Therapeutics in Hematology 1 Flashcards
treatment modality that attacks diseases more precisely via specific unique pathways and cell surface markers
targeted therapy
earliest targeted therapy
imatinib (gleevec) for chornic myelogenous leukemia
targets tk that is used in the proliferation of cells in cml
2nd generation tkis
inhibit tk in leukemia cells
nilotinib and dasatinib
moa and indication for gemtuzumab + ozogamicin
anticd 33 + calicheamicin
moa: attaches to cd33 receptor on aml cells and deliver “cellular poison” to kill cancer cell
i: acute myelogenous leukemia
moa and indication for denileukin + diptheria toxin
anti-IL 2 + protein synthesis inhibitor
I: cuteneous t-cell lymphoma
moa and indication ibritumomab + 90y
anticd 20 + ionizing radiation
moa: seeks cd20 receptors in bcell lymphoma and deliver ionizing radiation via yttrium isotope
I: refractory b cell lymphoma
indications for hematopoietic stem cell transplant
hematologic malignancies such as leukemias and lymphomas
principles in hsct
- replace an abnormal but not malignant lp system from normal donor
- replace malignant hematopoietic system with normal donor
- treat malignancy by allowing storage of the patient’s own hp system, followed by higher doses of myelosuppressive therapy
patients that benefit from allogenic sc transplant
stage 4 lymphoma with involvement of bone marrow
principles of allogenic bone marrow transplant
comes from another individual of the same species
advantage: new graft will exert a graft vs leukemia effect (fights of leukemia)
t/f the recipient in allogenic bmt gets high doses of chemo and radiation before transplant
true
principles of autologous bone marrow transplant
patient is the donor
advantages: no need of a donor or other person for the stem cells, no rejection
in autologous bmt, you look for ___ stem cells
unaffected stem cells
retrieve stem cells -> store -> destroy bone marrow -> return stored stem cells
possible donors in stem cell collection
twin (syngenic transplant) = BEST
matched related donor (siblings, not parents)
matched unrelated donor (using HLAs)
current practice for stem cell collection
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
prinicple of cord blood transplant
blood in the umbilical cord has small amount naive stem cells of
advantage: stem cells are still naive, compatible with anyone
how does a patient recieve stem cells
syringe, slow iv push, or central line (direct to major vessel)
diseases treated with both allogenic and autologous hct
acute myelogenous leukemia chronic myelogenous leukemia chronic lymphoblastic leukemia non hodgkin lymphoma myeloma waldenstrom macroglobulinemia
t/f all nonmalignant diseases can be treated with allogenic hct only
false, some selected autoimmune diseases can be treated with autologous hct
t/f treatment for all is already effective so transplant is not usually done
true
____ is indicated for multiple myelomas and lymphomas
autologous hct
but if autologous fails, we can proceed with allogenic
t/f in aplastic anemia allogenic hct is done because they do not have bone marrow
true
t/f in sickle cell anemia and pnh, autologous hct is done
false, not done because they are stem cell defects
immune system defect complications in hct
neutropenia (due to conditioning of marrow)
lymphopenia and hypogammaglobulinemia (due to suppression of immune proteins)
infections as complications in hct
mucositis, cetral line infections, thrombocytopenia due to heavy chemo
graft versus host disease occurs within ___ days
60
opportunistic infections in hct
hsv, candidiasis, cmv, vzv, late aspergillosis (due to prolonged myelosuppression), adenovirus, staph/strep/g-
low incidence: pneumocystis, ebv, toxoplasma
parasitic infections in hct
strongyloides and crytosporidium
principle of car t-cell therapy
t cells fight off other cells
process of car tcell therapy
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
indications for car t-cell therapy
b-cell acute lymphoblastic leukemia
hodgkin lymphoma
non-hodgkin lymphoma
advantages of car t-cell lymphoma
car t-cell treatment is 30-40% effective even for patients that have failed other treatments
minimal side effects (immune reconstitution)
disadvantages of car t-cell lymphoma
not widely available
expensive
1 donation of whole blood can help __ people
3-4
- red cells
- plasma
- platelets
types of fresh forzen plasma
cryoprecipitate and cryosupernatant contain clotting factors