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Oncology Therapeutics > Hodgkins/Non-Hodgkins Lymphoma > Flashcards

Hodgkins/Non-Hodgkins Lymphoma Flashcards

1
Q

How is HL vs NHL differentiated from each other

A

HL : Reed sternberg cells (CD15 and CD30+)

NHL : B or T cell lymphocyte markers

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2
Q

Risk Factors HL –> No well defined RF

1) ___ hx
2) Viruses such as ?

A
  1. Familial HX (same sex siblings of pts with HL have 10x greater risk)
  2. EBV, Infectious mononucleosis , HIV virus
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3
Q

Signs and Sx’s HL

Note Staging is divided into A and B catgeories where A is asx and B has sx’s

1) Painless swelling of?
2) F
3) Unexplained ___
4) Drenching ___
5) ___ loss
6) I

A
  1. Lymph nodes in neck, groin or armpit
  2. fatigue
  3. fevers - B sx
  4. night sweats - B sx
  5. weight loss > 10% body weight B sx
  6. Itching
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4
Q

TX for HL :
1) Whats our goal ?
2. Whats the combo therapy of initial chemotherapy we use? ABVD
3. Duration ? Cycles, what day

A
  1. Cure without tx related complications
  2. Adriamycin (Doxorubicin) + Bleomycin + Vinblastine + Dacarbazine
  3. 4-6 cycles (depending on stage)
    -Given on days 1 and 14, one cycle is given every 28 days
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5
Q

Doxorubicin :

  1. Drug class and MOA
  2. AE’s? (5)
  3. What is the dose limiting toxicity ?
  4. What should EF be ?
  5. Dose adjust for ?
  6. Turns urine ___
  7. Is a ___ needs what kind of line?
  8. max lifetime dose of ? (2 options)
A
  1. Anthracycline , TOPO2 inhibitor
  2. Cardiac, alopecia!, N/V (mod) , cytopenia, secondary malignancy
  3. Cardiac toxicity (Cardiomyopathy and CHF)
  4. > 40%
  5. Hepatic dysfunction
  6. Red
  7. vesicant –> central line
  8. 550 mg/m^2 or 450 mg/m^2 + mediastinal radiation
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6
Q

Bleomycin

  1. Drug class/MOA
  2. AE’s?
  3. Dose limiting toxicity ?
  4. Dose adjust for ?
  5. Dont use with ?
  6. W/lymphoma what is required ?
  7. For Bleo Pulm Toxicity whats the sx’s?
    -RF’s ?
A
  1. Anti tumor abx
  2. lung toxicity!!!, rash , severe allergic rxn anaphylaxis
  3. pneumonitis
  4. hepatic dysfunction
  5. GCSF
  6. Test dose/pre meds
  7. cough and dyspnea
    - age > 40, cig smoking, cum doses > 400 units, Use of GCSF
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7
Q

Vinblastine :
1. Drug class?
2. AE’s ? (2)
3. DLT ?
4. Dose adjust for ?
5. ___ needs central line
6. NEVER GIVE ___

A
  1. Vinca alkaloids
  2. Bone marrow suppression , neurotoxicity (?) more for vincristine , mucositis
  3. marrow suppression
  4. hepatic dysfunction
  5. VESICANT
  6. intrathecal
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8
Q

Dacarbazine

  1. Drug class?
  2. AE’s ? (2)
  3. DLT ?
  4. Does it need central line?
A
  1. Alkylating agent / cell cycle NON specific
  2. Highly emetogenic !!! Vesicant
  3. BMSuppression
  4. yes its a vessicant
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9
Q

Supportive Care for ABVD

  1. do u use GCSF?
  2. How do u prevent n/v?
  3. Don’t give with ? bc of DDI with?
A
  1. NOOOOOOO (Pulm toxic with bleo) –> can also get IV neutropenia
  2. 5HT3 antag and dexamethasone
  3. Azole antifungals –> Vinblastine and Doxorubicin
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10
Q

Salvage Chemotherapy : If they have relapse with Initial CR < 12 months

1.When do u do a stem cell transplant ?
2. WHat’s the ICE regimen in salvage chemotx?
3. ICE : what should be started 24 hrs after last dose of chemotx?
4. Level of Emetogenicity ?
5. What should u use for the N/V?

A
  1. If induction/reinduction failure (basically with refractory or recurrent HL)
  2. Isofamide + Carboplatin + Etoposide –> given at 2-3 week intervals for 2-3 cycles until remission
  3. GCSF
  4. HIGHLY emetogenic. But using aprepitant with ifos can incr risk of neurotoxic bc of DDI
  5. 5HT3 antag + Dexmethasone
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11
Q

Ifosfamide
1. Drug class?
2. AE’s ? (5)
3. DLT ?
4. What must be done before each dose?
5. Must be given with ?

A
  1. Alkylating agent
  2. BM suppression!, alopecia, moderate N/V, Cystitis!!!, neurotoxic (enceph, seizures) !!!
  3. BM suppression
  4. UA
  5. MESNA to prevent cystitis
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12
Q

Carboplatin :
1. Drug class?
2. AE’s (4)
3. DLT ?
4. Whats the AUC usually between ?

  1. How is dosing calculated (equation) ?
A
  1. platinum analog
  2. Marrow suppression !!
    renal toxicity
    Electrolyte abnorms (HYPOkalemia, MAG, CALCEMIA, PHOSPHATEMIA)
    Hypersensitivity rxns (anaphylaxis usually with > 6 cycles of drug)
  3. marrow suppression
  4. 4-7 –> making this HEC
  5. Calvert Eqn : where dose = (Target AUC) x (GFR+25)
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13
Q

Etoposide
1. Drug class?
2. Ae’s? (4)
3. DLT ?
4. Dose adjustment for ?
5. What can cause infusion effects?
6. DO NOT USE WITH WHICH DRUG ?
7. FInal conc must be ?

A
  1. TOPOISOM II inhib (cell cycle specific)
  2. hepatotoxic , bm suppression!, alopecia!, bronchospasm/hypotension
  3. Bone marrow suppression
  4. renal and hepatic dysfunction
  5. Polysorbate 80
  6. Azole antifungals
  7. > 0.4 mg/mL
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14
Q

NHL : Risk factors

  1. Immunodeficieny states such as?
  2. Enviro agents such as ?
A
  1. EBV, transplantation, immunosuppressive drugs (tacrolimus and cyclosporine)
  2. Herbicides, radiation , dyes
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15
Q

NHL : Follicular lymphoma
1. What type ?
2. TX for Stage 1 and 2?
3. TX for stage 3 and 4 ?
4. WHat is R-CHOP? and duration

A
  1. Indolent lymphoma
  2. Localized disease (stage 1 and 2) use radiation therapy
  3. Advanced diseases : RITUXAN + Combo chemo (R-CHOP)
  4. Rituxan + Cyclophos + Doxorubicin (Hydroxy daunorubicin) + Oncovin (vincristine) + Prednisone

4-6 cycles at 2-3 week intervals

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16
Q

Rituximab or Rituxin’s role in B cell Lymphomas ?
(What does it target)

WHy do we start with R-CHOP instead of just using CHOP?

A

It targets CD20 on both normal and malignant B cells . This can sensitize drug resistant B cell lymphoma cell lines to chemotx

CR higher in RCHOP. It reduces risk of tx failure and death!
also , FL is a B Cell lymphoma, R targets B cell CD20 specifically

17
Q

Rituximab (Rituxan)

  1. AE’s ? (2)
  2. What to check for prior to starting chemotx?
  3. Pre medicate with ?
A
  1. Infusion reactions and Hep B reactivation
  2. Check for Hep B negativity prior to starting
  3. Tylenol and benadryl
18
Q

Cyclophosphamide
1. Drug class?
2. Prior to high dose, what would u need to do? Wat should u monitor?

  1. AE’s ? (8)
  2. DLT ?
  3. CAn pre mediate with what for wasabi nose ?
  4. Doses > 1200 mg/M^2 require ??
A
  1. ALkylating agent , cell cycle non specific
  2. EKG prior to high dose,
    monitor for hematuria
  3. Cystitis!!, cardiac!!!! , BMS, alopecia, N/V, SIADH, LFT elevations, wasabi nose
  4. Cardiac
  5. Sudafed
  6. MESNA
19
Q

Vincristine
1. Drug class
2. AE”s ? (2)
3. DLT ?
4. Dose adjust for?
5. Vesicant needs ___ . Never give it ___
6. May need to dose adjust for ?
7. Ensure ___ before giving

A
  1. Vinca alkaloid, cell cycle specific
  2. neurotox!!! (Neuropathy, bone pain, jaw pain) , constipation
  3. Neurotoxic
  4. hepatic dysfunction
  5. Central line , intrathecally
  6. peripheral neuropathy
  7. BM (bowel movements i tink)
20
Q

CAR - T cell therapy :
1. What can they target and how does this relate to NHL?
2. Major AE of CAR T cell ? describe short term vs long term ae’s

  1. HOw do we treat CRS caused by CARTCELL therapy?
A
  1. Can target CD19 which is expressed on nearly all B cell malignancies like NHL
  2. CRS (cytokine release syndrome)

Short term : Fever, hypoxia, hypotension
Long term : Prolonged cytopenias, hypogammaglobulinemia, organ failure, sepsis, death, secondary malignancies

  1. Tocilizumab , and Corticosteroids
21
Q

What about ICANS caused by CAR-T cells? (Neurotoxicity syndrome)
What are the short term vs long term ae’s ?
What agents would u use to remedy this?

A
  1. Enceph, HA, tremor, dizzy, delirium, insomnia, anxiety
  2. Enceph, serious seizures, cerebral edema, death
  3. Tocilizumab and steroids as well

Oncology Therapeutics (17 decks)

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