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EXAM 4 Flashcards

1
Q

Multiple Myeloma is a malignancy of the ______ cells

A

plasma

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2
Q

MM can be measured in the ______ and _______

A

plasma
urine

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3
Q

What are the genetic factors of MM

A

familial clusters of MM
Multiple genetic mutations

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4
Q

What 2 conditions precede MM?

A

Monoclonal gammopathy of undetermined significance
Smoldering MM

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5
Q

What is the malignant plasma cell involved in unregulated production of a monoclonal antibody

A

M-protein

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6
Q

MM cells are in the bone marrow and are further expanded by what 4 “receptors/genes”

A

IL-6
VEGF
IGF-1
NF-kB

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7
Q

what are the symptoms of MM

A

bone pain
fatigue
infection
neurologic symptoms
polyuria
N/V

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8
Q

What labs will you see with MM?

A

elevated M-protein, SCr, B2-microglobulin, C-reactive protein
hypercalcemia
low hemoglobin, albumin

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9
Q

What is the acronym for MM symptoms?

A

C: hypercalcemia
R: renal insufficiency
A: anemia
B: bone lesions

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10
Q

staging and prognosis of MM includes looking at what labs?

A

serum B2-microglobulin
albumin
LDH
high-risk chromosomal abnormalities

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11
Q

Initial therapy for MM includes what regimen?

A

dexamethasone
immunomodulatory drugs
proteasome inhibitors

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12
Q

What is the VRd treatment regimen for MM?

A

Bortezomib
Lenalidomide
Dexamethasone

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13
Q

Candidates for HSCT in MM look at what eligibility factors?

A

age
renal function
performance status
comorbidities

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14
Q

MM maintenance therapy consists of what single agent drugs?

A

Lenalidomide
Bortezomib

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15
Q

High doses of dexamethasone are associated with what risks?

A

higher risk of infection
CNS toxicity
should be used in caution (especially older patients)

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16
Q

What are the 3 IMiDs for MM?

A

Thalidomide
Lenalidomide
Pomalidomide

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17
Q

what is the major side effect for IMiDs in MM?

A

VTE
severe birth defects (REMS program)

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18
Q

what are the 3 proteasome inhibitors for MM?

A

Bortezomib
Carflizomib
Ixazomib (PO)

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19
Q

Proteasome inhibitors inhibit what “receptor/gene”

A

NF-kB

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20
Q

Bortezomib has less neurotoxicity if given by what route?

A

SQ

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21
Q

Carfilzomib has less _____ compared to bortezomib

A

peripheral neuropathy

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22
Q

Ixazomib has what side effects?

A

infection (herpes zoster)

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23
Q

What monoclonal antibodies target CD38

A

Daratumumab
Isatuximab-irfc

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24
Q

What monoclonal antibody targets SLAMF7?

A

Elotuzmab

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25
26
what monoclonal antibody targets BCMA and has a REMS program?
Belantamab REMS program for ophthalmic exam prior to each dose
27
What drug is an oral inhibitor of histone deacetylase enzymes and has a side effects of QTc prolongation?
Panobinostat
28
What drug inhibits nuclear export of tumor suppressor proteins and exportin 1
Selinexor
29
What is the chimeric antigen receptor T-cell therapy drug for relapsed or refractory MM?
idecabtagene vicleucel
30
What is the VRd dosing regimen?
Lenalidomide PO QD x14 days Bortezomib SQ days 1,4,8,11 Dexamethasone PO days 1,8,15 repeat Q21 days
31
What are the bone modifying therapies for supportive care in MM?
zoledronic acid (dose adjustments for renal impairment) pamidronate (reduced dose for renal impairment) Denosumab (targets RANK-L, no dose adjustments)
32
Myelodysplastic syndrome is characteristed by ineffective hematopoiesis with morphologic dysplasia in what cells?
hematopoietic cells peripheral cytopenias
33
myelodysplastic syndrome is progressive _________ failure, a result of _________ hematopoiesis
bone marrow ineffective
34
neutrophils have reduced ________ and ________ activity despite a normal quantity
bacterial and fungal
35
Platelets may be normal in quantity but have impaired _________ , _________ , and _________
activation, secretion, and aggregation
36
IPSS classification of MDS is what chromosome abnormalities?
5q or 20q deletions and chromosome 7 abnormalities
37
What chromosome abnormalities are part of the IPSS-R system?
trisonomy 8 or 19, 12p or 11q deletions and double abnormalities
38
myelodysplastic clone is associated with what cellular dysfunctions?
excess secretion of cytokines defective differentiation genomic instability reduced response to regulatory cytokines
39
MDS is associated with what IMMUNE dysregulations?
impaired immune surveillance autoimmune reactions cytopenias related autoimmune T-cell mediated response
40
What are the 4 prognostic factors for MDS?
cytogenetic abnormalities % of bone marrow blasts age number of cytopenias
41
What labs will be observed in MDS?
anemia neutropenia thrombocytopenia multiple cytopenias
42
what are the clinical symptoms of MDS?
fatigue, lethargy, malaise, palpitations, dyspnea on exertion, exercise intolerance
43
What is treatment for lower-risk MDS?
immunomodulating agents Growth factors immunosuppressive therapy hypomethylating agents
44
what are the side effects for thalidomide?
fluid retention peripheral neuropathy thrombosis constipation
45
When is a patient a candidate for growth factors in MDS?
lower-risk MDS and symptomatic anemia who have a serum EPO level of <500
46
What are the growth factor drugs?
filgrastim luspatercept eltrombopag
47
What are the agents that modulate effector T-cells (immunosuppressive therapies)
antithymocyte globulin (ATG) cyclosporine corticosteroids
48
what are the hypomethylating agents to treat MDS?
azacitidine decatabine azacitadine and venetoclax
49
What are treatment options for higher-risk MDS?
DNA hypomethylating agents: prolong overall survival allogeneic HSCT: only curative option immunomodulating agents intensive chemotherapy
50
Venetoclax inhibits?
B-cell lymphoma (BCL-2)
51
What is the intensive chemotherapy for higher-risk MDS?
anthracycline plus cytarabine **bridge therapy to allogeneic HSCT**
52
MDS patients are at risk for?
anemia infections
53
colony stimulating factors stimulate _______ production, increasing the circulating ________, _________ the risk of infection
WBC neutrophils decreasing
54
What are the hematopoietic growth factors?
filgrastim sargramostim
55
patients with MDS can be treated with transfusions of _______ for anemia, but complications of transfusions include _________
RBC iron overload
56
patients with MDS and a ____ deletion generally have _______ prognosis and are ______ likely to respond to __________
5q favorable highly lenalidomide
57
patients with MDS can receive intensive chemotherapy as bridge therapy to HCST to ______ tumor burden and ______ disease while suitable donor is found
reduce control
58
What are some factors associated with the development of Non-Hodgkin lymphoma?
genetic diseases environmental agents infectious agents congenital and acquired immunodeficiency states
59
a diet high in _______ increases the risk of NHL?
meats and dietary fats
60
What infections are associated with the development of NHL?
Epstein-Barr human T-cell lymphotropic virus type 1 H. pylori Hep C
61
NHL is derived from proliferation of malignant _______ lymphocytes and their precursors
B or T in the US most is B-cell origin
62
Classification of NHL is based on what 3 things?
cell of origin (B or T) clinical features morphologic features
63
Most patients with NHL present with what symptom?
peripheral lymphadenopathy
64
What are the B symptoms for NHL?
fever weight loss night sweats
65
what is the gold standard for assessment of almost all lymphoma histology types?
PET-CT
66
Stage I Hodgkin Lymphoma involves how many lymph nodes?
One
67
Stage II Hodgkin Lymphoma involves?
2 or more lymph nodes on the SAME side of the diaphragm
67
68
stage III Hodgkin Lymphoma involves?
lymph node regions on BOTH sides of the diaphragm
68
stage IV Hodgkin Lymphoma involves?
diffuse or disseminated involvement of one or more extralymphatic organs or tissues with or without lymphnode enlargement
69
69
What other factors are used in the staging and prognosis or NHL?
A - no symptoms B - fever, night sweats, weight loss X - bulky disease E - involvement of extra lymphatic tissue on one side of the diaphragm S - involvement of the spleen CS - clinical stage PS - pathologic stage
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HEM/ONC (4 decks)

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