T-cell angioimmunoblastic lymphoma Flashcards
What is the age of the patient?
63
What are the chemo regimens that he has been on? What drugs make up each regimen?
CHOEP Carbocysteine Doxorubicin Vincristine Etoposide Prednisolone ICE Ifosfamide Carboplatin Etoposide
How does carbocysteine work and what is its main side effect?
Alkylating agent (Oxazaphosphorines). The main effect of cyclophosphamide is due to its metabolite phosphoramide mustard. This metabolite is only formed in cells that have low levels of ALDH. Phosphoramide mustard forms DNA crosslinks both between and within DNA strands at guanine N-7 positions (known as inter-strand and intra-strand cross linkages, respectively). This is irreversible and leads to cell apoptosis. Haemorrhagic cystitis.
How does doxorubicin work and what is its main side effect?
Anthracycline topoisomerase II inhibitor. Doxorubicin interacts with DNA by intercalation and inhibition of macromolecular biosynthesis. This inhibits the progression of topoisomerase II, an enzyme which relaxes supercoils in DNA for transcription. Doxorubicin stabilizes the topoisomerase II complex after it has broken the DNA chain for replication, preventing the DNA double helix from being resealed and thereby stopping the process of replication. It may also increase quinone type free radical production, hence contributing to its cytotoxicity.
Cardiotoxicity.
How does etoposide work and what is its main side effect?
Topoisomerase II inhibitor
Mouth sore and ulcers
How does vincristine work and what is its main side effect?
Vinca alkaloid mitotic inhibitor. Vincristine works partly by binding to the tubulin protein, stopping the tubulin dimers from polymerizing to form microtubules, causing the cell to be unable to separate its chromosomes during the metaphase. The cell then undergoes apoptosis. The vincristine molecule inhibits leukocyte production and maturation.
Peripheral neuropathy
How does prednisolone work and what is its main side effect?
Reduce sickness and allergic reactions to certain drugs
GI discomfort
How does ifosfamide work and what is its main side effect?
The cytotoxic action is primarily through the alkylation of DNA, done by attaching the N-7 position of guanine to its reactive electrophilic groups. The formation of inter and intra strand cross-links in the DNA results in cell death.
Nausea, vomiting and bone marrow suppression
How does carboplatin work and what is its main side effect?
Alkylating agents work by three different mechanisms: 1) attachment of alkyl groups to DNA bases, resulting in the DNA being fragmented by repair enzymes in their attempts to replace the alkylated bases, preventing DNA synthesis and RNA transcription from the affected DNA, 2) DNA damage via the formation of cross-links (bonds between atoms in the DNA) which prevents DNA from being separated for synthesis or transcription, and 3) the induction of mispairing of the nucleotides leading to mutations.
Nausea and vomiting
What is the type of cell involved in AINHL? What is their role in the body?
T follicular help cells
Secrete IL-21 and help guide B-cells to make appropriate antibodies to clear particular infections. Thymus dependent activation. Trigger isotype switching to IgA and IgG and hypermutation. Naive b cells communicate with Tfh cells via CD40 (b cell) and CD40L (Tfh cell)
What is the management of paracetamol overdose? What is the pharmacological treatment and how is it delivered?
Measure blood paracetamol level 4 hours after overdose. Check against normogram. If there is a requirement to treat: n-acetyl cysteine bag 1 150mg/Kg in 200ml 5% glucose over 1 hour, bad 2 50mg/Kg in 500ml 5% glucose over 4 hours, bag 3 100mg/Kg in 100ml over 16 hours.
How soon does treatment need to start for effective recovery?
Ideally within 8 hours
What are the staging criteria of NHL?
Stage 1- 1 LN region affected
Stage 2- 2 LN regions affected on one side of diaphragm
Stage 3- Both sides of the diaphragm
Stage 4- Diffuse lymphoma with extra-lymph organ involvement.
What are the B symptoms associated with NHL?
PUO, unexplained weight loss of greater than 10% over 6 months, night sweats
Which antibiotics are commonly used for cellulitis?
Flucloxacillin
