APL and Supportive Care

Question 1

APL

Answer 1

Acute Promyelocytic Leukemia

Question 2

APL arises from

Answer 2

single translocation like CML

Question 3

pathogenesis APL

Answer 3

oncologic emergency secondary to rapidly evolving clotting abnormalities and risk for fatal hemorrhage

Question 4

treatment of APL

Answer 4

All-trans retinoic acid

Arsenic tri-oxide

Question 5

mechanism ATRA for APL

Answer 5

directly addresses maturation block

Question 6

mechanism arsenic tri-oxide for APL

Answer 6

Induces degradation of chimeric protein

Induces apoptosis at higher doses by uncertain (and possibly multiple) mechanisms

Question 7

3 kinds of nausea

Answer 7

Anticipatory
Acute
Delayed (>24 hrs)

Question 8

2 pathways for nausea-vomiting

Answer 8

peripheral pathway - GI tract release 5HT onto vagal afferent (acute phase)

central pathway - (chronic, delayed) area postrema to vagus nerve w/ substance P

Question 9

what cancers known for thrombotic diathesis

Answer 9

Pancreas, Breast, Prostate, Bladder, Lung and CNS cancers all well known for thrombotic diathesis

Question 10

what clotting markers are consistently correlated w/ poor survival

Answer 10

Elevated D-dimer, elevated INR, and other measures of hypercoagulability

Question 11

most active agent for management of DVT in cancer

Answer 11

Low-molecular weight heparin

Question 12

clots and therapeutic warfarin

Answer 12

Clots often continue to form in setting of “therapeutic” warfarin
(distinctly inferior way – need LMWH)

Question 13

tx management of dvt in cancer

Answer 13

Cancer patients should get at least 2 weeks of LMWH, and ideally stay on LMWH until thrombogenic stimulus (e.g. chemotherapy) is removed.

Question 14

which cancers almost universally affect bone

Answer 14

breast and prostate

Question 15

bone directed treatment extends survival in what cancers

Answer 15

Myeloma and Breast and Renal Cell (NOT in Prostate)

Question 16

classic agents for anti-resorptive therapy of bone

Answer 16

bisphosphonate

Question 17

most potent and most used anti-resorptive therapy of bone at present

Answer 17

zoledronic acid

Question 18

treatment of constipation: gentle and does not generate gas

Answer 18

polyethylene glycol (miralax)

Question 19

______ to prevent tearing (with constipation) is quite important

Answer 19

mineral oil

Question 20

need to replace ____ w/ diarrhea

Answer 20

electrolyte

Question 21

what do you need to remember with both diarrhea and constipation

Answer 21

fiber

Question 22

what is extremely useful in tx of diarrhea

Answer 22

tincture of opium

Question 23

what are useful for quite useful for secretory diarrhea unresponsive to other measures

Answer 23

somatostatin analogues

Question 24

myelosuppression tx: now available as a recombinant therapeutic peptide

Answer 24

Granulocyte Colony Stimulating Factor (G-CSF)

Question 25

SE G-SCF

Answer 25

In young people getting only moderately myelosuppressive therapy, the long-acting form causes BAD low back pain. Snee this in the ED.

Question 26

anemia tx: now available as a recombinant therapeutic peptide

Answer 26

Epo

Question 27

therapeutic outcome with Epo

Answer 27

Unfortunately, pushing Hgb above 10 is consistently associated with WORSE outcome
BAD

Question 28

Use of EPO restricted to

Answer 28

The use of EPO for cancer patients is pretty much restricted to transfusion-dependent marrow failure

Question 29

Two agents FDA approved for refractory ITP

Answer 29

eltrombopag
romiplostim

No routine use of these agents at the moment for chemo-induced thrombocytopenia