemostat
Desmoid tumor treatment
Sorafenib for advanced/refractory, some will resolve just with observation
Dermatofibrosarcoma Protuberans (DFSP), translocation and treatment
t(17,22)- PDGFB, treatment with imatinib
Sequence for GIST treatment
Imatinib-> Sunitinib-> Regorafenib-> Ripretinib/Avapritinib
HPV assoc with cervical squamous vs adeno
squamous= 16, adeno= 18
Inflammatory breast cancer pearls
automatically T4 (T4d), no need for dermal lymphatics on path (clinical dx), use ddACT (neoadjuvant chemo in most cases), may not have discrete mass
Treatment of vulvar cancer with 1 mm or less invasion
wide local excision
BRCA chromosomes
BRCA1: chr 17, 50-85% lifetime risk of female breast cancer, 40% ovarian. BRCA2- chr 13
Sickle cell disease rule of 3s
3 or more pain episodes/year = hydroxyurea
HbS <30% to prevent progression of cerebral ischemia
3 bugs from autosplenectomy (Strep. pneumo, Haemophilus, Meningococcus)
VWD
- Type 1: LOW vWF:RCo and LOW vWF:Ag, ratio >0.6
- Type 2A: LOW FVIII, Very LOW vWF:RCo, LOW vWF:Ag, large multimers absent, normal platelet count and RIPA.
- Type 2B: Same as 2A + LOW platelet count, HIGH responsiveness to RIPA .
Type 2N: Very LOW FVIII, ratio of FVIII to vWF:Ag <= 0.6 - Type 2M: LOW FVIII, LOW vWF:Ag, Very LOW vWF:RCo. All multimers present
Indications for LP in AML
- WBC >40-50,000
- Biphenotypic leukemia
- Monocytic
- Extramedullary disease
Uterine serous carcinoma- biomarker indication
HER2 (30% of uterine serous)- carbo/taxol/trastuzumab
Adrenal carcinoma treatment
resect! poor prognosis if >5 cm
genetic event common in all germ cell tumors and related secondary somatic carcinomas from teratomas
12p amplification
MDS/AML from teratoma originates from what primary site
almost always a mediastinal non seminoma
PPI effect on erlotinib
decrease absorption (require low PH for absorption)
Weight based dosing for obese patients
Use actual body weight- exceptions are 2 mg for vincristine, carboplatin (cap to GFR 125-150)
lab monitoring with EGFR TKI
hypomagnesemia
MEK inhibitor side effects
Fever (can be hypotensive-fluid unresponsive), rare blurry vision, retinal detachment
mtor inhibitor side effects
stomatitis, pneumonitis, hyperglycemia, hyperlipidemia (may need statins and metformin)
indication for post mastectomy radiation
4 or more axilla lymph nodes, also can be considered 1-3 + nodes
indications for imaging in breast cancer
PET only indicated from inoperable stage III breast cancer
HER2+ criteria
If IHC 2+, count at least 20 cells with IHC 2+-> HER2/CEP17<2 with >6 HER2 signals per cell= positive
most sensitive test for dabigatran
thrombin time
duration of post operation VTE prophylaxis (ex: colon cancer surgery0
5 weeks
edoxaban vs LMWH in cancer VTE
Noninferior to LMWH in the composite endpoint of recurrent venous thromboembolism (VTE) and major bleeding. However, the risk of recurrent deep venous thrombosis was lower (although not for VTE overall), and the risk of major bleeding was higher with edoxaban.
reasons for minor elevation of BHCG
hypogonadism, hyperthyroidism, marijuana use
Main inheritance pattern for VWD
Autosomal dominant
elevated PT/PTT and prolonged TT
Hypofibrinogenemia or dysfibrinogenemia (vs factor 2, 5, 10 problems will be PT/PTT prolonged but normal thrombin time)
large platelets, thrombocytopenia, sensorineural hearing loss, renal failure, and dohle inclusions
MYH9 mutation
High PTT, bleeding after surgery, high prevalance in Jewish population
Factor 11 deficiency
Pt with bleeding gets plasma and RBC, then develops fever + dyspnea + pulm infiltrates
FFP-> most with TRALI-> mechanism: donor plasma with antibodies to recipient HLA granulocytes
hemolytic anemia, swift increase in retics with splenectomy
PK deficient (in which retics preferentially sequestered)
mutation that predict for aspirin benefit in colon ca
PIK3CA
INR >10 and no bleeding on warfarin
hold warfarin, give oral Vit K, no FFP or PCC
possible treatment for radiation necrosis of CNS if cant give steroids
Bevacizumab
Markers for AML, which ones poorer prognosis
CD11+, CD13+, CD33+, POOR RISK: CD34, CD56 (with t8,21 usually)
aplastic anemia -which atg
HORSE >Rabbit
Pneumonias + extensible limbs + eczema + high IgE
Hyperimmunoglobulin E, recurrent infection syndrome- 2 ROWS of teeth (baby teeth dont fall), mutations in stat3
short stature + cardiomyopathy + neutropenia
Barth syndrome
hypoplastic marrow, dysplastic nails, pulmonary fibrosis, oral leukoplakia
Dyskeratosis Congenita, mutations in DKC1, TERC, TER short telomeres
WT1+ calretinin +
Mesothelioma
Mutations in HLH (primary)
PRF1, UNC13D, STX11
flower cells leukemia/virus association
Adult T cell leukemia /HTLV1
epitheliod sarcoma and mutation and treatment
EZH2, Tazemetostat, ORR 15%
cetuximab reaction, can you try panitumumab?
yes- cetux is anti-EGFR chimeric, panitumumab is humanized so can try it
Tipraricil mechanism of action
inhibits thymidine phosphorylase
new liver nodules for a patient on surveillance for colon cancer who got adjuvant FOLFOX 3 years ago
always biopsy- can have focal nodular liver lesions, has been associated with oxaliplatin
Arsenic and cardiac toxicity
blocks K currents, can cause QT prolongation- maintain K and mg
KMT2A AML (t v,11)
high risk, transplant (MLL-KMT2A)
SIckle cell vs Sickle Beta Thal electrophoresis
B thal- still have some HbA but not absent
anemia 70% HbA and 30% Hb F
hereditary presence of Hgb F is a benign condition- mutation in B gene
early stage Hodgkin- unfavorable features
Bulky mediastinal, >10 cm, B symptoms, ESR >50, >3 sites of disease
t(3,14) NHL
favorable, BCL6
Type 1 vs 3 VWD inheritance
Type 1- aut recessive, Type 3- aut dom
baby born with thrombocytopenia and develops brusiing and lesions to necrosis
congenital protein C deficiency (purpura fulminans)
meningococcal septicemia and new brusising and necrotic lesions
purpura fulminans due to acquired protein C def
Myeloma renal impairment tx
bortezomib based tx, can give carfilzomib above cr cl >15
platelet receptor involved in platelet adhesion to vessel wall
Gp1b/Ix/V
Upshaw Schulman disorder
rare hereditary deficency of adamts13- congenital TTP
thienopyridine associated TTP
ex: clopidogrel- can be fast, <2 weeks from exposure
after abo and Rh, most common system
anti-Kell
warts, hypogammaglobulinemia, leukopenia
CXCRmutation= WHIM, can tx with plerixafor
if come off imatinib with good response CML, at what level do need to reinitatie
IS >0.1-> loss of major molecular response
Cold agglutinin disease vs PCH
Cold Agglutinin: usually underlying monoclonal, (can be polyclonal if viral) IgM, directed against RBC I or i, DAT + anti-C3, EXTRAVASCULAR hemolysis
PCH: polyclonal, children, post viral or post measles vaccine, INTRAVASCULAR hemolysis, IgG directed at P antigen
ring sideroblasts -non MDS reasons
alcohol, INH, pregnancy, copper def, lead toxicity
CLL relapsed options
Acalabrutinib, Ibrutinib, Duvelisib, Idelalisib + rituximab
Nilotinib cardiac SE
prolonged QT interval- check EKG (hold if QTC >480 msec)
post transplant consolidation for high risk classical HL
brentuximab vedotin
amyloidosis poor prognostic translocation
11,14
risk of thrombosis in CALR vs JAK
CALR is lower risk
Lymphomatoid Granulomatosis treatment
rare EBV related lymphoproliferative neoplasm- lungs nodules +, treatment if high grade is RCHOP with ARA-c
treatment of localized small cell of the bladder
neoadjuvant cis/etop followed by radiation or cystectomy
localized pure adenocarcinoma of the bladder
no data for neoadjuvant or adjuvant tx, usually cystectomy
risk of progression from MBL to CLL needed treatment
about 1-2 %/y
Fludarabine considerations in CLL
need to give antiviral prophylaxis, risk of secondary MDS/AML, can precipitate hemolytic anemia so dont give if having hemolysis from CLL
leucovorin mechanism for working with 5-FU
increases inhibition by 5FU inhibiting thymidilate synthase
MYH + surveillance
colonoscopy at age 25-30, consider EGD, yearly testicular US
BRCA1 surveillance
start annual breast MRI by age 25. for age 30-75: annyal mammo and breast MR
localized Merkel cell treatment
wide local excision + SLNB
Polatuzumab target
refractory DLBCL, anti-CD79b (B cell receptor)
features of CALR ET
higher plt count, concern for VWF antigen, esp if factor activity level <30%
first line treatment of amyloidosis
Dara-CyborD
Hypoplasia definition after AML induction, when to reassess
if cellularity <20% which blasts <5%-> await recovery, repeat bone marrow biopsy
CML type with marked neutrophilia
BCR ABL p230
when is CNS prophylaxis given for APL? Type of transplant?
after second remission, then proceed to autologous transplant
Hexagonal crystals and anemia
HbC- beta globin mutation, glutamic acid-> lysine
indications and duration of anticoagulation for LE superficial DVT
higher risk if >5 cm, close to DVT (esp saphenofemoral or saphenopoliteal)- anticoagulation for 45 days
cirrhosis + incidental portal vein thrombosis management
can observe with cirrhosis- no anticoagulation. consider if symptomatic, and also if extending into mesenteric vein
unprovoked left iliofemoral DVT in woman age 30
check for May thurner- contrast venogram
Pomalidomide can be given with renal failure
yes- with dose changes
how to prevent complications of neonatal hemochromatosis with mom with disease
weekly IVIG in pregnancy
quinine mechanism for thrombocytopenia
neoantigen formed binds to Gp 2b/3a
which antibiotic has anti-amyloidosis properties
doxycycline
APL high risk and treatment
WBC >10- ATRA+Dauno or Idarubicin+ Arsenic )may have cytrabine or gemtuzumab)
MDS after 1 y of chemo- which one
Topo inhibitors= doxorubicin, rearrangements in 11q23
when is ibrutinib stopped prior to surgery
3-7 days
early localized Hodgkin unfavorable treatment
ABVD x 4 + ISRT (RT improves EFS but not OS)
Erdheim chester BRAF + treatment
Vemurafenib
DRVVT starts with affecting what factor
Factor X
child with prolonged bleeding after procedure, normal coags, fibrinogen, platelet function
a2-antiplasmin deficiency
17p deletion and CLL treatment- what can you not give?
any chemo-immunotherapy- no FCR/chlorambucil based regimen
best prognosis CLL
13q del
T cell malignancy associated with rheumatoid arthritis
T-cell LGL
how long of remission ideal to retry same agent (ex: cladribine) with hairy cell
2 y
mutation leading to ibrutinib resistance
C481 on BTK
BPDCN immunophenotype
CD4+ CD56+ CD123+
treatment of B cell prolymphocytic leukemia
ibrutinib
Grade 3 B Follicular lymphoma
> 15 centroblasts/hpf + solid sheets of centroblasts, tx with RCHOP, even if asx. Likely to be CD10- BCL2- and lack t14,18 unlike other FL
antibiotic resistant translocation-h.pylori malt lymphoma
t(11,18)
lymphomatous polyposis associated with
mantle cell lymphoma
primary effusion lymphoma
HIV associated, etiology is hHV 8
S100+ large LN
Rosai Dorfman- can observe if asx
PFS for initial RVD, transplant and len maintenance
50 months
limitation of pluripotent stem cell for gene therapy
genomic instability, and pluripotent stem cell derived tissue may be immunogenic
localized vs systemic treatment with POEMS syndrome
localized radiation can be curative if 2 plasmacytomas or lyic bone lesions, no clonal cells in marrow. otherwise can do systemic therapy- auto transplant reasonable
serious fungal infection associated with ibrutinib tx
invasive aspergillosis
12 days after transplant- fever, dyspnea, lung consolidation, macular rash with thrombocytopenia
Engrafment syndrome, tx with steroids
bone marrow vs blood transplant source difference
bone marrow: higher graft failure, longer time to engrafement= higher risk of infection
blood: higher incidence of GVHD
SOS after transplant
hepatomegaly, can have renal failure-> defibrotide
MDS development after aplastic anemia- cytogenetic change
monosomy 7
management of isolated CNS relapse of ALL
aggressive tx with cranial irradiation, Intra ventricle chemo and re-induce for ALL
pre-B cell ALL with eosinophilia- translocation
t (5,14) (q31,32)-> IL3-IgH
B-all poor prognostic factor
IKAROS
mechanism of iron overload with ineffective erythropoiesis in MDS
increased erthroferrone made from erythrobalsts-> decrease hepcidin, and increased iron absorption
Deferasirox monitorihng when starting
weekly renal monitoring
treatment of mild porphyria
glucose loading, IV fluids, pain control
Accelerated Phase CML
look for 20% >basophils and plt <100,000. Blast -phase is usually 20% blasts
When is FCR contraindicated in CLL
if have 17p del/TP53, or also if already has autoimmune hemolytic anemia
cytogenetic abnormality poor adverse risk for amyloidosis
t(11,14)-> ongoing trials with venetoclax
PRRT long term risk
AML/MDS
hypoplastic MDS markers and treatment
HLADR2 and DR15, treat like aplastic anemia- cyclosporine/ATG
2 major criteria for POEMS
polyneuropathy + monoclonal plasma cell disorder
adjuvant bisphosphonate in breast cancer
improved survival in postmenopausal non metastatic breast cancer
Relapsed Kaposi Treatment
Pomalidomide (others- bevacizumab, etoposide, imatinib)
molecular testing for anaplastic thyroid cancers
BRAF V600 (can use dab/tram)
cancer drugs that can cause TTP/HUS
Gemcitabine, Mitomycin
breast cancer chemo safe in 2nd trimester
FAC (5-Fu, adriamycin, cyclophosphamide)
Paraneoplastic lung cancer syndromes- name the antibody: Cerebellar degneration
Anti-Hu
Paraneoplastic lung cancer syndromes- name the antibody: Opsoclonus/myoclonus
Anti-Ri
Paraneoplastic lung cancer syndromes- name the antibody: Stiff person
Anti-amphiphysin
adjuvant tx of uterine carcinosarcoma
chemotherapy + EBRT +/- vaginal brachytherapy
diffuse alveolar hemorrhage-% of hemosiderin laden macrophages for dx
20%
Selenixor mechanism of action
XPO1 inhibitor
Nivo vs Pembro indications in 2nd line esophageal cancer
Nivo for any esophageal squamous. Pembro for 2nd line esophageal squamous with CPS 10
mutation in mesothelioma
BAP1
what to do if at 3months of CML tx BCR AbL 25%
should be <10%, but if more than 50% reduction compared to baseline or minimally above 10% cutoff-can continue same dose of 2nd gen TKI, but should increase imatinib dose
Tx of MPN 5q33
Imatinib (encordes PDGFR)
papillary thyroid cancer- need for completion thyroidectomy when?
+ margins, + LN, +vascular invasion, + tumor size >4
carcinoid tumors of appendix- when do you need a right hemicolectomy?
> 2 cm, + margins, perforated appendix
Number of LN evaluate for gastric cancer
15
neutropenia with ABVD and hodgkin
continue WITHOUT growth factor, low incidence of febrile neutropenia, growth factors may increase bleo pulm toxicity
medullary breast cancer management
higher nuclear grade, but treat like ductal cancer, may have more favorable prognosis
Dose for 7+3 AML induction
Cytarabine 100-200 mg/m2 x 7 days and either Idarubicin 12mg/m2 or Dauno 60-90 mg/m2 x3 days
when to check bone marrow in hairy cell
if having hematologic recovery and spleen size reduction, dont check before 4 months after tx
When to use imatinib adjuvant for GIST
No imatinib benefit if no KIT or PDGFRA mutations, also if PDGFRA D842V
Give if >5 cm and 5mitoses, or >10 cm OR >10 mitoses OR rupture- for 3 years
for her 2 and TNBC when should adjuvant tx be by
8 weeks
RAI adjuvant doses for low risk disease (tumor <4 cm, N0 disease)
30 mCi (higher doses are 100-200 mCI)
Vitamin E and prostate cancer
increased risk
80% of merkel cell with what virus
polyomavirus
Indication for total thyroidectomy for papillary thyroid cancer
> 4 cm with central neck nodes
what agents cannot be used with prior seizure hx in prostate cancer
enzalutamide and apalutumide
eye exam standard of care dx for CNS lymphoma
Slit lamp + fundoscopic exam
HPV risk factors for cervical cancer
mainly 16,1 8 HPV 16 and 18 are responsible for 70% of all cervical cancers, but HPV 58 and 33 are also associated with cervical cancer (~10%) and represent a risk factor
what decreases severity of mucositis with bolus 5-FU
Oral cryotherapy can decrease the severity of bolus 5-FU associated mucositis
In what situation has rituximab shown to improve OS in lymphomas
2 cases in mantle cell
- elderly pt after RCHOP
- after induction DHAP + auto
if GBM and already on keppra 1000 mg BID and dex 4 mg BID and have seizures again- next step
need to expedite surgical resection
recurrent desmoid tumor treatment
sorafenib
association of renal cancer and sickle trait- which kind
renal medullary carcinoma, +hemorrhage and necrosis, +AE1, AE3, CEA
tubular breast cancer prognosis
usually excellent, ER+, good overall response with surgical removal alone, do adjuvant endocrine therapy like usual
mutation with granulosa cell tumors of ovary
FOXL2
if ALK FISH +, do need to wait for FISH?
no
There is no proven survival benefit for early initiation of ADT, particularly for slow PSADT or Gleason 7 and absence of metastatic disease. T or F?
true
risk factors for breast angiosarcoma
prior ionizing radiation, chronic lymphedema
Fibromellar carcinoma
rare hepatic tumor- not related to cirrhosis or Hepaitits, well circumscribed hepatic mass. will get biopsy with DNAJB1-KRTKACA fusions
DES exposure and risk of what type of vaginal cancer
adenocarcinoma (NOT squamous)
Vincristine max
2 mg
Use of bisphosphonate in adjuvant breast cancer
q6 months for postmenopausal women- decrease recurrent, improvement seen in mortality!
bleomycin and skin toxicity
flagellar erythema
bleomycin relative contraindications
age >50, any lung disease, reduced renal function
spermatocytic seminomas
usually older patients, no relation to cryptorchidism, no elevated markers. Orchiectomy usually sufficient
MRI brain indication for germ cell tumors
Bhcg >5000
Infusional 5FU vs Bolus
Infusional= lesser myelosuppression, more hand-foot syndrome, CORONARY VASOSPASM, slight advantage in tumor response
paclitaxel toxicity
bradycardia, AV nodal blockade
sudden arrthymia after starting AML therapy
can have sudden hypokalemia associatedw ith acute leukemia
Letermovir use
inhibits CMV teminase complex, used in CMV + transplant recipients
genetic GIST mutation
SDH
Gorlin syndrome
mandibular tumors, medulloblastomas. Mutations in PTCH1 or SUFU (hedgehog pathway)
CHEK2 cancer risks
breast, colon
PSA screening for BRCA2
age 40
HOXb13 and development of which cancer
familial association -prostate
if starting ciprofloxacin, what should do with ibrutinib
DECREASE DOSE! as cipro (quinolone) is an CYP inhibitor= so will increase Ibrutinib level
drugs that displace methotrexate and can increase toxicity
salicylates, ibuprofen, sulfa, phenytoin
chemo that requires seizure ppx
Busulfan
Pt getting FOLFIRI- neutropenia
UGT1A1 status for irinotecan
TPMT genotype deficient
TPMT breakds down 6MP. if lack= lower 6MMP (methylMP), higher level of thioguanine nucleotides. If homozygous- dose reduce 6MP by 80-90%, if heterozygous -10-15%
Allopurinol and 6-MP interaction
Allopurinol inhibit XO. 6MP catabolized by XO. if both tgether- then risk of 6-MP toxicity. Need to reduce dose of 6MP by 50%
what lab to monitor closely with cetuximab or panitumumab
Magnesium
Lapatinib rash
looks like acne with papules and pustules- HOLD drug, use oatmeal cream, clindamycin. NOT RETINOID cream
Aspariginase and MTX dosing together?
Asparaginase can rescue from MTX toxicity-> so give MTX and THEN asparaginase
intraductal papilloma of breast
surgical excision- is benign, but can be large, +blood ischarger. Can copresent though with premalignant features. Do not metastasize.
