Cancer Pharm Flashcards
(155 cards)
1
Q
adenoma
A
tumors that start in the epithelial tissue of a gland
2
Q
fibroids
A
made of connective tissue, often form in the uterus, can lead to bleeding, bladder problems and pelvic pain
3
Q
lipoma
A
formed by fat cells, most common benign tumors
4
Q
meningioma
A
develop in the brain and spinal cord membranes, commonly benign
5
Q
nevi
A
typically known as moles and appear on the skin
6
Q
oncogene
A
mutated form of a gene involved in normal cell growth
structurally and functionally heterogeneous group of genes
7
Q
PDGF-β
A
platelet-derived growth factor-beta
proto-oncogene: PDGFB
mode of activation: overexpression
associated tumor: astrocytoma
8
Q
fibroblast growth factors
A
HST1: overexpression, osteosarcoma
FGF3: amplification, stomach/bladder/breast cancer, melanoma
9
Q
TGF-α
A
transforming growth factor alpha
TGFA, overexpression
astrocytomas
10
Q
HGF
A
hepatocyte growth factor, aka “scatter factor”
overexpression, hepatocellular carcinomas
11
Q
growth factor receptors, RAS, PI3K, MYC, and D cyclins
A
oncoproteins that are activated by mutations in various cancers
12
Q
GTPase-activating proteins (GAPs)
A
apply brakes to RAS activation
13
Q
phosphatase and tensin homologue (PTEN)
A
applies breaks to PI3K activation
14
Q
BCR-ABL
A
target of imatinib
15
Q
p53
A
important at G1/S and G2/M checkpoints
16
Q
restriction point
A
G1 phase cell cycle checkpoint at which the cell becomes “committed” to the cell cycle
after this extracellular signals are no longer required to stimulate proliferation
17
Q
phosphorylation of retinoblastoma (Rb) gene protein
A
occurs in nucleus
unphosphorylated Rb inhibits E2F-mediated transcription
pRb –> E2F mediated transcription of cyclins A & E
18
Q
overactive CDKs and underactive CKIs lead to
A
decrease stringency of constriction point
19
Q
activation of normal p53 by DNA-damaging agents or by hypoxia leads to
A
cell cycle arrest in G1 and induction of DNA repair by transcriptional upregulation of the cyclin-dependent kinase inhibitor CDKN1A (encoding the cyclin-dependent kinase inhibitor p21) and GADD45 genes
20
Q
TP53 gene –> p53 protein
A
guardian of the genome
21
Q
more energy obtained from glycolysis, less from
A
O2 consumption if cells or growing and/or cancerous –> Warburg effect
22
Q
3 IDH isoforms in humans
A
mutations in the isocitrate dehydrogenase gene IDH1 found in several brain tumors
mutations of IDH2 and IDH1 were found in up to 20% of cytogenetically normal acute myeloid leukemia (AML)
23
Q
2-hydroxyglutarate
A
oncometabolite
24
Q
Wnt
A
gate keeper of colonic neoplasia
25
E-cadherin sequesters
β-catenin
26
curative surgery
removes cancerous tumor or growth
used when tumor is localized
often considered primary treatment but may have radiation before/after
27
preventative surgery
removes tissue that does not contain cancerous cells, but may develop into a malignant tumor (e.g., colon polyps)
28
diagnostic surgery
samples tissue for pathologist to determine if cells are cancerous and then type+/-stage if cancerous
29
staging surgery
works to uncover the extent of cancer by , for example, via laparoscopy and biopsy
30
debulking surgery
removes a portion of a cancerous tumor when all cannot be removed with hope that radiation or chemotherapy can treat the rest
31
palliative surgery
used to relieve discomfort the cancer or its treatment efforts may have created
32
supportive surgery
helps other cancer treatments work more effectively (eg, insertion of catheter)
33
restorative surgery
used to change or restore a person’s appearance or the function of a body part (e.g., breast reconstruction after breast cancer, mouth reconstruction after oral cancer)
34
cryosurgery
surgery technique that uses extremely cold temperatures (eg, liquid nitrogen or “cryoprobe”) to kill cancer cells, most often for skin cancer or cervical cancer
35
laser surgery
uses laser beams to precisely remove very small cancers (w/o damaging surrounding tissue), to shrink or destroy tumors, or to activate drugs to kill cancer cells
can be used to treat body areas that are difficult to reach including the skin, cervix, rectum, and larynx
36
electrosurgery
uses electrical current to kill cancer cells, sometimes used for skin or oral cancer
37
microscopically controlled surgery
used for surgery with delicate parts of the body (eg, eye) where layers of tissue are carefully removed until cancerous cells cannot be detected
38
radiation therapy
one of the most common treatments for cancer
given to >1/2 of people with cancer
not useful if cancer has spread to multiple sites
39
radiation therapy mechanism
uses high-energy particles or waves, such as x-rays, gamma rays, electron beams or protons --> small breaks in DNA
impairs cell growth and division --> cell death
cure or shrink early-stage cancers as these tend to be very sensitive to radiation
used in effort to prevent cancer from recurring elsewhere
40
radiation therapy given as
```
external beam radiation focused on tumor
internal radiation (brachytherapy) where a radioactive source is put into/near the tumor
systemic radiation … eg, by attaching radionuclide to monoclonal antibody that targets the cancer cells
```
41
brachytherapy
internal radiation where a radioactive source is put into or near the tumor
42
external beam radiation therapy
most often X-rays
| ionizing radiation causes breaks in the DNA, including double-stranded breaks
43
brachytherapy
```
radioactive sources (ie, “seeds”) placed in intimate contact with the cancerous tumor or gland to cause breaks in the DNA, including double-stranded breaks
can be “low-dose” over 1-7 d, “high-dose” over 10-20 min repeated over a few weeks or permanent
these patients emit radiation
```
44
only cell cycle independent agents mess with DNA structure
alkylating agents, platinum compounds: cross-link DNA
| anthracyclines, tiactinomycin: DNA intercalators
45
bleomycin: DNA strand breakage
selectively toxic in G2and M phases… seems to rely on chelation of iron --> ROS --> DNA breaks
46
interfere with DNA function
etoposide/teniposide: inhibits topiosomerase II
| irinotecan/topotecan: inhibits topiosomerase I
47
cancer drugs are highly toxic and are routinely administered based on ____
body surface area
48
classic chemotherapy resistance
mediated by ATP-binding cassette superfamily protein ABCB1 (aka MultiDrugResistance1)
49
ABCB1
codes for xenobiotic pump phenolic glycoprotein (P-gp)
50
other cancer cell fortress against drugs
```
up-reg drug detox mechanisms (CYP450)
reduced apoptosis
altered proliferation
increased DNA damage repair
altered drug targets
```
51
MDR1 Transporter (ABCB1) roles
helps rid body of waste (liver --> small intestine, kidney)
52
antitumor antibiotics
bleomycin
dactinomycin
anthracyclines (doxorubicin, daunorubicin)
53
bleomycin
antitumor antibiotic
mechanism: induces free radical formation, G2/M phase specific
use: testicular cancer, Hodgkin lymphoma
adverse effects: pulmonary fibrosis, skin hyperpigmentation
54
dactinomycin
antitumor antibiotic
mech: intercalates into DNA, prevent RNA synthesis
use: Wilms tumor, Ewing sarcoma, rhabdomyosarcoma
adverse: myelosuppression
55
anthracyclines 2
doxorubicin
| daunorubicin
56
anthracyclines
antitumor antibiotic
mech: generate free radicals, inhibits topiosomerase II
use: solid tumors, leukemias, lymphomas
adverse: dilated cardiomyopathy, myelosuppression
57
antimetabolites
```
thiopurines (azathioprine, mercaptopurine)
cladribine, pentostatin
cytarabine (ara-C)
5-fluorouracil
hydroxyurea
methotrexate
```
58
thiopurines: azathioprine, mercaptopurine
antimetabolite
mech: purine (thiol) analogs --> decrease de novo purine synthesis
use: RA, IBD, SLE, ALL, prevention of organ rejection
adverse: myelosuppression, GI/liver toxicity, increase toxicity with allopurinol or febuxostat
59
cladribine and pentostatin
antimetabolites
mech: purine analogs lead to multiple mech
use: hairy cell leukemia
adverse: myelosuppression
60
cytarabine (ara-C)
antimetabolite
mech: pyrimidine analog --> DNA termination, inhibit DNA polymerase
use: leukemias (AML), lymphomas
adverse: myelosuppression
61
5-fluorouracil
antimetabolite
mech: pyrimidine analog bioactivated to 5-dUMP --> thymidylate synthase inhibition --> decrease DNA synthesis
use: colon/pancreatic cancers, actinic keratosis, basal cell carcinoma
adverse: myelosuppression, hand-foot syndrome
62
hydroxyurea
antimetabolite
mech: inhibits ribonucleotide reductase --> decrease DNA synthesis
use: myeloproliferative disorders (CML, polycythemia vera), sickle cell disease
adverse: severe myelosuppression, megaloblastic anemia
63
methotrexate
antimetabolite
mech: folic acid analog, completely inhibits dihydrofolate reductase --> decrease dTMP and decrease DNA synthesis
use:
cancers: leukemias (ALL), lymphomas, choriocarcinoma, sarcoma
nonneoplastic: ectopic pregnancy, medical abortion (with misoprostol), RA, psoriasis, IBD, vasculitis
adverse: myelosuppression (reversible with leucovorin "rescue"), liver toxicity, mucositis, pulmonary fibrosis, folate def.
64
alkylating agents
```
busulfan
nitrogen mustards: cyclophosphamide, ifosfamide
nitrosoureas: carmustine, lomustine
procarbazine
temozolomide
```
65
busulfan
alkylating agent
mech: cross-links DNA
use: ablate bone marrow before transplant
adverse: severe myelosuppression, pulm fibrosis, hyperpigmentation
66
nitrogen mustards
cyclophosphamide
| ifosfamide
67
nitrogen mustards: cyclophosphamide, ifosfamide
alkylating agent
mech: cross-links DNA, require liver bioactivation
use: solid tumors, leukemia, lymphomas, rheumatic diseases (SLE, granulomatosis with polyangiitis)
adverse: myelosuppression, SIADH, Fanconi syndrome (ifo), hemorrhagic cystitis, bladder cancer (prevent with mensa))
68
nitrosoureas
carmustine
| lomustine
69
nitrosoureas: carmustine, lomustine
alkylating agent
mech: cross-link DNA, require liver bioactivation, *crosses blood-brain barrier
use: brain tumors
adverse: CNS toxicity (convulsions, ataxia, dizziness)
70
procarbazine
alkylating agent
mech: unknown, weak MAO inhibitor
use: Hodgkin lymphoma, brain tumors
adverse: myelosuppression, pulm toxicity, leukemia, disulfiram-like reaction
71
temozolomide
alkylating agent
mech: DNA methylation
use: glioblastoma multiforme
adverse: myelosuppression
72
platinum compounds
cisplatin
carboplatin
oxaliplatin
73
cisplatin, carboplatin, oxaliplatin
platinum compounds
mech: cross-link DNA
use: solid tumors (testicular, bladder, ovarian, GI, lung), lymphomas
adverse: nephrotoxicity (Fanconi syndrome- prevent with amifostine**), peripheral neuropathy, ototoxicity
74
amifostine
cytoprotective adjuvent
mech: detoxify reactive platinum metabolites
use: cancer chemo/radiotherapy involving DNA-binding chemotherapeutic agents
75
microtubule inhibitors (all M phase specific)
taxanes: docetaxal, paclitaxel
| vinca alkaloids: vincristine, vinblastine
76
taxanes: docetaxal, paclitaxel
microtubule inhibitor
mech: prevent breakdown of polymerized microtubules
use: various tumors (ovarian and breast carcinomas)
adverse: myelosuppression, neuropathy, hypersensitivity
77
taxanes
docetaxel
| paclitaxel
78
vinca alkaloids
vincristine
| vinblastine
79
vinca alkaloids: vincristine, vinblastine
microtubule inhibitor
mech: bind beta-tubulin to inhibit microtubule polymerization
use: solid tumors, leukemias, Hodgkin & non-Hodgkin lymphomas
adverse:
vincristine --> neural toxicity, peripheral neuropathy, constipation
vinblastine --> myelosuppression
80
topiosomerase inhibitors
all lead to increased DNA degradation
| cell cycle arrest in S and G2 phases
81
topiosomerase inhibitors
irinotecan, topotecan
| etoposide, teniposide
82
irinotecan, topotecan
topiosomerase inhibitor
mech: inhibits topiosomerase I, cuts one strand spins DNA around covalent bond
use: colon, ovarian, small cell lung cancers
adverse: severe myelosuppression, diarrhea
83
etoposide, teniposide
topiosomerase inhibitor
mech: inhibits topiosomerase II, cuts both strands simultaneously spins, re-ligates with energy from ATP hydrolysis
use: testicular cancer, small cell lung cancer, leukemia, lymphoma
adverse: myelosuppression, alopecia
84
cisplatin, carboplatin
ototoxicity
| nephrotoxicity
85
vincristine
peripheral neuropathy
86
bleomycin, busulfan
pulmonary fibrosis
87
doxorubicin, daunorubicin
cardiotoxicity
88
trastuzumab
cardiotoxicity
89
cyclophosphamide
hemorrhagic cystitis
90
common toxicities of almost all cytotoxic chemotherapies
myelosuppression
GI toxicity (N/V, mucositis)
alopecia
91
myelosuppression
neutropenia
anemia
thrombocytopenia
92
chemotoxicity amelioration drugs
```
amifostine
dexrazoxane
leucovorin
mesna
rasburicase
ondanstetron, granisetron
prochlorperazine, metoclopramide
aprepitant, fosaprepitant
filgrastim
sargramostim
epoetin alfa
```
93
amifostine
chemotoxicity amelioration drug
mech: free radical scavenger
use: nephrotoxicity from platinum compounds
94
dexrazoxane
chemotoxicity amelioration drug
mech: iron chelator
use: cardiotoxicity from anthracyclines
95
leucovorin
chemotoxicity amelioration drug
mech: tetrahydrofolate precursor
use: myelosupp from methotrexate ("leucovorin rescue"), enhances effects of 5-FU
96
mesna
chemotoxicity amelioration drug
mech: sulfhydryl compound that binds acrolein of nitrogen mustards
use: hemorrhagic cystitis from cyclophosphamide or ifosfamide
97
rasburicase
chemotoxicity amelioration drug
mech: recombinant uricase that catalyzes metabolism of uric acid to allantoin
use: tumor lysis syndrome
98
ondansetron, granisetron
chemotoxicity amelioration drug
mech: 5-HT3 receptor antagonist
use: acute N/V after chemotherapy ( in 1-2 hrs)
99
prochlorperazine, metoclopramide
chemotoxicity amelioration drug
mech: D2 receptor antagonist
use: acute N/V after chemotherapy (in 1-2 hrs)
100
aprepitant, fosaprepitant
chemotoxicity amelioration drug
mech: NK1 receptor antagonists
use: delayed N/V after chemotherapy (>24 hrs)
101
filgrastim
chemotoxicity amelioration drug
mech: recombinant G-CSF
use: neutropenia
102
sargramostim
chemotoxicity amelioration drug
mech: recombinant GM-CSF
use: neutropenia
103
epoetin alfa
chemotoxicity amelioration drug
mech: recombinant erythropoietin
use: anemia of chronic kidney disease
104
why use combination chemotherapy
drugs administered hopefully synergize at drug target while having off-target toxicities distributed so that adverse impacts are diminished
105
CHOP or R-CHOP
```
R = rituximab
C = cyclophosphamide
H = doxorubicin hydrochloride (Hydroxydaunomycin)
O = vincristine sulfate (Oncovin)
P = prednisone
```
106
(+/- R) CHOP used to treat
non-hodgkin lymphoma
| + R if B cell derived
107
ABVD
```
A = doxorubicin hydrochloride (Adriamycin)
B = bleomyicn
V = vinblastine sulfate
D = dacarbazine
```
108
ABVD used to treat
Hodgkin lymphoma
109
BEP
```
B = bleomycin
E = etoposide phosphate
P = cisplatin (Platinol)
```
110
BEP used to treat
ovarian germ cell tumors
| testicular germ cell tumors
111
FOLFIRI, FOLFIRINOX, FOLFOX
```
FOL = leucovorin (FOLinic acid)
F = fluorouracil
IRI(N) = irinotecan
OX = oxaliplatin
```
112
FOLFIRI used to treat
colorectal cancer
113
FOLFIRINOX, FOLFOX used to treat
pancreatic cancer
114
selective estrogen receptor modulator
tamoxifen
115
tamoxifen
selective estrogen receptor modulator
mech: antagonist in breast tissue, blocks estrogen binding to ER in ER+ cancer cells
use: prevention/tx of breast cancer, prevention of gynecomastia in patients receiving anti-androgen prostate cancer therapy
adverse: hot flashes, increase risk thromboembolic events, increase risk endometrial cancer
116
GnRH, anti-GnRH and anti-androgens
leuprolide, goserelin
degarelix
abirataterone
flutamide, bicalutamide, enzalutamide
117
leuprolide, goserelin
GnRH, anti-GnRH and anti-androgens
mech: GnRH agonist, given continuosly --> GnRH receptor down-reg in pituitary
use: prostate cancer
adverse: flare-up, hypogonadism, decrease libido, ED, N/V
118
degarelix
GnRH, anti-GnRH and anti-androgens
mech: GnRH antagonist
use: prostate cancer
adverse: hot flashes, liver toxicity
119
abirataterone
GnRH, anti-GnRH and anti-androgens
mech: decrease androgen synthesis
use: prostate cancer
adverse: hypertension, hypokalemia (due to increase mineralcorticoids)
120
flutamide, bicalutamide, enzalutamide
GnRH, anti-GnRH and anti-androgens
mech: non-steroidal competitive inhibitors at androgen receptors
use: prostate cancer
adverse: gynecomastia, sexual dysfunction
121
enzalutamide
GnRH, anti-GnRH and anti-androgens
broader action
competitive inhibitor plus prevents translocation of androgen receptor to nucleus and in nucleus inhibits AR binding to DNA
122
anticancer monoclonal antibodies
neutralize extracellular targets and/or promote immune system recognition --> elimination by macrophages
123
anticancer monoclonal antibodies drug names
```
alemtuzumab
bevacizumab
cetuximab
rituximab, obinutumab
trastuzumab, pertuzumab
pembrolizumab, nivolumab
atezolizumab
ipilimumab
```
124
alemtuzumab
anticancer monoclonal antibodies
target: CD52
use: CLL, multiple sclerosis
adverse: ↑ risk of infection and autoimmunity
125
bevacizumab
anticancer monoclonal antibodies
target: VEGF
use: colorectal cancer, renal cell carcinoma, non-small cell lung cancer, angioproliferative retinopathy
adverse: hemorrhage, blood clots, impaired wound healing
126
cetuximab
anticancer monoclonal antibodies
target: EGFR
use: metastatic colorectal cancer, head & neck cancer
adverse: rash, ↑ liver function tests, diarrhea
127
rituximab, obinutuzumab
target: CD20 on mature B cells
use: non-Hodgkin lymphoma, CLL, RA, ITP, TTP, autoimmune hemolytic anemia, multiple sclerosis
adverse: infusion reaction
128
obinutuzumab
anticancer monoclonal antibodies
| fully humanized, less glycosylated → ↑ ability to activate NK cells
129
trastuzumab, pertuzumab
anticancer monoclonal antibodies
target: HER2
use: breast cancer, gastric cancer
adverse: dilated cardiomyopathy (often reversible)
130
pembrolizumab, nivolumab
anticancer monoclonal antibodies
target: PD-1
use: various including NSCLS, RCC, melanoma, urothelial carcinoma
adverse: ↑ risk of autoimmunity
131
atezolizumab
anticancer monoclonal antibodies
target: PD-L1
use: various including NSCLS, RCC, melanoma, urothelial carcinoma
adverse: ↑ risk of autoimmunity
132
ipilimumab
anticancer monoclonal antibodies
target: CTLA-4
use: various including NSCLS, RCC, melanoma, urothelial carcinoma
adverse: ↑ risk of autoimmunity
133
checkpoint inhibitors
pembrolizumab, nivolumab
atezolizumab
ipilimumab
very important class of anti-cancer drugs, active against multiple tumors
134
side effects of checkpoint inhibitors
common/mild: diarrhea, N, fatigue, cough, rash, poor appetite, constipation, muscle/joint pain
more serious: infusion reactions and autoimmune reactions
135
antibody-drug conjugates formation
linking monoclonal antibodies with cytotoxic chemotherapeutic drugs
antibody selectivity → targeted drug delivery to tumor cells sparing healthy cells: ↑ efficacy, ↓ toxicity
ex: ado-trastuzuMAB emtansine (T-DM1) for HER2+ breast cancer
136
CAR T-Cell Therapy mechanism
customized to each patient
collect T-cells from patient → re-engineer to produce chimeric antigen receptors (CARs) → CARs recognize/bind specific Ags on cancer cells → revamped T-cells are infused back into patient → CAR T-cells continue to multiply and recognize/kill cancer cells that have target on cell surface
137
CAR T-Cell adverse effects
tumor lysis syndrome
cytokine release syndrome (managed with steroids, tocilizumab blocks IL-6 activity also helps)
neurologic effects: severe confusion, seizure-like activity, impaired speech (responds to steroids but not tocilizumab)
138
currently approved CAR T-cell drugs
all end in "-leucel"
139
anticancer small molecule inhibitors
```
imatinib
ruxolitinib
bortezomib
vemurafenib
palbociclib
olaparib
```
140
imatinib
anticancer small molecule inhibitor
target: BCR-ABL
use: CML, ALL, GI stromal tumor
adverse: myelosuppression, ↑ LFTs, edema, myalgies
141
ruxolitinib
anticancer small molecule inhibitor
target: JAK1/2
use: polycythemia vera
adverse: bruises, ↑ LFTs
142
bortezomib
anticancer small molecule inhibitor
target: proteasome
use: multiple myeloma, mantle cell lymphoma
adverse: peripheral neuropathy, herpes zoster reaction
143
vemurafenib
anticancer small molecule inhibitor
target: BRAF (V600E mutation)
use: melanoma, often co-admin with MEK inhibitors
adverse: rash, fatigue, N, diarrhea
144
palbociclib
anticancer small molecule inhibitor
target: CDK 4/6 (induces arrest at G1-Sphase)
use: breast cancer
adverse: myelosuppression, pneumonitis
145
olaparib
anticancer small molecule inhibitor
target: poly (ADP-ribose) polymerase (PARP) → ↓ DNA repair
use: breast, ovarian, pancreatic, prostate cancers
adverse: myelosuppression, edema, diarrhea
146
anti-cancer top sellers not in First Aid
lenalidomide
ibrutinib
daratumumab
ventoclax
147
lenalidomide
anti-cancer top seller
#1 top selling drug
mech: thalidomide analog, multiple mech
know for: causing phocomelia when used to treat morning sickness in pregnancy
use: multiple myeloma, myelodysplastic syndromes, mantle cell lymphoma
adverse: potentially severe anemia, neutropenia, thrombocytopenia, DVT, PE
148
ibrutinib
anti-cancer top seller
mech: bruton tyrosine kinase inhibitor
use: CLL, mantle cell lymphoma, Waldenstrom macroglobulinemia
adverse: mild diarrhea, URI, bleeding, fatigue
149
daratumumab
anti-cancer top seller
mech: binds CD38 → apoptosis
use: multiple myeloma (CD38 overexpression)
adverse: many - cough, URI, anemia, fatigue, N, peripheral neuropathy
150
ventoclax
anti-cancer top seller
mech: blocks anti-apoptotic Bcl-2 protein → apoptosis of CLL cells
use: CLL, SLL, AML
adverse: neutropenia, tumor lysis syndrome, URI, fatigue, diarrhea
151
hyperthermia to treat cancer
local, regional, or whole-body
local: small tumor - radiofrequency ablation
regional: isolated blood supply not hot enough to destroy tissue but to augment effects of chemo/radiation
whole-body: ↑ body temp with blankets, warm-water immersion to augment effects of chemo for metastatic cancer
152
photodynamic therapy to treat cancer
photosensitizing agents injected into bloodstream/absorbed in skin then activated by local light
works as well as surgery/radiation for some cancers
no long-term side effects, less invasive, short time, precise targeting, same site can receive tx many times, little to no scarring, costs less
only works if: visible light can reach cancer (5-10 mm), its localized
pt hypersensitive to light, can't use if pt has porphyria
153
stem cell transplant to treat cancer
replace bone marrow cells that have been destroyed by cancer (leukemias, lymphomas, myeloma) OR destroyed by the chemo/radiation
names of tx: bone marrow transplant, peripheral blood stem cell transplant, cord blood transplant
154
autologous stem cell transplant
stem cells come from patient themselves
| neg: may collect cancer cells and/or cancer cells able to escape patient's immune system again
155
allogenic stem cell transplant
stem cells taken from another person
graft can target cancer but can also target healthy cells (graft-vs-host disease) needing immunosuppressive drugs → infections
