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Blood and Lymph > Treatment of Leukemia and Lymphoma > Flashcards

Treatment of Leukemia and Lymphoma Flashcards

1
Q
  • covalently bind/modify biological molecules
  • DNA is key target
  • must be reactive - inherent, or generated by metabolism
  • CCNS, but replicating cells are more sensitive
A

alkylating agents

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2
Q
  • bone marrow, GI tract, spermatogenesis (rapidly growing cells)
  • decreased leukocytes and platelets - dose limiting toxic effect
  • max suppression 10 days to 4 weeks after therapy
  • recovery 3-6 weeks after drug
  • monitor patient tolerance - CBC, hematocrit
A

adverse effects of alkylating agents

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3
Q

secondary malignancy risk in what class of drugs?

A

alkylating agents

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4
Q
  • nitrogen mustard, first alkylating agent
  • vesicant, caustic to skin/mucus membranes
  • IV only, often in arterial supply to tumor
  • half life several minutes, rapidly reacts
  • adverse: n/v, delayed - decreased blood counts
  • primary use for Hodgkin’s lymphoma, part of MOPP
A

mechlorethamine

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5
Q
  • oral or IV; alkylating agent
  • nitrogen mustard pro drug, activated by host metabolism in liver
  • widely used, leukemias and lymphomas
  • adverse: bone marrow depression, alopecia, sterile hemorrhagic cystitis
A

cyclophosphamide

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6
Q
  • analog of cyclophosphamide
  • IV only
  • Hodgkin’s and non-Hodgkins lymphomas; high dose for bone marrow or stem cell rescue; component of ICE
  • severe bone marrow depression, peripheral neuropathies, CNS effects maybe due to chloroacetaldehyde
A

ifosfamide

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7
Q
  • phenylalanine nitrogen mustard
  • highly reactive, chemical half life 50 minutes
  • IV, renal excretion
  • myelosuppression
  • Multiple myeloma, myeloablative therapy
A

melphalan

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8
Q
  • nitrogen mustard, oral, 1X daily dosing
  • plasma life 1.5 hours
  • CLL, rarely used
A

chlorambucil

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9
Q
  • alkylsulfonate
  • oral administration, IV for high dose
  • used to be key drug for CML before imatinib
  • profound myelosuppression, high dose –> pulmonary fibrosis, hepatic veno occlusive disease
A

busulfan

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10
Q
  • nitrogen mustard, IV, plasma half life 30 min
  • alkylates DNA, inhibits mitotic checkpoints
  • partial cross resistance with other alkylating agents
  • CLL, indolent B cell non Hodgkin’s lymphoma
  • n/v/myelosuppression/mucositis
A

bendamustine

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11
Q
  • alkylating agent, IV, activated by host
  • n/v/dose limiting myelosuppression
  • Hodgkin’s, multiple myeloma
A

dacarbazine

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12
Q
  • oral
  • inhibits DNA/RNA/protein synthesis, causes strand breaks
  • high potential for secondary malignancy than with other alkylating agents
  • Hodgkin, non-Hodgkin
A

procarbazine

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13
Q
  • analog of a normal component of the target cells
  • enters normal metabolic path, then blocks path
  • folate, purine, pyrimidine analogs
A

antimetabolites

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14
Q
  • DHFR substrate and inhibitor
  • tumor cells more sensitive than normal cells, greater accumulation in tumor cells
  • blocks production of bases for DNA synthesis
  • IV/oral/intrathecal, urine excretion
  • high dose, then rescue dose with folinic acid (citrovorin, leucovorin)
  • hepatotoxicity, resistance due to altered DHFR or amplified
A

methotrexate

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15
Q
  • purine analog, oral, well tolerated
  • blocks DNA and RNA synthesis (inhibits AMP/GMP; enters RNA)
  • resistance due to decrease in hprt activity or increase in alk phosphatase
A

6-mercaptopurine, 6-thioguanine

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16
Q
  • purine analog, oral or IV as monophosphate
  • dephosphorylated in plasma and absorbed by cells
  • di: inhibits ribonucleotide reductase; tri: inhibits DNA pol and ligase
  • effective mono or combination therapy for CLL
  • myelosuppression, n/v
A

fludarabine

17
Q
  • purine analog, IV, activated by deoxycytidine kinase
  • strand breaks, inhibits ribonucleotide reductase
  • hairy cell leukemia, CLL, low grade lymphoma
  • resistance, bone marrow suppression
A

cladribine (2-chlorodeoxyadenosine)

18
Q
  • pyrimidine analog, IV or intrathecal
  • activated by deoxycytidine kinase (polymorphic)
  • tri incorporated into DNA, inhibits elongation and repair
  • AML, ALL
  • more toxic than purines, myelosuppression, GI, stomatitis
A

cytarabine

19
Q
  • most produced by microbes
  • interact with DNA/RNA, don’t alkylate, block access or function
  • all given IV
  • unique toxicities
A

antitumor antibiotics

20
Q
  • intercalate into DNA, block topoisomerase II, inhibit RNA and DNA synthesis, strand breaks
  • generate free radicals, IV, metabolized in liver
  • alopecia, cardiotoxicity (function of cumulative), arrhythmias/CHF/cardiomyopathy, free radical mechanism
A

anthracyclines: doxorubicin, daunorubicin, idarubicin

21
Q

least cardiotoxic anthracycline?

A

idarubicin

22
Q

free radical mechanism in anthracyclines reduced by administering?

A

dexrazoxane

23
Q
  • mix of glycopeptides
  • binds DNA, generates free radicals, causes strand breaks, active in G2 (CCS)
  • hypersensitivity, cutaneous reactions
  • pulmonary toxicity, fibrosis
A

bleomycin

24
Q
  • isolated from periwinkle, inhibits/reverse tubulin polymerization, disrupts mitotic spindles
  • causes metaphase arrest
  • IV admin, biliary excretion
A

Vina: microtubule poisons

25
Q
  • vinca alkaloid

- n/v, alopecia, bone marrow depression

A

vinBlastine

26
Q
  • vinca alkaloid
  • less toxic to bone marrow, no nausea and vomiting
  • peripheral neuropathy
A

vincristine

27
Q
  • topoisomerase II inhibitor, double strand breaks, DNA degradation (CCS)
  • arrest cells in S-G2 stage
  • oral and IV
  • n/v/alopecia/bone marrow suppression
A

etoposide (VP-16)

28
Q
  • catalyzes breakdown of asparagine in blood
  • inhibits growth of ALL cells, which lack asparagine synthetase
  • allergic responses, enhance coagulation
A

asparaginase

29
Q
  • monoclonal antibody, blocks CD20 B cell antigen
  • IV, half life 22 days
  • used for B cell lymphomas, CLL and non-Hodgkin’s
  • allergic rxns, hypogammaglobulinemia, autoimmune disorders
A

rituximab

30
Q
  • adrenocorticosteroids, suppress proliferation of immune cells
  • oral, for leukemias and lymphomas
  • fluid retention, immunosuppression, diabetes
A

dexamethosone, prednisone

31
Q
  • inhibits Bcr-Abl and c-KIT tyrosine kinases
  • blocks growth factor signaling in CML
  • used in any malignancy with Philadelphia chromosome
  • myelosuppressive, edema and fluid retention, hepatotoxicity
A

Imatinib (Gleevec)

32
Q
  • newer broad spectrum TK inhibitors, use in resistance to imatinib
  • continue until tumor gains resistance, patient dies, or patient discontinues drug
A

dasatinib, nilotinib

33
Q
  • inhibits Bruton’s tyrosine kianse, essential for B cell receptor signaling
  • oral, metabolized by CYP3A4, metabolite 15X more potent as BTK inhibitor
  • mantle cell lymphoma, refractory CLL (17p deletion)
  • GI, thrombocytopenia, neutropenia, infections, fatigue
A

ibrutinib

34
Q
  • oral PI3K inhibitor
  • metabolized by aldehyde oxidase and CYP3A4, strong CYP3A4 inhibitor
  • relapsed CLL and SLL, relapsed follicular B cell non Hodgkins
  • hepatotoxicity, diarrhea/colitis, pneumonitis, intestinal perforation
A

idelalisib

35
Q
  • inhibits 26S proteasome, disrupts multiple signaling cascades, leads to apoptosis
  • IV, plasma half life 5.5 hours, half life of inhibition 24 hours
  • MM, mantle cell lymphoma
  • thrombocytopenia, fatigue, peripheral neuropathy
  • hypotension upon infusion
A

bortezimib

36
Q
  • induces terminal differentiation, treats APL
  • binds RAR-alpha receptor, promotes differentiation
  • degradation of PML-RAR alpha fusion protein
  • resistance through enhanced clearance or loss of expression of fusion gene
A

all trans retinoic acid

37
Q
  • inhibits thioredoxin reductase, enhancing oxidative stress
  • modification and degradation of APL fusion protein
  • cytotoxic, promotes differentiation
A

arsenic trioxide

38
Q
  • thalidomide derivative
  • CLL, multiple myeloma
  • lacks teratogenic, sedative effects of thalidomide
  • inhibits effects of rituximab
A

lenalidomide

39
Q

Induction: vincristine and prednisone, add an anthracycline, asparaginase for pediatrics, if Philadelphia (+) add dasatinib, if CD20 (+) add rituximab, intrathecal methotrexate and cytarabine
-maintenance 2-3 years: daily 6-mercaptopurine, weekly methotrexate, monthly vincristine and prednisone, imatinib or dasatinib (Ph+)

A

treatment of Acute Lymphocytic Leukemia (ALL)

Blood and Lymph (10 decks)

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