Week 1 Flashcards by B. Smith

What is leukemia?

uncontrolled growth of WBC progenitor cells in bone marrow

blasts crowd out the healthy bone marrow, so you can’t make RBCs or platelets

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What is lymphoma?

uncontrolled growth of B or T cells in the lymphoid tissue

can’t make WBCs, RBCs or platelets

form tumors in the lymph nodes

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if you see fevers, chills, night sweats, are you thinking leukemia or lymphoma?

lymphoma

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How does treatment for chronic vs acute leukemias differ?

acute = chemo

chronic = pills (like a -nib)

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What 3 drugs are risk factors for AML?

benzenes, radiation, prior chemo (alkylating agents)

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What marker is positive in AML?

MPO+

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What is hallmark sign of AML?

Auer rods

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What is APL?

a subtype of AML associated with t(15:17)

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Which type of leukemia disrupts the retinoic acid receptor?

APL [t(15;170]

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What type of chemo for AML?

doxorubin

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What is MOA of doxorubin?

inhibits topoisomerase II

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How do you treat APL?

all-trans retinoic acid

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What are the cells in the myeloid lineage?

neutrophils

basophils

eosinophils

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What is a hallmark physical exam finding of CML?

splenomegaly

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What is defining chromosome translocation in CML?

Philadelphia t(9;22)

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Do you see blasts in acute or chronic leukemias?

acute

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How do you treat CML?

imatinib

a tyrosine kinase inhibitor pill

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If you have <20% blasts that are MPO+, what are you looking at?

myelodysplastic syndrome

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Which leukemia presents with bone pain?

ALL

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What is a common associated finding in ALL?

mediastinal mass

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Philadelphia chromosome with ALL, means what prognosis?

poor

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What is a marker of lymphoid leukemia?

TdT+

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Do myeloid or lymphoid leukemias tend to have enlarged lymph nodes?

lymphoid

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What is a characteristic finding of CLL?

Smudge cells on smear

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What is abnormal cytometry seen in CLL?

CD5+ with CD20+ (B-cells)

How can you treat CLL for fixed duration?

rituximab

Rituximab MOA

CD20 monoclonal antibody

TRAP staining indicates ...

hairy cell leukemia

How do you treat hairy cell leukemia?

with cladribine, which is a purine analog

How many lymph nodes involved in Hodgkin lymphoma?

How many lymph nodes involved in non-Hodgkin lymphoma?

many

What is seen on histology for Hodgkin lymphoma?

Reed-sternberg cells

What predicts a good prognosis in Hodgkin lymphoma?

lymphocyte rich

What does Reed Sternberg cell look like?

Owl eyes

What 3 chemos can you give for Hodgkin lymphoma?

doxorubicin bleomycin vincristine

What is main side effect of doxorubicin?

cardiotoxic

Wha is main side effect of bleomycin?

pulmonary fibrosis

What is main side effect of vincristine?

neuropathy

What is most common Non-Hodgkin lymphoma?

diffuse large B-cell lymphoma

What translocation do you see in Burkitt lymphoma?

t(8:14) Starry sky

What type of lymphoma is Burkitt?

B-cell non-Hodgkin's lymphoma

When should you add rituximab to treatment of non-Hodgkin lymphoma?

if CD20+

How does multiple myeloma look on smear?

looks like a straight line of RBCs

What happens in multiple myeloma?

you have too many plasma cells which leads to too many immunoglobulins being secreted

What are the symptoms of multiple myeloma?

CRAB criteria! C: hypercalcemia R: renal insufficiency A: anemia B: bone lytic lesions

How does multiple myeloma cause hypercalcemia?

RANK-L secretion increases osteoclast activity and Ca2+ released from bones into blood

What is a symptom of multiple myeloma?

back pain

How can you make the multiple myeloma diagnosis? (2)

1) M spike on SPEP 2) Free light chain ratio

If you have a small M spike with no CRAB criteria what do you have?

MGUS

If you have a larger M spike (>3) with no CRAB criteria what do you have?

smoldering myeloma

If you have CRAB and M spike what do you have?

multiple myeloma

What is treatment for multiple myeloma? And MOA?

-mibs proteasome inhibitors that arrest G2-M phase

What is waldenstrom macroglobulinemia?

type of multiple myeloma with IgM overproduced leads to hyperviscosity

What type of control is neoadjuvant therapy?

local control – treatment of cancer we can measure

What type of control is adjuvant therapy?

systemic control – treatment of cancer we cannot measure

What are examples of neoadjuvant therapy?

radiation, surgery

What are examples of adjuvant therapy?

chemo, immunotherapy, TKIs

Name 4 common alkylating agents for chemo

1) Cyclophosphamide 2) Cisplatin 3) Busulfan 4) ifosfamide

Side effect of cyclophosphamide

hemorrhagic cystitis

Side effect of ifosfamide

renal Fanconi's syndrome

Side effect of cisplatin

hearing loss, renal damage

What is MOA of doxorubicin?

planar rings that block polymerase

Which drug has unique side effect of heart failure?

doxorubin

What is MOA of methotrexate?

folate antagonist that blocks purine synthesis

What is MOA of topotecan / irinotecan?

topoisomerase inhibitor that leads to super coiling of DNA

What phase do topotecan and irinotecan work on?

S phase

Which drugs specific side effect is diarrhea?

topo inhibitors

Which drug has incurable leukemia as a side effect?

etoposide (topo II inhibitor)

Which drugs are M phase specific?

taxanes (docetaxol, paclitaxol) vincristine

How do taxanes work?

prevent depolymerization in M-phase

How does vincristine work?

prevent polymerization in M-phase

Which drugs are taxanes?

ones that end in -taxol

What is side effect of vincristine?

stocking glove neuropathy

How does bleomycin work?

blocks G2 to M phase induces DNA breaks to prevent DNA replication

How do you do traditional chemo?

big doses every 21 days (bone marrow regenerates)

What is purpose of metronomic therapy?

continuous smaller dose to prevent growth of blood vessels

What pathway does imatinib block?

BCR-ABL pathway in CML *targets a specific oncogene*

Which monoclonal antibody works against CTLA-4?

ipilimumab

Which monoclonal antibody works on Veg-F?

bevacizumab

What is PD1?

limits T-cell activation nivolumab works against PD1

What are main side effects (2) of immunotherapy with PD1?

psoriasis ocular autoimmune disease

What is an irreversible side effect of immunotherapy with PD1?

thyroid effects

How do you treat neutropenic fever?

Cefepime IV antibiotic ASAP

When you have a mediastinal mass what should you avoid?

sedation

What is treatment for TLS?

rasburicase to catalyze metabolism of uric acid

What is only low lab value in TLS?

hypocalcemia

How do you prophylaxis for TLS?

IV fluids and allopurinol

What disease is leukostasis most common in?

AML

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Week 1 Flashcards

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