Therapeutics in Hematology 1

Question 1

treatment modality that attacks diseases more precisely via specific unique pathways and cell surface markers

Answer 1

targeted therapy

Question 2

earliest targeted therapy

Answer 2

imatinib (gleevec) for chornic myelogenous leukemia

targets tk that is used in the proliferation of cells in cml

Question 3

2nd generation tkis

Answer 3

inhibit tk in leukemia cells

nilotinib and dasatinib

Question 4

moa and indication for gemtuzumab + ozogamicin

Answer 4

anticd 33 + calicheamicin

moa: attaches to cd33 receptor on aml cells and deliver “cellular poison” to kill cancer cell
i: acute myelogenous leukemia

Question 5

moa and indication for denileukin + diptheria toxin

Answer 5

anti-IL 2 + protein synthesis inhibitor

I: cuteneous t-cell lymphoma

Question 6

moa and indication ibritumomab + 90y

Answer 6

anticd 20 + ionizing radiation

moa: seeks cd20 receptors in bcell lymphoma and deliver ionizing radiation via yttrium isotope
I: refractory b cell lymphoma

Question 7

indications for hematopoietic stem cell transplant

Answer 7

hematologic malignancies such as leukemias and lymphomas

Question 8

principles in hsct

Answer 8

1. replace an abnormal but not malignant lp system from normal donor
2. replace malignant hematopoietic system with normal donor
3. treat malignancy by allowing storage of the patient’s own hp system, followed by higher doses of myelosuppressive therapy

Question 9

patients that benefit from allogenic sc transplant

Answer 9

stage 4 lymphoma with involvement of bone marrow

Question 10

principles of allogenic bone marrow transplant

Answer 10

comes from another individual of the same species

advantage: new graft will exert a graft vs leukemia effect (fights of leukemia)

Question 11

t/f the recipient in allogenic bmt gets high doses of chemo and radiation before transplant

Answer 11

true

Question 12

principles of autologous bone marrow transplant

Answer 12

patient is the donor

advantages: no need of a donor or other person for the stem cells, no rejection

Question 13

in autologous bmt, you look for ___ stem cells

Answer 13

unaffected stem cells

retrieve stem cells -> store -> destroy bone marrow -> return stored stem cells

Question 14

possible donors in stem cell collection

Answer 14

twin (syngenic transplant) = BEST
matched related donor (siblings, not parents)
matched unrelated donor (using HLAs)

Question 15

current practice for stem cell collection

Answer 15

apheresis

• needle inserted in vein
• give mobilizzation agents so stem cells go outside to peripheral blood
• draw blood
• apheresis machine will separate stem cells and return other components
• result = 1 unit of pure stem cells

Question 16

prinicple of cord blood transplant

Answer 16

blood in the umbilical cord has small amount naive stem cells of

advantage: stem cells are still naive, compatible with anyone

Question 17

how does a patient recieve stem cells

Answer 17

syringe, slow iv push, or central line (direct to major vessel)

Question 18

diseases treated with both allogenic and autologous hct

Answer 18

acute myelogenous leukemia
chronic myelogenous leukemia
chronic lymphoblastic leukemia
non hodgkin lymphoma
myeloma
waldenstrom macroglobulinemia

Question 19

t/f all nonmalignant diseases can be treated with allogenic hct only

Answer 19

false, some selected autoimmune diseases can be treated with autologous hct

Question 20

t/f treatment for all is already effective so transplant is not usually done

Answer 20

true

Question 21

____ is indicated for multiple myelomas and lymphomas

Answer 21

autologous hct

but if autologous fails, we can proceed with allogenic

Question 22

t/f in aplastic anemia allogenic hct is done because they do not have bone marrow

Answer 22

true

Question 23

t/f in sickle cell anemia and pnh, autologous hct is done

Answer 23

false, not done because they are stem cell defects

Question 24

immune system defect complications in hct

Answer 24

neutropenia (due to conditioning of marrow)

lymphopenia and hypogammaglobulinemia (due to suppression of immune proteins)

Question 25

infections as complications in hct

Answer 25

mucositis, cetral line infections, thrombocytopenia due to heavy chemo

Question 26

graft versus host disease occurs within ___ days

Answer 26

60

Question 27

opportunistic infections in hct

Answer 27

hsv, candidiasis, cmv, vzv, late aspergillosis (due to prolonged myelosuppression), adenovirus, staph/strep/g-

low incidence: pneumocystis, ebv, toxoplasma

Question 28

parasitic infections in hct

Answer 28

strongyloides and crytosporidium

Question 29

principle of car t-cell therapy

Answer 29

t cells fight off other cells

Question 30

process of car tcell therapy

Answer 30

extract blood and do apheresis
engineer t-cells by inserting gene for car = expression of car for cancer cells
car t-cells proliferate
infuse car t-cells back

Question 31

indications for car t-cell therapy

Answer 31

b-cell acute lymphoblastic leukemia
hodgkin lymphoma
non-hodgkin lymphoma

Question 32

advantages of car t-cell lymphoma

Answer 32

car t-cell treatment is 30-40% effective even for patients that have failed other treatments
minimal side effects (immune reconstitution)

Question 33

disadvantages of car t-cell lymphoma

Answer 33

not widely available

expensive

Question 34

1 donation of whole blood can help __ people

Answer 34

3-4

• red cells
• plasma
• platelets

Question 35

types of fresh forzen plasma

Answer 35

cryoprecipitate and cryosupernatant contain clotting factors