Treatment for Blood Cancers

Question 1

how does chemo and radiotherapy work

Answer 1

damaged DNA of cancer cells as it divides

cell initiates apoptosis via P53

Question 2

what do mutations in P53 mean (seen in chronic lymphocytic leukaemia)

Answer 2

make it harder to treat with chemo and radio

Question 3

why do you try to use a lower dose of chemo and radio

Answer 3

lower dose causes apoptosis and formation of blebbing- cell breaks down into several apoptotic bodies which are phagocytosed= no inflammation

higher doses cause the cell to swell, plasma membrane to rupture = cellular and nuclear lysis= inflammation

lower dose= less side effects

Question 4

why do lymphomas/ CLL/ acute leukaemias responds well to chemo and radio

Answer 4

lymophocytes undergo apoptosis in normal lymph node
lymphoma and CLL responds to chemo and radio
AL respond to chemo (cells dividing more quickly)

Question 5

what causes the side effects of chemo and radio

Answer 5

normal cells having their DNA damaged

Question 6

what are the side effects of chemo and radiotherapy

Answer 6

immediate: hair loss, nausea and vomiting, neutropenic infection, TIREDNESS

long term: heart damage, lung damage, other cancers

Question 7

what supportive therapies should be given for blood cancers

Answer 7

prompt treatment of neutropenic fever/ infection 
broad spectrum antibiotics 
red cell and platelet infusions 
growth factors (GCSF)
prophylatic antibiotics and antifungals

Question 8

who is given prophylatic antifungals e.g. itraconazole, posaconazole

Answer 8

all at risk (compromised immune system )

Question 9

when are pet scans used

Answer 9

to improve radiotherapy treatment in HL

Question 10

when would you want to increase the doses of chemo and radio

Answer 10

in those who need it for cure- have to accept the side effects

Question 11

what chemo therapy regimes are used for HL

Answer 11

ABVD 6 cycles
avoid side effects by missing out B (bleomycin) in cycles 3-6

if PET +ve after 2 cycles escalate to escBEACOPP

Question 12

what are the targeted therapies for blood cancers

Answer 12

monoclonal antibodies (rituximab)
biological agents
molecularly targeted treatments

Question 13

how do monoclonal antibodies work

Answer 13

immune treatment- affect only cells which possess target protein
(avoid side effects)
currently used in combo with chemo

Question 14

what is FCR (rituximab) used to treat

Answer 14

CLL

Question 15

what is RCHOP (rituximab) used to treat

Answer 15

high grade B cell NHL

Question 16

what is R- chemo (rituximab) and maintenance rituximab used to treat

Answer 16

mantel cell NHL

Question 17

name anti B cell antibodies used in monoclonal antibody treatment

Answer 17

rituximab
ofatumumunab
obinutumab
(last two used when not respond to rituximab)

Question 18

what is bretuximan vedotin

Answer 18

targeted chemo therapy used in hodgkins disease (antibody drug conjugate)

Question 19

what are the side effects of targeted chemotherapy

Answer 19

nerve damage
low neutrophils
fatigue +++

Question 20

how do biological treatment work

Answer 20

(not targeted to malignant/ dividing cells= side effects)

proteosome inhibitors- prevents breakdown of old proteins in cell into amino acids= toxic proteins accumulate= apoptosis

IMIDs- method not understood

Question 21

give an example of a proteosome inhibitors

Answer 21

bortezomib- low grade NHL

Question 22

what are the side effects of proteosome inhibitors

Answer 22

nerve damage and platelets

Question 23

name an IMID and their side effects

Answer 23

lenalidomide
nerve damage 
risk to detus 
effect on blood counts 
other cancers

Question 24

give examples of molecular/ targeted treatments

Answer 24

tyrosine kinase inhibitors: CML

targeting malignant B cells: ibrutinib and idelalisib= CLL/ NHL

stopping tumour evade the immune system= nivolumab

Question 25

how do molecular/ targeted treatments work

Answer 25

target pathway specific to cancer

avoid side effects and more effective than chemo

Question 26

when gene when mutated causes CML

Answer 26

BCR-ABL

Question 27

what drug inhibits BCR-ABL

Answer 27

imatinib (tyrosine kinase inhibitors)

Question 28

what are the side effects of tyrosine kinase inhibitors

Answer 28

generally well tolerated
diarrhoea
fluid in lungs
neutropenia

Question 29

what have tyrosine kinase inhibitors allowed

Answer 29

CML to be a chornic disease

Question 30

what drugs affect B cell signalling pathways

Answer 30

ibrutinib and idelalisib

used in low grade NHL and B cell CLL that dont respond to rituximan and chemo

Question 31

what are the side effects of ibrutinib and idelalisib

Answer 31

idelalisib: diarrhoea, rash, fatigue, liver abnormality, fever
ibrutinib: fever, low platelets, anaemia, SOB

Question 32

what do checkpoint inhibitors do e.g. nivolumab

Answer 32

prevent the cancer evading to immune system

used in relapsed/ resistant lymphoma

Question 33

what are the side effects of nivolumab

Answer 33

rash
decreased platelets 
fatugue 
pyrexia 
diarrhoea
pruritus 
(most resolve with dose reduction)

Question 34

what is immune therapy

Answer 34

allogenic bone marrow transplant (from matched donor)
T cells from donor attack cancer
risk of graft verus host disease (immune attack of normal cells)

Question 35

what is adoptive immunotherapy

Answer 35

makes patients own immune cells recognise the cancer as foreign and attack it (avoid graft versus host disease)
CART cell therapy (patients on T cells are genetically modified antigen receptors added to then and infused back to patient)