Therapies

Question 1

Chemotherapy overview

Answer 1

Induction –> to induce complete remission

Consolidation –> further chemo or HSCT to consolidate that remission

Maintenance chemo

Question 2

Rituximab

Answer 2

Description: monoclonal antibody

Used to treat: NHL and CLL

Question 3

MEC for R/R AML

Answer 3

MEC = mitoxantrone, etoposide, cytarabine

Indication: Relapsed/refractory AML or othere high grade neoplasms (usu of poor risk)

FLAG (fludarabine, cytarabine, G-CSF) also used for this purpose.

A majority of adults with AML will need re-induction (“salvage”) chemo due to failure of initial chemotherapy, or relapse from complete remission (CR)

Etoposide: interferes with topoisomerase enzymes (topoisomerase I and II). Topoisomerase enzymes control the manipulation of the structure of DNA necessary for replication (these enzymes keep oncogenic DNA in shape whilst dividing). Blocking these enzymes leads to cancer cell death

Cytarabine (Ara-C): an antimetabolite analogue of cytidine (with an arabinose sugar moiety). It competes with cytidine in DNA and hinders DNA synthesis. Used for AML, ALL, CML, non-hodgkins. Main effects inc hepatotoxicity (transient hyperbilirubinemia), mucositis, diarrhoea, gram-neg septicaemia

Lenalidomide: inhibits the growth of new blood vessels (angiogenesis) in tumors, enhancing the status of the immune system, or decreasing cytokine and growth factor production

Mitoxantrone: interferes with cell reproduction, suppresses proliferation of T cells, B cells, mac’s, impairs antigen presentation, secretion of cytokines, antibody production. Half life ranges from 9hrs to 9days. Developed in 1980s as a doxorubicin analogue (but less cardiotoxic). Indicated for R/R AML, R/R multiple sclerosis, progressive MS

Question 4

FLAG-Amsa (R/R AML)

Answer 4

For pts <60yo, pre-allograft.

Filgrastim

Fludarapine

Cytarabine

Amsacrine

Question 5

Melphalan

Answer 5

Derived from nitrogen mustard.

Alkylates DNA (attaches to alkyl groups on guanine DNA base) and induces cross-linkages, inhibiting DNA and RNA synthesis of dividing and non-dividing cells.

Used in MM, ovarian cancer, pre-HSCT (myeloablative therapy).

Effects: hepatotoxicity (sinusoidal obstruction syndrome)