Shared Flashcard Set

Details

Hemat/Onc EXAM 4
Hemat/Onc EXAM 4 - Hecht Lymphoma
26
Pharmacology
Graduate
02/13/2012

Additional Pharmacology Flashcards

 


 

Cards

Term
lymphoma
Definition
lymphoma is a malignant transformation of immune cells that reside predominantly in lymphoid tissue

bone marrow and thymus

lymph nodes, spleen, Waldeyer's Ring, lamina propira of GI tract

2 major types of lymphoma:
Hodgkin's Disease
Non-Hodgkin's Lymphoma
Term
lymphoma presentation
Definition
slight male predominance

HD: bimodal age distribution (20s and 60s)

NHL: average age 65

HD: overall 5 year survival 82%

NHL: overall 5 year survival 53%
Term
lymphoma work up and diagnosis
Definition
work up: history and physical, laboratory, radiographic evaluation

biopsy of pathologic tissue:

lymph node excisional biopsy preferred
want to remove the entire lymph node to look at the architecture of the lymph node

bone marrow biopsy
Term
lymphoma symptoms
Definition
symptoms come and go

adenopathy (enlarged lymph nodes): usually painless and rubbery

adenopathy complications

pruritis

B symptoms: fever, night sweats, weight loss

bone marrow involvement = myelosuppression
Term
lymphoma Cotswolds Staging (NEED TO KNOW)
Definition
Stage I:
involves a single LN region or single extra lymphatic organ or site

Stage II:
involves 2 or more LN regions on the same side of the diaphragm

Stage III:
involves LN regions on both sides of the diaphragm

Stage IV:
disseminated multi-focal involvement
bone marrow involvement
Term
Hodgkin's Disease (HD) - etiology
Definition
origin is unknown

environment factors

infection - EPSTEIN BARR

Reed-Sternberg (RS) cell is the malignant clone
thought to be B-cell in origin but has lost the B cell characteristics (including CD20 receptor)
do express the CD30 receptor

genetic factors
Term
hodgkin's disease - poor prognostic factors
Definition
albumin < 4

Hgb < 10.5

male

age > 45

stage IV

WBC > 15

lymphocytes < 600 (0.6)

4 OR MORE POOR PROGNOSTIC FACTORS = HIGH RISK OF RELAPSE
Term
hodgkin's disease treatment
Definition
goal is to obtain the highest possible cure rate for all patients while minimizing side effects

surgery has minimal to no role

radiation - controversial b/c of collateral damage

chemotherapy
Term
HD treatment - radiation
Definition
involved nodal region

extended field/regional radiotherapy:
mantle irradiation (upper chest)
para-aortic irradiation

ADRs:
side effects are local
xerostomia, hypothyroidism, pneumonitis, cardiotoxicity, infertility

lymph node regions: cervical (neck), supra-clavicular (above clavicle), mediastinal (middle chest), axillary (arm pit), periaortic, illiac, inguinal, femoral
Term
HD treatment - chemotherapy
Definition
1st cancer successfully treated with chemotherapy

use aggressive combination chemo

ABVD:
doxorubicin
bleomycin
vinblastine
dacarbazine

Stanford V
Term
HD treatment - early stage
Definition
early stage; favorable = stage IA, IIA (no B-symptoms):
90% cure rate and 80% long term survival
chemotherapy (2 cycles) + involved node radiation

early stage; unfavorable = Stage IB, IIB (B-symptoms):
long term survival in 87%
chemotherapy + involved node radiation
give 2 cycles beyond complete response (minimum 4)
Term
HD treatment - advanced state
Definition
stage III-IV

CR in 60-90%

long term survivors 40-50%

chemotherapy (6-8 cycles)
minimum 6 cycles
should get 2 cycles after CR seen
Term
HD salvage therapy
Definition
radiation alone as initial therapy: chemotherapy

chemotherapy as initial therapy: stem cell transplant
stem cell transplant is not therapeutic but allows you to give an even higher dose of chemotherapy b/c not worried about the dose limiting toxicity of bone marrow suppression

brentuximab vedotin:
targets CD-30
attached to antimicrotubule agent (auristatin)
indicated as 3rd line therapy
Term
ABVD (doxorubicin, bleomycin, vinblastine, dacarbazine) major counseling poinast
Definition
fertility

Quick ADRs:
hypersensitivity
extravastation (anthracycline)

Short Term ADRs:
N/V
myelosuppression
mucositis
alopecia
neuropathies (vinblastine)
red secretions
blood clots (bleomycin)

Long Term ADRs:
cardiac toxicity
pulmonary toxicity (bleomycin)
Term
Non-Hodgkin's Lymphoma (NHL) - etiology
Definition
origin is unknown

immunosuppression: acquired, congenital, drug induced

autoimmune disorders

infection: EBV, H. pylori, HHV8, HTLV1

chemical: herbicides, organophosphate, nuclear, and chemotherapy exposure
Term
NHL histology
Definition
monoclonal proliferation of malignant B or T lymphocytes and their precursors

80% are B cell lymphomas

description of cells (size and nuclear features), where they are found (follicular or diffuse), and cell surface markers determine normal counterpart, tumor growth characteristics and treatment
Term
NHL presentation
Definition
subtypes often associated with specific features

local or general adenopathy: painless, rubbery LN

bone marrow involvement: anemia, neutropenia, thrombocytopenia

GI involvement: nausea, vomiting, pain
Term
NHL clinical course
Definition
indolent (low grade): follicular grade I and II, mantle cell, MALT

aggressive (intermediate grade): follicular grade III, large/diffuse B cell

highly aggressive (high grade): burkitt's and burkitt's like

untreated clinical course (time to death):
indolent - years (10 years)
aggressive - months (6-12 months)
highly aggressive - weeks (6-12 weeks)

types of lymphomas:
indolent - nodal (mantle or follicular) and extranodal (MALT)
aggressive - diffuse large B cell and peripheral T cell
highly aggressive - lymphoblastic,, burkitts, and adult T cell

presentation:
indolent - wax and wane adenopathy
aggressive - B symptoms or symptoms of obstruction
highly aggressive - rapidly growing mass
Term
NHL treatment
Definition
goals: relieve symptoms, cure disease, minimize toxicity

options:
chemotherapy
radiation
biological agents
Term
NHL treatment - follicular
Definition
indolent disease

early stage (I/II):
observation
localized radiation if symptomatic

advanced stage (III/IV) disease:

indications for treatment - symptomatic, threatened end organ function, cytopenias, massive bulk, steady progression, patient choice

treatment options:
fludarabine + rituximab

maintenance rituximab: dosed every 8 weeks for up to 2 years after initial chemotherapy is done

relapsed disease:
radiopharmaceuticals (ibritumomab-ytrium, tositumomab-iodinine)
bendamustine
Term
NHL treatment - gastric MALT
Definition
early stage (I/II):
treat H. pylori

advanced stage (III/IV):

indications - bleed, massive bulk, symptoms, progression, danger to end organ function, patient preference

chemotherapy - CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone) + rituximab

H. pylori treatment
Term
NHL treatment - diffuse large B cell
Definition
most common form of NHL

early stage (I/II):
CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone) x 4 cycles + rituximab
followed by radiation

advanced stage (III/IV):
CHOP x6-8 cycles + rituximab
treat 2 cycles beyond CR

relapse:
multidrug combination regimens
stem cell transplant
Term
R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisone) major counseling points
Definition
Quick ADRs:
hypersensitivity
extravasation

Short Term ADRs:
N/V
myelosuppression
mucositis
alopecia
neuropathies
red secretions

Long Term ADRs:
cardiac toxicity
Term
NHL treatment - highly aggressive: Burkitt's and lymphoblastic lymphoma
Definition
all stages (I-IV) treated the same

combination chemotherapy:
alkylating agent, anthracycline, HD methotrexate, intrathecal chemotherapy
hyper CVAD

low response rate, few cures

clinical trials
Term
hyper CVAD

course 1: cyclophosphamide, mesna, vincristine, doxorubicin, dexamethasone

course 2: methotrexate, leucovorin, cytarabine

major counseling points
Definition
Quick ADRs:
hypersensitivity
extravastation

Short Term ADRs:
N/V
myelosuppression
MUCOSITIS - methotrexate
alopecia
neuropathies
red secretions
hemorrhagic cystitis - cyclophophamide

Long Term ADRs:
cardiac toxicity

VERY TOXIC

VERY COMPLICATED

MUST BE INPATIENT
Term
NHL and AIDS
Definition
NHL incidence 80% increased in incidence

2/3 highly aggressive histology: Burkitt's, primary CNS

chemotherapy based on type
Supporting users have an ad free experience!