Term
small cell lung cancer in non smoker
? management |
|
Definition
| please revisit slides one more time |
|
|
Term
Bronchoalveolar carcinoma
BAC
-presentation |
|
Definition
most common in non smokers ( females)
Xray - interstitial or multifocal pattern
often miss dx as interstitial disease
no sx or diarrhea of airways (copious sputum)
Severe SOB
responds to TKI
|
|
|
Term
| Most common translocation in Mantle cell lymphoma |
|
Definition
|
|
Term
| Most common translocation in Burkit |
|
Definition
allways involves 8 ( form or to )
t8;22 MYC and Ig l
t2;8 Ig K- MYC
t 8:14 Myc Ig H |
|
|
Term
| Most common translocation in DBLCL |
|
Definition
|
|
Term
| Most common translocation in Anaplastic LCL Alk + |
|
Definition
|
|
Term
| Most common translocation in maltoma |
|
Definition
T11;18 API2 and MALT1
T 14;18 Ig H and MALT1
t 1 ;14 Bcl10 and Ig H " |
|
|
Term
|
Definition
most common DLBCL
Follicular
Malt
MCL
CLL/SLL
PMBCL
burkits |
|
|
Term
|
Definition
CLL? SLL
Spleic B cell marginal zone
lymphoplacutic lymphoma
MALT ( mucosal assosisated lymhoid tissue,lymphoma
nodal margninal
follicular
primary cutaneous follicle center lymph
MCL |
|
|
Term
| distint clinical finding in small NHL |
|
Definition
every thing common in all small lymphocyte NHL except
MCL - male predominace
MALT - rarely involve BM and offer present as stage 3 or 4 |
|
|
Term
| common clinical feature of small cell NHL |
|
Definition
age 60- 65
BM -40- 70 ( but MALT)
rare B sx
late state ( except MALT ) |
|
|
Term
| Small B cell NHL Immunophenotype ( distinct) |
|
Definition
CD 5 only in SLL, MCL/ CD 23 is never + in MCL
MCL allways Cyclin D 1 +
FL- always and only CD 10 +
all Bcl @ + |
|
|
Term
|
Definition
| bu number of centrolblast /hpf |
|
|
Term
|
Definition
FL in 80 -90 % and in 10 - 20 % DLBCL
produce BCL 2 - inhibit apoptosis |
|
|
Term
|
Definition
gastric- h pylori
small bowel- C jejuni
thyroid/ - hashimoto
parotid/lung- sjogren synd
skin B burgdoreferi |
|
|
Term
| common translocation in MALT |
|
Definition
11;18 ( lung and gastric- if + does not respond to h pylori treatment
14;18 in lung ,liver, ocular
1;14
3;14
14; |
|
|
Term
| common translocation in MALT |
|
Definition
11;18 ( lung and gastric- if + does not respond to h pylori treatment
14;18 in lung ,liver, ocular
1;14
3;14
14; |
|
|
Term
|
Definition
small B cell
diffuse growth pate
CCND 1- t11;14 ( also in MM)
over expression of cyling D1
95 % in mantle cell lymphoma ( poor prognosis)
Site- GI always involved GI trac |
|
|
Term
|
Definition
25 % all NHL
t 14;18 and t 3:var
centroblastic aor immunoblastic |
|
|
Term
|
Definition
at 3q27, a zinc finger trnscription factor, expresssed by germinal center B cells tanslocation to var or 14 lead to deregulated transcription
most common in DLBCL or FL |
|
|
Term
|
Definition
ERCC1 and RRM1 expression
Low ERCC1 expression is associated with platinum responsiveness and low RRM1 is associated with response to gemcitabine. Prospective data in support of treatment assignment according to ERCC1 and RRM1 are awaited. |
|
|
Term
|
Definition
| low expression detects response to platinum |
|
|
Term
|
Definition
| low RRM1 is associated with response to gemcitabine |
|
|
Term
|
Definition
|
|
Term
| tyrosine kinases receptor |
|
Definition
| which include the EGFR (also called HER1 or ERBB-1) and the epidermal growth factor receptor 2 (ERBB-2, also called HER2). |
|
|
Term
| intergroup 0139 trial- results ( stage 3 a nSCLC) |
|
Definition
| and noted equivalent survivals when surgery was preceded by induction chemotherapy or chemoradiotherapy.3 Subgroup analysis of this study revealed disparate outcomes in patients requiring pneumonectomy and those requiring lobectomy.3 Patients whose surgery could be accomplished with lobectomy derived a significant survival advantage from induction chemoradiotherapy followed by surgery compared to full-dose chemoradiotherapy (33.6 month median survival vs 21.7 months ). |
|
|
Term
| stage IIIA N2 NSCLC optimal management consistent with |
|
Definition
| disease to either induction chemo/radiation followed by planned surgery in nonprogressing patients or a nonsurgical approach ( in with multistation disease or bulky disease) |
|
|
Term
| isochromosome associated with |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
may be in seminoma
embroynoal
choriocarcinoma
false + cross react with LH, and marijuana
half life 24 hr |
|
|
Term
| Beta Hcg Negative in which germ cell tumor |
|
Definition
|
|
Term
| which germ cel tumor are AFP + |
|
Definition
embrynoal, yolk sac, liver disease ( HCC)
half life 5 - 6 days
never + in seminoma, chrio ca, teratoma, |
|
|
Term
|
Definition
| serum marker normal but mass is growing in chest - do resection |
|
|
Term
| DLBCL - gene profiling, germinal ceneter, activated- prognosis |
|
Definition
|
|
Term
|
Definition
starry sky, high grade
three type, endemic- africa - EBV
sproadic- western- bimodal-abdominal -ileocecal - 20 - 40% EBV +
Immunodeficient- 20- 40% EBV + |
|
|
Term
|
Definition
| t8q24- 14,32 - MYC to IG L or use fish prob for myc |
|
|
Term
| anaplastic large cell lymphoma - |
|
Definition
T cell - large, CD 30 + , express ALK1(usually not seen in mature cell)
t 2- 5 ALK- NPM(nucelo phsomen gene) = NPM ALK -40- 60% |
|
|
Term
|
Definition
ALK + - young pt , male predomiance, good prog
ALK - - older , poor prog |
|
|
Term
|
Definition
1,nodular lymphocyte predominat
2, Classical
-nodular sclerosis
-mixed cellularity
-lymphocyte depleted
-lymphocyte rich classical- |
|
|
Term
| nodular lymphocyte predominate HD |
|
Definition
| nodualr pattern - LP( L&h or pop corn cell) no RS cell, no necrosis |
|
|
Term
|
Definition
nodualr or diffuse
RS cell, or lacunar cell ( in sclerosis subtype)
inflammatory back ground
+- necrosis |
|
|
Term
| diff between classical vs nodular type of HD by IHS |
|
Definition
CD 30 and CD 45
CD 30+ in classical
Cd45 + in Nodular type |
|
|
Term
|
Definition
reactive thrombocytosis,PV, CML, MDS, PMF
order iron study, PFA, JAK2 , smear, and BM bx |
|
|
Term
| what increase risk of transformation in ET - ( cytogenetics) |
|
Definition
17 p deletion,
no increase with HU |
|
|
Term
| two main cytoreductive therapy for ET |
|
Definition
Hydroxyurea
anagrelide 2.5 mg bid or tid ( arrhythmia and CHF
IF for pregnant |
|
|
Term
| biphasic soft tissue sarcoma |
|
Definition
| both ca + sarcoma feature = synovial sarcoma |
|
|
Term
| mutation in soft tissue sarcoma |
|
Definition
t X-18 in osteo
t 11-22 ewing
ring chromosome para osteo |
|
|
Term
| age group in different sarcomas |
|
Definition
below 10 - rhabdomyosarcoma
10 -20 osteo / ewing
20- 40 synovial
above 40 - chondrosarcoma / chondroma/ liposarcoma |
|
|
Term
|
Definition
diaphysis - ewing(pelvis)
meta- osteo and chondro ( plevis)
epi- osteo
spine - mets and chrondroma |
|
|
Term
| general rule for staging in sarcoma |
|
Definition
1- 2a- low grade less than 5 cm
2b- 2c low grade above 5 cm
3 + high grade
4 metastatic |
|
|
Term
|
Definition
immunodeficient
autoimmune ( hasimoto, thyroiditis sjogren synd
infec- evv, h pylori, KS, |
|
|
Term
| mature peripheral B cell neoplasm |
|
Definition
CLL/ SLL
extranodal marginal zone lymphoma of MALT type
nodal marginal zone lymphoma
splenic marginal zone
lymphoplasmacytic lymphoma
follicular |
|
|
Term
| mature peri T cell neoplasm |
|
Definition
mycosis fungoides, seary synd
other t cell lymph |
|
|
Term
|
Definition
H/P B sx, progression and duration of LAD
EOD, KPS
incisional bx
labs- cbc, bmp, beta 2 ldh, hep, spep/siep
CT
bmbx (+- MRI of brain or LP) |
|
|
Term
| for indolent lymphoma PET scan ? |
|
Definition
|
|
Term
| molecular studies in low grade lymphoma |
|
Definition
Ig H rearrangement usefull in differentiating lymphoid hyperplasia from lymphoma
PCR assay 14-18 translocation |
|
|
Term
| ann arbor staging sys for lymphoma |
|
Definition
1= single LN group
2 = multiple on same side of diaphragm
3- multiple on both side
4 extranodal ( multiple or single with LN
X= bulk- more than 10 cm
E- extranodal or single site of extranodal disease
B- wt loss of 10%, fever, drenching night sweat |
|
|
Term
| FLIPI- follicular lymphoma international prognostic index |
|
Definition
age 60
stage 2/3
Hb below 12,
nodal site more than 4
LDH above normal |
|
|
Term
|
Definition
0-1 5 year 91%good
intermideate -2- 78%
poor -3+= 53% |
|
|
Term
| indolent lymphoma - when to treat |
|
Definition
clincal trail
cytopenia / endo organ fx/ sx/ bulky disease, splenomegaly( massive/ steady progression |
|
|
Term
| follicular lymphoma - local disease , stage 1- 2 |
|
Definition
|
|
Term
| advanced follicular lymphoma - treatment option |
|
Definition
not cure able
enroll in clinical trial
observe if possible
consider biologic agent (rituxan) |
|
|
Term
| folicular lymphoma with local disease -role of xrt |
|
Definition
| can get prolognd remssion with XRT |
|
|
Term
| advanced stage low grade lymphoma- Follicular treatment |
|
Definition
not cure able with chemo alone
chemo improves performance status |
|
|
Term
|
Definition
12;18 translocation
drug resistatnce , inhinbit apoptosis
monitor by PCR for residual disease (MRD)
clearing improves DFS after BMT |
|
|
Term
|
Definition
watch and worry
CVP/ CHOP ? Fludara with biologic or radio immunotherapy |
|
|
Term
| NCCN- grade 1 therapy for NHL indolent |
|
Definition
R CHOP
R CVP
chemo - Radioimmunotherapy
cate 2- fludara bine + R
ludara+mito + dex+ FND+ R |
|
|
Term
| first line for elderly pt with indolent NHL |
|
Definition
| R alone or single agent alkylator like chlorambucil , cyclophos |
|
|
Term
|
Definition
| use in lymphoa ( indolent ) wiht Rituxan resistant diseae |
|
|
Term
| clinical feathure of SLL/ CLL |
|
Definition
5% as lymphoma w/o leukemic componenet
hypo Ig - inf
auto immune disease |
|
|
Term
| prognostic factor in SLL/ CLL |
|
Definition
bad- beta2, unmutated Ig Vh, increased CD38, ZAP 70+
worse deletion of 11q 179
repeate FISH befre each tehrapy |
|
|
Term
|
Definition
chloarmbucil + pred
CVP
alemtuzumab
bendamustine
CHOP
hyper CVAD
EPOCH
OFAR ( oxali fluda, cytara, Rituxan ) |
|
|
Term
| deleltion of 17 P in SLL / CLL therapy |
|
Definition
FCR- f;uda cyclo rit
FR
HDMO + R
CFAR + campath |
|
|
Term
| 5 microb that can cause lymphoma |
|
Definition
h pylori
Borrelia burgdorferi Lyme
C jejuni
chlamydia psittachi ( occularadnexal MALT
hep c |
|
|
Term
| SMZL- splenic lymphoma clinical feature |
|
Definition
| splenomegaly/ LAD uncommon, BM90% +, monoclonoal gamapathy 50%, Ig M,r/o Hep c |
|
|
Term
| SMZL splenic lymphoma- tx |
|
Definition
|
|
Term
|
Definition
| mature B cell lymph with plasmocytic defferentiation CD1920+ Cd 5- |
|
|
Term
|
Definition
first dose reaction
Hep B reactivation
TLC
TLC
severe muco cutatnous raction
PML |
|
|
Term
| RIT- zevalin ( Y 90 ibritumomab tiuxetan ) and tositumomab I131- use in / |
|
Definition
effective in tumor less than 5 cm , chemo senstive,
dont give to - MArrow more 25 % / cytopenia
prior RT to marrow |
|
|
Term
|
Definition
| URacheal ca / do partial cystectomy |
|
|
Term
|
Definition
FGFR 3 50 % '
CDKN2A 16%
HRAS
PIK3CA
RBI 33% |
|
|
Term
| Active regimen in bladder ca |
|
Definition
MVAC - standard of care can cure ( 36%
HD MVAC 58% cure
GC-gem+cis) + MVAC
best - GC + MVAC gives same result |
|
|
Term
| bladder cancer gc or gc+paclitaxol |
|
Definition
gcp has little better
oc no diff
standard of care gc or mvac |
|
|
Term
| poor prognosis in bladder ca |
|
Definition
visceral mets
poor PF
good uf only nodal disease |
|
|
Term
|
Definition
|
|
Term
| is carbo and cis + in bladder ca |
|
Definition
|
|
Term
|
Definition
PR 64% check RR after 2 cycle
OC - 19 month, ( GC 14 month) |
|
|
Term
| standard of care in bladder |
|
Definition
0 or 1 risk - GC or MVAC ( if renal fx allow- CRI carbo)
2 risk - do single no platinum for palliation |
|
|
Term
|
Definition
pemtrexate
ifosamide
taxol
( no 2 nd line fda approved drug ) |
|
|
Term
|
Definition
|
|
Term
| sx for TCC in muscle invasion |
|
Definition
be aggressive
man - bladder prostatectomy- b/l pelvic LN
total cystectomy, hyster and oophro salpinog, and b/l pelvic LN |
|
|
Term
|
Definition
CMV - cyc mtx and vinlastin
MVAC for 12 weeks
14% improvement |
|
|
Term
|
Definition
|
|
Term
|
Definition
tri modality can be tried
remove tumor
chemo and XRT - f/u then more xrt |
|
|
Term
|
Definition
Grade plays big prognsotic role
other bad signs- multiple , 3+ cm,vascular invasion
intravesical chemo - reduce short term tumor reccurence no long term effect
BCG is makes diff in CIS intravesical - weekly for 6 weeks maintenance is controvertial
for papilary BCG and chemo equal |
|
|
Term
| most common PRIMARY CNS tumor |
|
Definition
glioma (
GBM50%
ALL TUMOR - IS METS |
|
|
Term
| classification of CNS tumor |
|
Definition
no TNM
go by GRade 1-4
G 1 piloctuc and astrocytoma
G2 astro, and oligodenderoglioma or mixed
G3 anplastic oligo , astro, and mixed
G4 - GBM |
|
|
Term
|
Definition
|
|
Term
| prognositic factor in CNS tumor |
|
Definition
| location PS, age, radiation, extent of surgery |
|
|
Term
| GBM / anaplastic standard of care |
|
Definition
XRT 60 gy+ temo or BCNU ( gliadel)
second line add bev |
|
|
Term
|
Definition
primary GBM- EGFR amplification
MDM2 amplification
P16 DELETION
RB alteration |
|
|
Term
|
Definition
| if MGMT was methylated increased response to TMZ and XRT |
|
|
Term
|
Definition
|
|
Term
| Grade 3 CNS tumor- astrocytoma |
|
Definition
cytoreduction, -- PCV ( procarbazine CCNU, vincristine )or BCNUor TMZ
EBRT alone - 3 year
EBRT + chemo = 5 year |
|
|
Term
| 1P19q loss in CNS tumor has ??? |
|
Definition
|
|
Term
|
Definition
| focal XRT, +_ PCV with XRT, no change in OS, but increase PFS PS |
|
|
Term
|
Definition
less than 2 cm
T1 mic - 0.1 cm
T1a -0.5
T1b - 1 cm
T1c - 1 to 2 cm |
|
|
Term
|
Definition
| T2 2-5 cm T 3 above 5 cm but no invasion in near by structure |
|
|
Term
|
Definition
T4 -
a- invasion to chest wall
b edema peau D orange
C - both a + b
D- inflammatory ca |
|
|
Term
|
Definition
Nx--- N3c
N1- ipsi, axillar LN ( mobile
N2 a - fixed auxillary, B- ipsi int mammary ( no auxillary )
N3- A- infraclacicular, B- auxi and int mamary , C supra clavicualr |
|
|
Term
|
Definition
0 tis
1= t1
2A= N1 with T 0 or t1 or T2
2B- T2+ N1 or T3
3A- T0-T3 with N2 or
3B- any T4 with N0 - 2
3C- any T with N3
4 - any mets |
|
|
Term
|
Definition
| Nottingham grade Gx-3 just prognostic |
|
|
Term
|
Definition
| CLL cells characteristically express CD19, CD20, CD23, CD5 and surface immunoglobulin, although these tend to be relatively low in intensity. The expression of CD5 differentiates CLL from other B-cell malignant disease with the exception of mantle cell lymphoma, which is also CD5+. However, in contrast to CLL, mantle cell lymphoma cells are negative for CD23 and stain positively for cyclin D1. |
|
|
Term
|
Definition
| front-line therapy of mantle cell lymphoma and Burkitt’s lymphoma |
|
|
Term
|
Definition
is much more common in men and
+ for expression of CD11c, CD103, CD123 and tartrate resistant acid phosphatase. |
|
|
Term
|
Definition
which is CD2-positive, CD3-positive, CD4-positive, but usually CD8-negative.
The cells tend to be cerebriform in appearance. |
|
|
Term
| Side effects associated with bortezomib includes |
|
Definition
| fatigue, peripheral neuropathy, and herpes zoster reactivation. Antiviral prophylaxis is recommended for all patients |
|
|
Term
| follicular thyroid cancer - pathologic feature |
|
Definition
follicular development and colloid good prgnosis
poorly differentiated with solid growth, absence of follicles, marked nuclear atypia, and extensive vascular and/or capsular invasion - poor prognosis |
|
|
Term
| variats of follicular thyroid cancer |
|
Definition
| Hurtle cell, and insular thyroid cell |
|
|
Term
| DX of thyroid follicular ca |
|
Definition
| nodule, US- NM scan - FNA - if follicular then surgery for path eval between adenoma and cancer |
|
|
Term
| summary of follicular thyroid cancer |
|
Definition
Follicular thyroid cancer, a well-differentiated tumor of thyroid epithelium, is the second most common type of thyroid cancer after papillary thyroid cancer. It is more common in iodine deficient areas, and tends to occur in an older population when compared to papillary thyroid cancer. (See 'Clinical presentation' above.)
The diagnosis of follicular thyroid cancer usually occurs during the evaluation of a cold thyroid nodule. FNA biopsy alone cannot distinguish between follicular adenomas and cancers. Microscopically, the diagnosis of follicular cancer requires identification of tumor extension through the tumor capsule and/or vascular invasion. (See 'Pathologic features' above.)
Most FTCs contain either RAS mutations or a PAX8-PPAR gamma 1 rearrangement but not both, indicating that similar yet distinct molecular events may originate with these two oncogenes. (See 'Molecular pathogenesis' above.)
Important prognostic features include stage, age, and tumor characteristics (tumor size, vascular invasion, capsular extension, histologic grade, and distant metastases). (See 'Prognostic features' above.)
Therapy — The treatment options available for follicular thyroid cancer are the same as for all differentiated thyroid cancers [30]. The optimum |
|
|
Term
|
Definition
Active MM
• ≥10% plasma cells
• M spike +
AND
C - High calcium
R - Renal dysfunction
A - Anemia
B - Bone lesions
Hyperviscosity,
amyloidosis, recurrent
infection |
|
|
Term
| Smoldring MM/ MGUS criteria |
|
Definition
MGUS
• <3 g M spike
• <10% plasma cells
AND
SMM
• ≥3 g M spike
• ≥10% plasma cells
Active MM
• ≥10% plasma cells
• M spike + |
|
|
Term
| Staging and Prognosis in MM |
|
Definition
• ISS staging system (β2M/albumin) is universally applicable
• Cytogenetics is informative in only 25% of cases, but abnormal karyotype predicts poor outcome
• Deletion 13 by metaphase cytogenetics (but not FISH alone) is predictive of poor outcome
• Poor risk is conveyed by t(4;14), t(14;16), and del 17p13 detected by FISH |
|
|
Term
| Progression-Free Survival in MM iwth MP or MPT |
|
Definition
MPT 20.3 m/ MP- 14.9 m
OS - MPT 39.3 MP 32.7 m B7 metaanalysis of 1700 pts |
|
|
Term
|
Definition
CTDa: Cyclophosphamide 500 mg orally QW, Thal 200 mg/d, Dex 20 mg d1–4, 15–18 of a 28-day cycle ( UK trial for less fit pt )
was equally effective as MPT but no direct comperison |
|
|
Term
VISTA: VELCADE as Initial Standard Therapy in
MM: Assessment With Melphalan and Prednisone - results |
|
Definition
700 pts compared with VMP / MP
VMP
Cycles 1–4
Bortezomib 1.3 mg/m2
IV, d 1, 4, 8, 11, 22, 25, 29, 32
Melphalan 9 mg/m2 , and prednisone 60 mg/m2 , d 1–4
Cycles 5–9
Bortezomib 1.3 mg/m2
IV, d 1,8,22,29
Melphalan 9 mg/m2
and prednisone 60 mg/m2
, d 1–4
MP
Cycles 1–9
Melphalan 9 mg/m2
and prednisone 60 mg/m2
, d 1–4 |
|
|
Term
| results of vista trail for MM |
|
Definition
VMP/MP- Time to progression 24/16.6
OS= 3 year survival 68% / 54% |
|
|
Term
| LOW DOSE VS HIGH DOSE IN MM |
|
Definition
low dose 40 mg on day 1,8,15,22
HD dex - 40 mg day 1-4, 9-12, 17-20
low dose has better prog |
|
|
Term
| Induction Therapy Prior to Stem Cell in MM |
|
Definition
Initial Therapy
• Melphalan, prednisone
+ thalidomide + bortezomib,
+ lenalidomide
• Thalidomide + dex
• Bortezomib + dex
• Bortezomib combos
• Bortezomib + liposomal
doxorubicin
• Bortezomib + lenalidomide + dex
• Lenalidomide + dex
if CR good candidate send, to ASCT if not
repeat primary therapy |
|
|
Term
|
Definition
|
|
Term
Len/Bz/Dex (RVD) in Newly Diagnosed
Multiple Myeloma |
|
Definition
– CR/nCR: 39%
– ≥VGPR: 67%
– Estimated 18-mos OS rate: 97%
– Estimated 18-mos PFS rate: 75%
no prognostication by adverse cyto
ISS 1 did well then 2 or 3 |
|
|
Term
The EVOLUTION Study:
Randomized Phase 2 Study of Len, Bz,
Cy, and Dex in Newly Diagnosed MM |
|
Definition
VRD \\\ VDC \\\\ CRVD
ORR 90 \\\ 87 \\\\ 94
CR 12 \\\ 6 \\\\ 15
VGPR 33 \\\ 35 \\\\ 42
PR 45 \\\ 45 \\\36 |
|
|
Term
| risk stratification in MM |
|
Definition
High Risk
– t(4;14), t(14;16)
– Deletion 17
– Deletion 13
– High β2M
– Light chain, IgA MM
– Renal failure
– Advanced bone disease
– Extramedullary MM
(Expected OS 4 yr
Standard Risk
– t(11;14), t(6;14)
– Hyperdiploid
– Low β2M
– Normal serum albumin
(Expected median OS 7 yr) |
|
|
Term
|
Definition
The largest and most influential trial is the United Kingdom Medical Research Council MAGIC trial, in which 503 patients with potentially resectable gastric (74 percent), distal esophageal (11 percent), or EGJ adenocarcinomas (15 percent) were randomly assigned to surgery alone or surgery plus perioperative chemotherapy (three preoperative and three postoperative cycles of epirubicin, cisplatin and infusional 5-fluorouracil [ECF]) [4].
A higher proportion of chemotherapy-treated patients with gastric cancer who underwent radical surgery had a potentially curative procedure (79 versus 70 percent), and significantly more had T1/2 tumors (52 versus 37 percent) and N0/N1 disease (84 versus 71 percent) [28]. Chemotherapy was well tolerated overall; excluding patients with neutropenia (23 percent), fewer than 12 percent of all patients had serious (grade 3 or 4) toxic effects. Despite this, only 104 (42 percent) were able to complete protocol treatment, including surgery and all three cycles of the postoperative chemotherapy. These data underscore one of the major problems with the perioperative approach, which is the difficulty in administering full number of postoperative chemotherapy cycles.
Nevertheless, with median four-year follow-up, progression-free survival was significantly worse in the surgery alone group (hazard ratio [HR] 0.66) as was overall survival (HR 0.75). The 25 percent reduction in the risk of death favoring chemotherapy translated into an improvement in five-year survival from 23 to 36 percent. Local failure occurred in 14 percent of the chemotherapy-treated patients compared to 21 percent of those undergoing surgery alone. Distant metastases developed in 24 and 37 percent of patients, respectively.
French FNLCC/FFCD trial — A similar benefit for preoperative chemotherapy |
|
|
Term
| SHARP trial for HCC july 08 NEJM |
|
Definition
Median overall survival was 10.7 months in the sorafenib group and 7.9 months in the placebo group
median time to symptomatic progression (4.1 months vs. 4.9 months, respectively, P=0.77).
time to radiologic progression was 5.5 months in the sorafenib group and 2.8 months in the placebo(P<0.001).
Seven patients in the sorafenib group (2%) and two patients in the placebo group (1%) had a partial response; no patients had a complete response. |
|
|
Term
| RCC stage 1- 3- role of adjuvant |
|
Definition
no role as per ECOG 2003
italian study 2007 asco abstract |
|
|
Term
|
Definition
not a surgical candidate
single ~ 5 cm or 4 not bigger than 5 cm
child pugh stage c
no a candidate for transplant, or not availabel imidately |
|
|
Term
|
Definition
CR -Disappearance of all target lesions and reduction in the short axis measurement of all pathologic lymph nodes to ≤10 mm
PR ≥30 percent decrease in the sum of the longest diameter of the target lesions compared with baseline
PD ≥20 percent increase in the sum of the longest diameter of the target lesions compared to the smallest sum of the longest diameter recorded since treatment started
The appearance of one of more new lesions
≥20 percent increase of at least 5 mm in the sum of the longest diameters of the target lesions compared with the smallest sum of the longest diameter recorded
SD Neither PR nor PD |
|
|
Term
|
Definition
| Thrombus in the main portal vein
Encephalopathy
Biliary obstruction
Child-Pugh C cirrhosis |
|
|
Term
Relative contraindications
to TACE
|
|
Definition
Serum bilirubin >2 mg/dL
- Lactate dehydrogenase >425 units/L
- Aspartate aminotransferase >100 units/L
- Tumor burden involving >50 percent of the liver
- Cardiac or renal insufficiency
- Ascites, recent variceal bleed, or significant thrombocytopenia
|
|
|
Term
| what should be tested ata dx in Adeno ca of lung |
|
Definition
| his has been the policy at Memorial Sloan-Kettering since January 2009, using the driver mutations KRAS, EGFR, BRAF, HER2, PIK3CA, AKTI, MEKI (MAP2K1) NRAS, and EML4-ALK. |
|
|
Term
| Short-Term Neoadjuvant Androgen Deprivation and Radiotherapy for Locally Advanced Prostate Cancer XRT + ADT TROG Randomised Trial |
|
Definition
, 3 months NADT -decreased PSA progression and local progression and improved event-free survival
6 months of NADT further reduced PSA progression and local progression , and led to a greater improvement in event-free survival
. 3-month NADT had no effect on distant progression and prostate cancer-specific mortality, or all-cause mortality
6-month NADT decreased distant progression , prostate cancer-specific mortality and all-cause mortality |
|
|
Term
| NCCN Tightens Active Surveillance in Prostate Cancer Guidelines |
|
Definition
Prostate-specific antigen (PSA) testing at least every 6 months and as often as every 3 months.
• Digital rectal examination (DRE) at least every 12 months and as often as every 6 months.
• Repeat needle biopsy within 18 months for patients in whom the initial biopsy was 10 or more cores.
• Repeat initial biopsy within 6 months for patients in whom the initial biopsy was fewer than 10 cores.
• Consideration of a repeat biopsy for all patients as often as 12 months. |
|
|
Term
| Monoclonal B lymphocytosis (MBL) |
|
Definition
Absolute monoclonal B lymphocyte count
< 5000/mm3 ·
All lymph nodes< 1.5 cm ·
No anemia ·
No thrombocytopenia |
|
|
Term
|
Definition
Hematopathology review of all slides
PCR for IGHV and TCR gene rearrangements,
FISH for major translocations
Flow cytometry of blood adequate for diagnosis of CLL/SLL (biopsy not required).
·
Adequate immunophenotyping to establish diagnosis b,c b Recommended panel for paraffin section
immunohistochemistry: CD3, CD5, CD10, CD20, CD23, cyclin D1
or
b Cell surface marker analysis by flow cytometry: kappa/lambda, CD19, CD20, CD5, CD23, CD10
·
Absolute monoclonal B lymphocyte countd
prognostic marker
t(11;14);
t(11q;v); +12; del(11q); del(13q); del(17p) ·
Molecular genetic analysis to detect:
immunoglobulin heavy chain variable gene
(IGHV) mutation status ·
Determination of CD38 and Zap 70 expression |
|
|
Term
|
Definition
Physical exam:
attention to node-bearing areas, including
Waldeyer’s ring, and to size of liver and spleen · Performance status · B symptoms ·
CBC, LDH ·CMP, Hepatitis B testing g
MUGA /echocardiogram
USEFUL UNDER CERTAIN CIRCUMSTANCES: · Quantitative immunoglobulins ·
Reticulocyte count, hepatoglobin, and direct Coombs’ test ·
Chest/abdominal/pelvic CT should be done prior to initiation of
therapy
· Beta-2-microglobulin · Uric acid · Unilateral bone marrow biopsy (± aspirate) at initiation of therapy
· PET scan is generally not useful in CLL but can assist in directing nodal biopsy if Richter's transformation is suspected |
|
|
Term
|
Definition
Rai system
0 Lymphocytosis, lymphocytes in blood > 15,000/mcL and > 40%
lymphocytes in the bone marrow
I Stage 0 with enlarged node(s)
II Stage 0-I with splenomegaly, hepatomegaly, or both
IIIc Stage 0-II with hemoglobin < 11.0 g/dL or hematocrit < 33%
IVc Stage 0-III with platelets < 100,000/mcL |
|
|
Term
|
Definition
Binet Syste Stage
Description
A Hemoglobin above10 g/dL and Platelets above 100,000/mm and < 3 enlarged areas
B Hemoglobin below 10 g/dL and Platelets below 100,000/mm 3 and MOre than 3 enlarged areas
Cc Hemoglobin < 10 g/dL and/or Platelets < 100,000/mm and
any number of enlarged areas |
|
|
Term
| role of del 11 i CLL/ SLL |
|
Definition
CLL with del (11q)h,j · Outcomes are
more favorable in patients with 11q deletion who receive regimens containing an alkylator. |
|
|
Term
|
Definition
| FOLFIRINOX treatment consisted of a 2-hour infusion of oxaliplatin (85 mg/m2), followed by a 2-hour infusion of leucovorin (400 mg/m2) combined with irinotecan (180 mg/m2), followed by a bolus of fluorouracil (400 mg/m2), and then a continuous 46-hour infusion of fluorouracil (2400 mg/m2); this regimen was repeated every 2 weeks. |
|
|
Term
|
Definition
RR 31.6% in the FOLFIRINOX group and 9.4% in the gemcitabine group (
FOLFIRINOX; median OS was 11.1 months vs 6.8 months in the gemcitabine
Median PFS was 6.4 months vs 3.3 months
FOLFIRINOX was associated with significantly greater toxicity, including a higher incidence of grade 3 or 4 neutropenia, febrile neutropenia, thrombocytopenia, diarrhea, and sensory neuropathy. |
|
|
Term
| tumor marker in breast cancer |
|
Definition
ER/ PR 70%, weakly prognostic, indolent disease, benefit from hormon therapy
Her2 - IHC/ FISH, 15-20%, good prognostic, aggressive disease, with early mets |
|
|
Term
| Etopside long term side effect- |
|
Definition
|
|
Term
| who should not get bleo in germ cell tumor |
|
Definition
| age bove 50 , impaired renal fx, COPD, or multiple lung mets, primary medastinal non seminoma germ cell tumor |
|
|
Term
|
Definition
| no need for 3 cycles of BEP, if 4 c base line PFT and then one before 4th cycle, or devlops any symptom |
|
|
Term
| Bleo can cause pseudo nodule on CT scan |
|
Definition
| in GCT if you f/u with CT chest after treatment |
|
|
Term
| GCT marker after oorechectomy Advanced disease and needed tx |
|
Definition
advanced- PMNSGCT, non pulmo visc mets, AFp above 10000, HcG 50000, LDH 10X
treat with BEP4x or VIP 4x |
|
|
Term
|
Definition
|
|
Term
|
Definition
seminoma with non pulmomets, AFP 1000-10000. HCG 5000-50000, LDH 1.5 to 10x
treate with BEP x4 or BEP3x and 1x EP |
|
|
Term
| prostate ca - molecular pathway |
|
Definition
androgen receptor singaling
IGF-1 / PTEN pathway
ETS activation |
|
|
Term
| PCPT trial finastride in prostate ca prevention |
|
Definition
55 y old men wiht PSA less than 3, end point prostate ca
results - 25% reduction in prostate ca ( 7 year f/u) |
|
|
Term
| reduce trial - CAP chemo prevention |
|
Definition
8200 men wiht psa 2.5-3 bx negative, on dutasteride
result 23% reduction, no increase in high grade as with finastride |
|
|
Term
| PSA screening works ? ERSPC |
|
Definition
ERSPC- 162k men psa every 4 year, 9 year f/u
20% reduction prostate cancer related mortality |
|
|
Term
| PSA screening works ? PLCO |
|
Definition
| US - NEJM 09, 150k men - no diff on 7 year f/u |
|
|
Term
| PSA screening works ? Goterborg |
|
Definition
| 20000 men 44% reduction after 14 year |
|
|
Term
| RP in CAp reduce ca related mortality by ? |
|
Definition
| 5% overall 17 RP to save one life |
|
|
Term
| Homozygoscity for UGT1a1*28 polymorphism affects metabolism of (Gilbert’s syndrome) |
|
Definition
|
|
Term
defi of DPD
dyhydropyrimidine dehydrogenase |
|
Definition
|
|
Term
| CYP2D6 affecect metabolism |
|
Definition
|
|
Term
| anti depersant with tamoxifen |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| hypo mag, infusion reaction |
|
|
Term
|
Definition
| interstitial lung disease, |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
FA - mutations in one of thirteen genes that localize to DNA repair foci and participate in double stranded break repair.
The FA complex functions to monoubiquitinate two of the FA proteins, and this plays a critical role in their localization to repair foci |
|
|
Term
|
Definition
| Defective DNA repair of UV treatment and results from impaired excision repair |
|
|
Term
| MSI= hereditary nonpolyposis colon ca |
|
Definition
| Defective DNA mismatch repair results in genetic instability at short tandem repeat sequences, termed microsatellite instability (MIN), and mutations in mismatch repair genes is responsible for hereditary nonpolyposis colon cancer syndromes |
|
|
Term
| defective double-stranded break repair and cause ??? |
|
Definition
| Radioresistant DNA synthesis is characteristic of ataxia telangiectasia |
|
|
Term
|
Definition
dominant, autosomal
mutations in several genes involved in DNA mismatch repair.
HNPCC gene - hMSH2, hMLH1, hPMS1, and hPMS2.
Affected individuals inherit one mutant and one wild-type allele and subsequently lose the normal allele in the target tissue.
ca- colon, uterus, no polyp |
|
|
Term
|
Definition
|
|
Term
| Inherited ATM mutations are associated with ???? |
|
Definition
| ataxia telangiectasia, whereas mutations within the nucleotide excision repair system cause sun-sensitive diseases such as xeroderma pigmentosum. |
|
|
Term
|
Definition
| 5-azacytidine inhibits DNA methylation and reactivates genes silenced by methylation. |
|
|
Term
|
Definition
Capecitabine /5FU
dihydropyrimidine dehydrogenase (DPD) enzyme is responsible for the elimination of approximately 85% of administered dose of 5-FU. |
|
|
Term
|
Definition
metabolized by the liver and the CYP3A4/3A5
fluconazole and diltiazem are cyp3a inhibitor |
|
|
Term
|
Definition
| The relationship between the dose and plasma concentration achieved |
|
|
Term
|
Definition
| The relationship of an administered dose of a drug and a change in a biologic target |
|
|
Term
| when to offer surgery for Barrett's |
|
Definition
High grade dysplasia, 1
10% per year risk of cancer
30 % coincident risk |
|
|
Term
| ROle of 17 p del in SLL/ CLL |
|
Definition
17p deletion is
associated with low response rates with all treatments and there is no standard treatment, clinical trial is recommended |
|
|
Term
| ECOG 1594- avanced NSCLC for diff drugs |
|
Definition
| cis+ paclitaxol or gem or docetaxol or carbo /paclitaxol all give 35 % one year survival |
|
|
Term
| IPASS NEJM 2009- Gefitinib vs carbo/pacllitaxel |
|
Definition
EGFR mutation += Gif 9.3 m vs 6.3
EGFR Mut neg- = Gif 1.6 vs 5.3 months |
|
|
Term
| who should be tested for EGFR mutation |
|
Definition
|
|
Term
| marker for adeno ca of lung |
|
Definition
TTF1 best
napsin and PE10 |
|
|
Term
|
Definition
|
|
Term
| T790M, KRAS, MET amplification in NSCLC with EGFR mutation mean |
|
Definition
| Resistance to TKI - erlotinib/ tarceva. iressa |
|
|
Term
| LACE meta analysis for adjuvant NSCLC |
|
Definition
no benefit in 1a
1b not significant
II and III benefit
most pt got vinorelbine and cis |
|
|
Term
Path report for colon cancer should inculde
> |
|
Definition
>Grade of the cancer
> Depth of penetration, (T)
> Number of lymph nodes evaluated and number positive (N)
> Status of proximal, distal, and radial margins
> Lymphovascular invasion 10,11
> Perineural invasion 12-14
> Extra Nodal tumor deposits 15-18 |
|
|
Term
|
Definition
History and Physical every 3-6 months for 2 years, then every 6 months for a total of 5 years.
· CEA every 3-6 months for 2 years, then every 6 months for a total of 5 years.
· CT scan of abdomen and pelvis annually for 3 years.·
Colonoscopy at 1 year, then as clinically indicated |
|
|
Term
|
Definition
Primary Tumor (T)
TX - cannot be assessed
T0 -No evidence of primary tumor
Tis Carcinoma in situ: intraepithelial or invasion of lamina propria a
T1 Tumor invades submucosa
T2 Tumor invades muscularis propria
T3 Tumor invades through the muscularis propria into the pericolorectal tissues
T4a Tumor penetrates to the surface of the visceral peritoneum
T4b Tumor directly invades or is adherent to other organs or structures |
|
|
Term
|
Definition
Regional Lymph Nodes (N)
NX cannot be assessed
N0 No regional lymph node metastasis
N1 1-3 regional lymph nodes
N1a one regional lymph node
N1b Metastasis in 2-3 lymph nodes
N1c Tumor deposit(s) in the subserosa, mesentery, or nonperitonealized pericolic or perirectal tissues without regional nodal metastasis
N2 4+ LN
N2a 4-6 regional lymph nodes
N2b seven or more regional lymph nodes |
|
|
Term
CHILD-PUGH SCORE
looks at - |
|
Definition
| Encephalopathy . Ascites, Albumin , Prothrombin time prolonged , Bilirubin |
|
|
Term
| when surgery is option for pt with HCC? |
|
Definition
medically fit for a major operation.
potentially curative
Adequate liver function (generally Child-Pugh Class A without portal hypertension)
Solitary mass without major vascular invasion
Adequate future liver remnant (at least 20% without cirrhosis and at least 30% to 40% with Child-Pugh Class A cirrhosis)
adequate vascular and biliary inflow/outflow |
|
|
Term
|
Definition
Primary Tumor (T)
TX - Primary tumor cannot be assessed
T0- No evidence of primary tumor
T1 Solitary tumor without vascular invasion
T2 Solitary tumor with vascular invasion or multiple tumors none more than 5 cm
T3a Multiple tumors more than 5 cm
T3b Single tumor or multiple tumors of any size involving a major branch of the portal vein or hepatic vein
T4 Tumor(s) with direct invasion of adjacent organs other than the gallbladder or with perforation of visceral peritoneum
T= stage 1,2,3
any + LN stage 4a, distent mets = 4b |
|
|
Term
|
Definition
Platinum -cisplatin, carboplatin(most active )
Taxanes - paclitaxel , docetaxel
Vinorelbine
Gemcitabine
Pemetrexed
Camptothecins irinotecan, topotecan |
|
|
Term
| Vinorelbine (navelbine)- indications |
|
Definition
NSCLC*
Breast ca
Cervical
Mesothelioma
ovarian ca |
|
|
Term
| Vinorelbine (navelbine) - MOA |
|
Definition
Alkolid
M phase
inhibid tubilin polymerization and disruption of micortubule formation |
|
|
Term
| Vinorelbine (navelbine) dose/ combination |
|
Definition
best use with cisplatin
25-30 mg/m2 iv weekly
max dose 60 mg ( mesothelioma ) |
|
|
Term
| Vinorelbine (Navelbine) metabolism |
|
Definition
P450.
active metabolite- desacetyl vinorelbine
excreted in feces via billiary system
half life 27- 43 h |
|
|
Term
| Vinorelbine (navelbine) interaction |
|
Definition
cisplatin - increase BM toxicity
decrease blood level of phenytoin
mitomycin - increased allergic reaction |
|
|
Term
| Vinorelbine (navelbine) toxicity |
|
Definition
BM
LFT
GI - C>D>stomatits>anorexia
vesicant
neurotoxic- mild ( more in preexisting neuromuscular disease) |
|
|
Term
|
Definition
5-FU
Irinotecan
Oxaliplatin
Cetuximab and panitumumab (EGFR)
Bevacizumab ( VEGF) |
|
|
Term
Bevacizumab (Avastin)
Use |
|
Definition
Breast cancer- 10 mg/kg every 2 weeks/ with taxol
Colorectal cancer- 5 or 10 mg/kg every 2 weeks with 5FU
Glioblastoma: 10 mg/kg every 2 weeks monotherapy or with irinotecan
Lung cancer, nonsquamous cell nonsmall cell -15 mg/kg every 3 weeks with carbo taxol
Renal cell cancer 10 mg/kg every 2 weeks Mono or with interferon alfa
Ovarian cancer 15 mg/kg every 3 weeks |
|
|
Term
|
Definition
Infusion reaction
protein uria
HTN
fistula/ perforation / wiound dehiscence
Bleeding
hypercoagulation |
|
|
Term
Irinotecan
dose adjustment needed in ? |
|
Definition
homozygosity for UGT1A1*28 allele,
65 or +
prior pelvic/abdominal radiotherapy,
performance status of 2, |
|
|
Term
|
Definition
|
|
Term
small cell lung cancer in non smoker
? management |
|
Definition
| please revisit slides one more time |
|
|
Term
Bronchoalveolar carcinoma
BAC
-presentation |
|
Definition
most common in non smokers ( females)
Xray - interstitial or multifocal pattern
often miss dx as interstitial disease
no sx or diarrhea of airways (copious sputum)
Severe SOB
responds to TKI
|
|
|
Term
| Most common translocation in Mantle cell lymphoma |
|
Definition
|
|
Term
| Most common translocation in Burkit |
|
Definition
allways involves 8 ( form or to )
t8;22 MYC and Ig l
t2;8 Ig K- MYC
t 8:14 Myc Ig H |
|
|
Term
| Most common translocation in DBLCL |
|
Definition
|
|
Term
| Most common translocation in Anaplastic LCL Alk + |
|
Definition
|
|
Term
| Most common translocation in maltoma |
|
Definition
T11;18 API2 and MALT1
T 14;18 Ig H and MALT1
t 1 ;14 Bcl10 and Ig H " |
|
|
Term
|
Definition
most common DLBCL
Follicular
Malt
MCL
CLL/SLL
PMBCL
burkits |
|
|
Term
|
Definition
CLL? SLL
Spleic B cell marginal zone
lymphoplacutic lymphoma
MALT ( mucosal assosisated lymhoid tissue,lymphoma
nodal margninal
follicular
primary cutaneous follicle center lymph
MCL |
|
|
Term
| distint clinical finding in small NHL |
|
Definition
every thing common in all small lymphocyte NHL except
MCL - male predominace
MALT - rarely involve BM and offer present as stage 3 or 4 |
|
|
Term
| common clinical feature of small cell NHL |
|
Definition
age 60- 65
BM -40- 70 ( but MALT)
rare B sx
late state ( except MALT ) |
|
|
Term
| Small B cell NHL Immunophenotype ( distinct) |
|
Definition
CD 5 only in SLL, MCL/ CD 23 is never + in MCL
MCL allways Cyclin D 1 +
FL- always and only CD 10 +
all Bcl @ + |
|
|
Term
|
Definition
| bu number of centrolblast /hpf |
|
|
Term
|
Definition
FL in 80 -90 % and in 10 - 20 % DLBCL
produce BCL 2 - inhibit apoptosis |
|
|
Term
|
Definition
gastric- h pylori
small bowel- C jejuni
thyroid/ - hashimoto
parotid/lung- sjogren synd
skin B burgdoreferi |
|
|
Term
| common translocation in MALT |
|
Definition
11;18 ( lung and gastric- if + does not respond to h pylori treatment
14;18 in lung ,liver, ocular
1;14
3;14
14; |
|
|
Term
| common translocation in MALT |
|
Definition
11;18 ( lung and gastric- if + does not respond to h pylori treatment
14;18 in lung ,liver, ocular
1;14
3;14
14; |
|
|
Term
|
Definition
small B cell
diffuse growth pate
CCND 1- t11;14 ( also in MM)
over expression of cyling D1
95 % in mantle cell lymphoma ( poor prognosis)
Site- GI always involved GI trac |
|
|
Term
|
Definition
25 % all NHL
t 14;18 and t 3:var
centroblastic aor immunoblastic |
|
|
Term
|
Definition
at 3q27, a zinc finger trnscription factor, expresssed by germinal center B cells tanslocation to var or 14 lead to deregulated transcription
most common in DLBCL or FL |
|
|
Term
|
Definition
ERCC1 and RRM1 expression
Low ERCC1 expression is associated with platinum responsiveness and low RRM1 is associated with response to gemcitabine. Prospective data in support of treatment assignment according to ERCC1 and RRM1 are awaited. |
|
|
Term
|
Definition
| low expression detects response to platinum |
|
|
Term
|
Definition
| low RRM1 is associated with response to gemcitabine |
|
|
Term
|
Definition
|
|
Term
| tyrosine kinases receptor |
|
Definition
| which include the EGFR (also called HER1 or ERBB-1) and the epidermal growth factor receptor 2 (ERBB-2, also called HER2). |
|
|
Term
| intergroup 0139 trial- results ( stage 3 a nSCLC) |
|
Definition
| and noted equivalent survivals when surgery was preceded by induction chemotherapy or chemoradiotherapy.3 Subgroup analysis of this study revealed disparate outcomes in patients requiring pneumonectomy and those requiring lobectomy.3 Patients whose surgery could be accomplished with lobectomy derived a significant survival advantage from induction chemoradiotherapy followed by surgery compared to full-dose chemoradiotherapy (33.6 month median survival vs 21.7 months ). |
|
|
Term
| stage IIIA N2 NSCLC optimal management consistent with |
|
Definition
| disease to either induction chemo/radiation followed by planned surgery in nonprogressing patients or a nonsurgical approach ( in with multistation disease or bulky disease) |
|
|
Term
| isochromosome associated with |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
may be in seminoma
embroynoal
choriocarcinoma
false + cross react with LH, and marijuana
half life 24 hr |
|
|
Term
| Beta Hcg Negative in which germ cell tumor |
|
Definition
|
|
Term
| which germ cel tumor are AFP + |
|
Definition
embrynoal, yolk sac, liver disease ( HCC)
half life 5 - 6 days
never + in seminoma, chrio ca, teratoma, |
|
|
Term
|
Definition
| serum marker normal but mass is growing in chest - do resection |
|
|
Term
| DLBCL - gene profiling, germinal ceneter, activated- prognosis |
|
Definition
|
|
Term
|
Definition
starry sky, high grade
three type, endemic- africa - EBV
sproadic- western- bimodal-abdominal -ileocecal - 20 - 40% EBV +
Immunodeficient- 20- 40% EBV + |
|
|
Term
|
Definition
| t8q24- 14,32 - MYC to IG L or use fish prob for myc |
|
|
Term
| anaplastic large cell lymphoma - |
|
Definition
T cell - large, CD 30 + , express ALK1(usually not seen in mature cell)
t 2- 5 ALK- NPM(nucelo phsomen gene) = NPM ALK -40- 60% |
|
|
Term
|
Definition
ALK + - young pt , male predomiance, good prog
ALK - - older , poor prog |
|
|
Term
|
Definition
1,nodular lymphocyte predominat
2, Classical
-nodular sclerosis
-mixed cellularity
-lymphocyte depleted
-lymphocyte rich classical- |
|
|
Term
| nodular lymphocyte predominate HD |
|
Definition
| nodualr pattern - LP( L&h or pop corn cell) no RS cell, no necrosis |
|
|
Term
|
Definition
nodualr or diffuse
RS cell, or lacunar cell ( in sclerosis subtype)
inflammatory back ground
+- necrosis |
|
|
Term
| diff between classical vs nodular type of HD by IHS |
|
Definition
CD 30 and CD 45
CD 30+ in classical
Cd45 + in Nodular type |
|
|
Term
|
Definition
reactive thrombocytosis,PV, CML, MDS, PMF
order iron study, PFA, JAK2 , smear, and BM bx |
|
|
Term
| what increase risk of transformation in ET - ( cytogenetics) |
|
Definition
17 p deletion,
no increase with HU |
|
|
Term
| two main cytoreductive therapy for ET |
|
Definition
Hydroxyurea
anagrelide 2.5 mg bid or tid ( arrhythmia and CHF
IF for pregnant |
|
|
Term
| biphasic soft tissue sarcoma |
|
Definition
| both ca + sarcoma feature = synovial sarcoma |
|
|
Term
| mutation in soft tissue sarcoma |
|
Definition
t X-18 in osteo
t 11-22 ewing
ring chromosome para osteo |
|
|
Term
| age group in different sarcomas |
|
Definition
below 10 - rhabdomyosarcoma
10 -20 osteo / ewing
20- 40 synovial
above 40 - chondrosarcoma / chondroma/ liposarcoma |
|
|
Term
|
Definition
diaphysis - ewing(pelvis)
meta- osteo and chondro ( plevis)
epi- osteo
spine - mets and chrondroma |
|
|
Term
| general rule for staging in sarcoma |
|
Definition
1- 2a- low grade less than 5 cm
2b- 2c low grade above 5 cm
3 + high grade
4 metastatic |
|
|
Term
|
Definition
immunodeficient
autoimmune ( hasimoto, thyroiditis sjogren synd
infec- evv, h pylori, KS, |
|
|
Term
| mature peripheral B cell neoplasm |
|
Definition
CLL/ SLL
extranodal marginal zone lymphoma of MALT type
nodal marginal zone lymphoma
splenic marginal zone
lymphoplasmacytic lymphoma
follicular |
|
|
Term
| mature peri T cell neoplasm |
|
Definition
mycosis fungoides, seary synd
other t cell lymph |
|
|
Term
|
Definition
H/P B sx, progression and duration of LAD
EOD, KPS
incisional bx
labs- cbc, bmp, beta 2 ldh, hep, spep/siep
CT
bmbx (+- MRI of brain or LP) |
|
|
Term
| for indolent lymphoma PET scan ? |
|
Definition
|
|
Term
| molecular studies in low grade lymphoma |
|
Definition
Ig H rearrangement usefull in differentiating lymphoid hyperplasia from lymphoma
PCR assay 14-18 translocation |
|
|
Term
| ann arbor staging sys for lymphoma |
|
Definition
1= single LN group
2 = multiple on same side of diaphragm
3- multiple on both side
4 extranodal ( multiple or single with LN
X= bulk- more than 10 cm
E- extranodal or single site of extranodal disease
B- wt loss of 10%, fever, drenching night sweat |
|
|
Term
| FLIPI- follicular lymphoma international prognostic index |
|
Definition
age 60
stage 2/3
Hb below 12,
nodal site more than 4
LDH above normal |
|
|
Term
|
Definition
0-1 5 year 91%good
intermideate -2- 78%
poor -3+= 53% |
|
|
Term
| indolent lymphoma - when to treat |
|
Definition
clincal trail
cytopenia / endo organ fx/ sx/ bulky disease, splenomegaly( massive/ steady progression |
|
|
Term
| follicular lymphoma - local disease , stage 1- 2 |
|
Definition
|
|
Term
| advanced follicular lymphoma - treatment option |
|
Definition
not cure able
enroll in clinical trial
observe if possible
consider biologic agent (rituxan) |
|
|
Term
| folicular lymphoma with local disease -role of xrt |
|
Definition
| can get prolognd remssion with XRT |
|
|
Term
| advanced stage low grade lymphoma- Follicular treatment |
|
Definition
not cure able with chemo alone
chemo improves performance status |
|
|
Term
|
Definition
12;18 translocation
drug resistatnce , inhinbit apoptosis
monitor by PCR for residual disease (MRD)
clearing improves DFS after BMT |
|
|
Term
|
Definition
watch and worry
CVP/ CHOP ? Fludara with biologic or radio immunotherapy |
|
|
Term
| NCCN- grade 1 therapy for NHL indolent |
|
Definition
R CHOP
R CVP
chemo - Radioimmunotherapy
cate 2- fludara bine + R
ludara+mito + dex+ FND+ R |
|
|
Term
| first line for elderly pt with indolent NHL |
|
Definition
| R alone or single agent alkylator like chlorambucil , cyclophos |
|
|
Term
|
Definition
| use in lymphoa ( indolent ) wiht Rituxan resistant diseae |
|
|
Term
| clinical feathure of SLL/ CLL |
|
Definition
5% as lymphoma w/o leukemic componenet
hypo Ig - inf
auto immune disease |
|
|
Term
| prognostic factor in SLL/ CLL |
|
Definition
bad- beta2, unmutated Ig Vh, increased CD38, ZAP 70+
worse deletion of 11q 179
repeate FISH befre each tehrapy |
|
|
Term
|
Definition
chloarmbucil + pred
CVP
alemtuzumab
bendamustine
CHOP
hyper CVAD
EPOCH
OFAR ( oxali fluda, cytara, Rituxan ) |
|
|
Term
| deleltion of 17 P in SLL / CLL therapy |
|
Definition
FCR- f;uda cyclo rit
FR
HDMO + R
CFAR + campath |
|
|
Term
| 5 microb that can cause lymphoma |
|
Definition
h pylori
Borrelia burgdorferi Lyme
C jejuni
chlamydia psittachi ( occularadnexal MALT
hep c |
|
|
Term
| SMZL- splenic lymphoma clinical feature |
|
Definition
| splenomegaly/ LAD uncommon, BM90% +, monoclonoal gamapathy 50%, Ig M,r/o Hep c |
|
|
Term
| SMZL splenic lymphoma- tx |
|
Definition
|
|
Term
|
Definition
| mature B cell lymph with plasmocytic defferentiation CD1920+ Cd 5- |
|
|
Term
|
Definition
first dose reaction
Hep B reactivation
TLC
TLC
severe muco cutatnous raction
PML |
|
|
Term
| RIT- zevalin ( Y 90 ibritumomab tiuxetan ) and tositumomab I131- use in / |
|
Definition
effective in tumor less than 5 cm , chemo senstive,
dont give to - MArrow more 25 % / cytopenia
prior RT to marrow |
|
|
Term
|
Definition
| URacheal ca / do partial cystectomy |
|
|
Term
|
Definition
FGFR 3 50 % '
CDKN2A 16%
HRAS
PIK3CA
RBI 33% |
|
|
Term
| Active regimen in bladder ca |
|
Definition
MVAC - standard of care can cure ( 36%
HD MVAC 58% cure
GC-gem+cis) + MVAC
best - GC + MVAC gives same result |
|
|
Term
| bladder cancer gc or gc+paclitaxol |
|
Definition
gcp has little better
oc no diff
standard of care gc or mvac |
|
|
Term
| poor prognosis in bladder ca |
|
Definition
visceral mets
poor PF
good uf only nodal disease |
|
|
Term
|
Definition
|
|
Term
| is carbo and cis + in bladder ca |
|
Definition
|
|
Term
|
Definition
PR 64% check RR after 2 cycle
OC - 19 month, ( GC 14 month) |
|
|
Term
| standard of care in bladder |
|
Definition
0 or 1 risk - GC or MVAC ( if renal fx allow- CRI carbo)
2 risk - do single no platinum for palliation |
|
|
Term
|
Definition
pemtrexate
ifosamide
taxol
( no 2 nd line fda approved drug ) |
|
|
Term
|
Definition
|
|
Term
| sx for TCC in muscle invasion |
|
Definition
be aggressive
man - bladder prostatectomy- b/l pelvic LN
total cystectomy, hyster and oophro salpinog, and b/l pelvic LN |
|
|
Term
|
Definition
CMV - cyc mtx and vinlastin
MVAC for 12 weeks
14% improvement |
|
|
Term
|
Definition
|
|
Term
|
Definition
tri modality can be tried
remove tumor
chemo and XRT - f/u then more xrt |
|
|
Term
|
Definition
Grade plays big prognsotic role
other bad signs- multiple , 3+ cm,vascular invasion
intravesical chemo - reduce short term tumor reccurence no long term effect
BCG is makes diff in CIS intravesical - weekly for 6 weeks maintenance is controvertial
for papilary BCG and chemo equal |
|
|
Term
| most common PRIMARY CNS tumor |
|
Definition
glioma (
GBM50%
ALL TUMOR - IS METS |
|
|
Term
| classification of CNS tumor |
|
Definition
no TNM
go by GRade 1-4
G 1 piloctuc and astrocytoma
G2 astro, and oligodenderoglioma or mixed
G3 anplastic oligo , astro, and mixed
G4 - GBM |
|
|
Term
|
Definition
|
|
Term
| prognositic factor in CNS tumor |
|
Definition
| location PS, age, radiation, extent of surgery |
|
|
Term
| GBM / anaplastic standard of care |
|
Definition
XRT 60 gy+ temo or BCNU ( gliadel)
second line add bev |
|
|
Term
|
Definition
primary GBM- EGFR amplification
MDM2 amplification
P16 DELETION
RB alteration |
|
|
Term
|
Definition
| if MGMT was methylated increased response to TMZ and XRT |
|
|
Term
|
Definition
|
|
Term
| Grade 3 CNS tumor- astrocytoma |
|
Definition
cytoreduction, -- PCV ( procarbazine CCNU, vincristine )or BCNUor TMZ
EBRT alone - 3 year
EBRT + chemo = 5 year |
|
|
Term
| 1P19q loss in CNS tumor has ??? |
|
Definition
|
|
Term
|
Definition
| focal XRT, +_ PCV with XRT, no change in OS, but increase PFS PS |
|
|
Term
|
Definition
less than 2 cm
T1 mic - 0.1 cm
T1a -0.5
T1b - 1 cm
T1c - 1 to 2 cm |
|
|
Term
|
Definition
| T2 2-5 cm T 3 above 5 cm but no invasion in near by structure |
|
|
Term
|
Definition
T4 -
a- invasion to chest wall
b edema peau D orange
C - both a + b
D- inflammatory ca |
|
|
Term
|
Definition
Nx--- N3c
N1- ipsi, axillar LN ( mobile
N2 a - fixed auxillary, B- ipsi int mammary ( no auxillary )
N3- A- infraclacicular, B- auxi and int mamary , C supra clavicualr |
|
|
Term
|
Definition
0 tis
1= t1
2A= N1 with T 0 or t1 or T2
2B- T2+ N1 or T3
3A- T0-T3 with N2 or
3B- any T4 with N0 - 2
3C- any T with N3
4 - any mets |
|
|
Term
|
Definition
| Nottingham grade Gx-3 just prognostic |
|
|
Term
|
Definition
| CLL cells characteristically express CD19, CD20, CD23, CD5 and surface immunoglobulin, although these tend to be relatively low in intensity. The expression of CD5 differentiates CLL from other B-cell malignant disease with the exception of mantle cell lymphoma, which is also CD5+. However, in contrast to CLL, mantle cell lymphoma cells are negative for CD23 and stain positively for cyclin D1. |
|
|
Term
|
Definition
| front-line therapy of mantle cell lymphoma and Burkitt’s lymphoma |
|
|
Term
|
Definition
is much more common in men and
+ for expression of CD11c, CD103, CD123 and tartrate resistant acid phosphatase. |
|
|
Term
|
Definition
which is CD2-positive, CD3-positive, CD4-positive, but usually CD8-negative.
The cells tend to be cerebriform in appearance. |
|
|
Term
| Side effects associated with bortezomib includes |
|
Definition
| fatigue, peripheral neuropathy, and herpes zoster reactivation. Antiviral prophylaxis is recommended for all patients |
|
|
Term
| follicular thyroid cancer - pathologic feature |
|
Definition
follicular development and colloid good prgnosis
poorly differentiated with solid growth, absence of follicles, marked nuclear atypia, and extensive vascular and/or capsular invasion - poor prognosis |
|
|
Term
| variats of follicular thyroid cancer |
|
Definition
| Hurtle cell, and insular thyroid cell |
|
|
Term
| DX of thyroid follicular ca |
|
Definition
| nodule, US- NM scan - FNA - if follicular then surgery for path eval between adenoma and cancer |
|
|
Term
| summary of follicular thyroid cancer |
|
Definition
Follicular thyroid cancer, a well-differentiated tumor of thyroid epithelium, is the second most common type of thyroid cancer after papillary thyroid cancer. It is more common in iodine deficient areas, and tends to occur in an older population when compared to papillary thyroid cancer. (See 'Clinical presentation' above.)
The diagnosis of follicular thyroid cancer usually occurs during the evaluation of a cold thyroid nodule. FNA biopsy alone cannot distinguish between follicular adenomas and cancers. Microscopically, the diagnosis of follicular cancer requires identification of tumor extension through the tumor capsule and/or vascular invasion. (See 'Pathologic features' above.)
Most FTCs contain either RAS mutations or a PAX8-PPAR gamma 1 rearrangement but not both, indicating that similar yet distinct molecular events may originate with these two oncogenes. (See 'Molecular pathogenesis' above.)
Important prognostic features include stage, age, and tumor characteristics (tumor size, vascular invasion, capsular extension, histologic grade, and distant metastases). (See 'Prognostic features' above.)
Therapy — The treatment options available for follicular thyroid cancer are the same as for all differentiated thyroid cancers [30]. The optimum |
|
|
Term
|
Definition
Active MM
• ≥10% plasma cells
• M spike +
AND
C - High calcium
R - Renal dysfunction
A - Anemia
B - Bone lesions
Hyperviscosity,
amyloidosis, recurrent
infection |
|
|
Term
| Smoldring MM/ MGUS criteria |
|
Definition
MGUS
• <3 g M spike
• <10% plasma cells
AND
SMM
• ≥3 g M spike
• ≥10% plasma cells
Active MM
• ≥10% plasma cells
• M spike + |
|
|
Term
| Staging and Prognosis in MM |
|
Definition
• ISS staging system (β2M/albumin) is universally applicable
• Cytogenetics is informative in only 25% of cases, but abnormal karyotype predicts poor outcome
• Deletion 13 by metaphase cytogenetics (but not FISH alone) is predictive of poor outcome
• Poor risk is conveyed by t(4;14), t(14;16), and del 17p13 detected by FISH |
|
|
Term
| Progression-Free Survival in MM iwth MP or MPT |
|
Definition
MPT 20.3 m/ MP- 14.9 m
OS - MPT 39.3 MP 32.7 m B7 metaanalysis of 1700 pts |
|
|
Term
|
Definition
CTDa: Cyclophosphamide 500 mg orally QW, Thal 200 mg/d, Dex 20 mg d1–4, 15–18 of a 28-day cycle ( UK trial for less fit pt )
was equally effective as MPT but no direct comperison |
|
|
Term
VISTA: VELCADE as Initial Standard Therapy in
MM: Assessment With Melphalan and Prednisone - results |
|
Definition
700 pts compared with VMP / MP
VMP
Cycles 1–4
Bortezomib 1.3 mg/m2
IV, d 1, 4, 8, 11, 22, 25, 29, 32
Melphalan 9 mg/m2 , and prednisone 60 mg/m2 , d 1–4
Cycles 5–9
Bortezomib 1.3 mg/m2
IV, d 1,8,22,29
Melphalan 9 mg/m2
and prednisone 60 mg/m2
, d 1–4
MP
Cycles 1–9
Melphalan 9 mg/m2
and prednisone 60 mg/m2
, d 1–4 |
|
|
Term
| results of vista trail for MM |
|
Definition
VMP/MP- Time to progression 24/16.6
OS= 3 year survival 68% / 54% |
|
|
Term
| LOW DOSE VS HIGH DOSE IN MM |
|
Definition
low dose 40 mg on day 1,8,15,22
HD dex - 40 mg day 1-4, 9-12, 17-20
low dose has better prog |
|
|
Term
| Induction Therapy Prior to Stem Cell in MM |
|
Definition
Initial Therapy
• Melphalan, prednisone
+ thalidomide + bortezomib,
+ lenalidomide
• Thalidomide + dex
• Bortezomib + dex
• Bortezomib combos
• Bortezomib + liposomal
doxorubicin
• Bortezomib + lenalidomide + dex
• Lenalidomide + dex
if CR good candidate send, to ASCT if not
repeat primary therapy |
|
|
Term
|
Definition
|
|
Term
Len/Bz/Dex (RVD) in Newly Diagnosed
Multiple Myeloma |
|
Definition
– CR/nCR: 39%
– ≥VGPR: 67%
– Estimated 18-mos OS rate: 97%
– Estimated 18-mos PFS rate: 75%
no prognostication by adverse cyto
ISS 1 did well then 2 or 3 |
|
|
Term
The EVOLUTION Study:
Randomized Phase 2 Study of Len, Bz,
Cy, and Dex in Newly Diagnosed MM |
|
Definition
VRD \\\ VDC \\\\ CRVD
ORR 90 \\\ 87 \\\\ 94
CR 12 \\\ 6 \\\\ 15
VGPR 33 \\\ 35 \\\\ 42
PR 45 \\\ 45 \\\36 |
|
|
Term
| risk stratification in MM |
|
Definition
High Risk
– t(4;14), t(14;16)
– Deletion 17
– Deletion 13
– High β2M
– Light chain, IgA MM
– Renal failure
– Advanced bone disease
– Extramedullary MM
(Expected OS 4 yr
Standard Risk
– t(11;14), t(6;14)
– Hyperdiploid
– Low β2M
– Normal serum albumin
(Expected median OS 7 yr) |
|
|
Term
|
Definition
The largest and most influential trial is the United Kingdom Medical Research Council MAGIC trial, in which 503 patients with potentially resectable gastric (74 percent), distal esophageal (11 percent), or EGJ adenocarcinomas (15 percent) were randomly assigned to surgery alone or surgery plus perioperative chemotherapy (three preoperative and three postoperative cycles of epirubicin, cisplatin and infusional 5-fluorouracil [ECF]) [4].
A higher proportion of chemotherapy-treated patients with gastric cancer who underwent radical surgery had a potentially curative procedure (79 versus 70 percent), and significantly more had T1/2 tumors (52 versus 37 percent) and N0/N1 disease (84 versus 71 percent) [28]. Chemotherapy was well tolerated overall; excluding patients with neutropenia (23 percent), fewer than 12 percent of all patients had serious (grade 3 or 4) toxic effects. Despite this, only 104 (42 percent) were able to complete protocol treatment, including surgery and all three cycles of the postoperative chemotherapy. These data underscore one of the major problems with the perioperative approach, which is the difficulty in administering full number of postoperative chemotherapy cycles.
Nevertheless, with median four-year follow-up, progression-free survival was significantly worse in the surgery alone group (hazard ratio [HR] 0.66) as was overall survival (HR 0.75). The 25 percent reduction in the risk of death favoring chemotherapy translated into an improvement in five-year survival from 23 to 36 percent. Local failure occurred in 14 percent of the chemotherapy-treated patients compared to 21 percent of those undergoing surgery alone. Distant metastases developed in 24 and 37 percent of patients, respectively.
French FNLCC/FFCD trial — A similar benefit for preoperative chemotherapy |
|
|
Term
| SHARP trial for HCC july 08 NEJM |
|
Definition
Median overall survival was 10.7 months in the sorafenib group and 7.9 months in the placebo group
median time to symptomatic progression (4.1 months vs. 4.9 months, respectively, P=0.77).
time to radiologic progression was 5.5 months in the sorafenib group and 2.8 months in the placebo(P<0.001).
Seven patients in the sorafenib group (2%) and two patients in the placebo group (1%) had a partial response; no patients had a complete response. |
|
|
Term
| RCC stage 1- 3- role of adjuvant |
|
Definition
no role as per ECOG 2003
italian study 2007 asco abstract |
|
|
Term
|
Definition
not a surgical candidate
single ~ 5 cm or 4 not bigger than 5 cm
child pugh stage c
no a candidate for transplant, or not availabel imidately |
|
|
Term
|
Definition
CR -Disappearance of all target lesions and reduction in the short axis measurement of all pathologic lymph nodes to ≤10 mm
PR ≥30 percent decrease in the sum of the longest diameter of the target lesions compared with baseline
PD ≥20 percent increase in the sum of the longest diameter of the target lesions compared to the smallest sum of the longest diameter recorded since treatment started
The appearance of one of more new lesions
≥20 percent increase of at least 5 mm in the sum of the longest diameters of the target lesions compared with the smallest sum of the longest diameter recorded
SD Neither PR nor PD |
|
|
Term
|
Definition
| Thrombus in the main portal vein
Encephalopathy
Biliary obstruction
Child-Pugh C cirrhosis |
|
|
Term
Relative contraindications
to TACE
|
|
Definition
Serum bilirubin >2 mg/dL
- Lactate dehydrogenase >425 units/L
- Aspartate aminotransferase >100 units/L
- Tumor burden involving >50 percent of the liver
- Cardiac or renal insufficiency
- Ascites, recent variceal bleed, or significant thrombocytopenia
|
|
|
Term
| what should be tested ata dx in Adeno ca of lung |
|
Definition
| his has been the policy at Memorial Sloan-Kettering since January 2009, using the driver mutations KRAS, EGFR, BRAF, HER2, PIK3CA, AKTI, MEKI (MAP2K1) NRAS, and EML4-ALK. |
|
|
Term
| Short-Term Neoadjuvant Androgen Deprivation and Radiotherapy for Locally Advanced Prostate Cancer XRT + ADT TROG Randomised Trial |
|
Definition
, 3 months NADT -decreased PSA progression and local progression and improved event-free survival
6 months of NADT further reduced PSA progression and local progression , and led to a greater improvement in event-free survival
. 3-month NADT had no effect on distant progression and prostate cancer-specific mortality, or all-cause mortality
6-month NADT decreased distant progression , prostate cancer-specific mortality and all-cause mortality |
|
|
Term
| NCCN Tightens Active Surveillance in Prostate Cancer Guidelines |
|
Definition
Prostate-specific antigen (PSA) testing at least every 6 months and as often as every 3 months.
• Digital rectal examination (DRE) at least every 12 months and as often as every 6 months.
• Repeat needle biopsy within 18 months for patients in whom the initial biopsy was 10 or more cores.
• Repeat initial biopsy within 6 months for patients in whom the initial biopsy was fewer than 10 cores.
• Consideration of a repeat biopsy for all patients as often as 12 months. |
|
|
Term
| Monoclonal B lymphocytosis (MBL) |
|
Definition
Absolute monoclonal B lymphocyte count
< 5000/mm3 ·
All lymph nodes< 1.5 cm ·
No anemia ·
No thrombocytopenia |
|
|
Term
|
Definition
Hematopathology review of all slides
PCR for IGHV and TCR gene rearrangements,
FISH for major translocations
Flow cytometry of blood adequate for diagnosis of CLL/SLL (biopsy not required).
·
Adequate immunophenotyping to establish diagnosis b,c b Recommended panel for paraffin section
immunohistochemistry: CD3, CD5, CD10, CD20, CD23, cyclin D1
or
b Cell surface marker analysis by flow cytometry: kappa/lambda, CD19, CD20, CD5, CD23, CD10
·
Absolute monoclonal B lymphocyte countd
prognostic marker
t(11;14);
t(11q;v); +12; del(11q); del(13q); del(17p) ·
Molecular genetic analysis to detect:
immunoglobulin heavy chain variable gene
(IGHV) mutation status ·
Determination of CD38 and Zap 70 expression |
|
|
Term
|
Definition
Physical exam:
attention to node-bearing areas, including
Waldeyer’s ring, and to size of liver and spleen · Performance status · B symptoms ·
CBC, LDH ·CMP, Hepatitis B testing g
MUGA /echocardiogram
USEFUL UNDER CERTAIN CIRCUMSTANCES: · Quantitative immunoglobulins ·
Reticulocyte count, hepatoglobin, and direct Coombs’ test ·
Chest/abdominal/pelvic CT should be done prior to initiation of
therapy
· Beta-2-microglobulin · Uric acid · Unilateral bone marrow biopsy (± aspirate) at initiation of therapy
· PET scan is generally not useful in CLL but can assist in directing nodal biopsy if Richter's transformation is suspected |
|
|
Term
|
Definition
Rai system
0 Lymphocytosis, lymphocytes in blood > 15,000/mcL and > 40%
lymphocytes in the bone marrow
I Stage 0 with enlarged node(s)
II Stage 0-I with splenomegaly, hepatomegaly, or both
IIIc Stage 0-II with hemoglobin < 11.0 g/dL or hematocrit < 33%
IVc Stage 0-III with platelets < 100,000/mcL |
|
|
Term
|
Definition
Binet Syste Stage
Description
A Hemoglobin above10 g/dL and Platelets above 100,000/mm and < 3 enlarged areas
B Hemoglobin below 10 g/dL and Platelets below 100,000/mm 3 and MOre than 3 enlarged areas
Cc Hemoglobin < 10 g/dL and/or Platelets < 100,000/mm and
any number of enlarged areas |
|
|
Term
| role of del 11 i CLL/ SLL |
|
Definition
CLL with del (11q)h,j · Outcomes are
more favorable in patients with 11q deletion who receive regimens containing an alkylator. |
|
|
Term
|
Definition
4 classes
Nitrogen mustered - melohalan, ifosfamide, cyclophosphamide
Nitrosoureas BI CNU= carmustine
Heavy metal - platins
Misc- dacrbazine and temozolamide |
|
|
Term
|
Definition
Three group
Pyrimidine - gemcitabibe, 5FU, cytaraabine, xeloda
Purine- 6 MP
Folic acid- MTX, Pemetrexate |
|
|
Term
| Mitotic/ spindle inhibitor |
|
Definition
| Pacli and docetaxel, ixabepilon, vinblastine, vincristine , vinorelbine |
|
|
Term
| Topoisomerase i inhibitor |
|
Definition
Irinotecan .CPT11
Topotecan
Etoposide |
|
|
Term
|
Definition
| Mito,doxorubicin, dactomycin epirubicin, bleomysin |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| Interim analysis results of COU-AA-302, a randomized, phase III study of abiraterone acetate in chemotherapy- naïve patients with metastatic castration-resistant prostate cancer |
|
Definition
1:1 randomization of 1088
chemo-naïve , 1 gm abiraterone acetate (AA) + 5 mg prednisone twice daily, vs prednisone alone, showed at a median follow-up of 22 months that AA + prednisone improved radiographic progression-free survival (median not reached in the AA arm vs 8.3 months in the control arm; P <.0001) and significant benefit in the co-primary endpoint of overall survival (median not reached vs 27.2 months; P = .0097).
Time to chemotherapy initiation was also delayed by a median of 8.4 months on AA (25.2 vs 16.8 months), and no new safety concerns were identified (transaminitis was more common in patients receiving AA, with no significant difference in symptomatic adverse effects) |
|
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Term
| Intermittent versus continuous androgen deprivation in hormone sensitive metastatic prostate cancer patients: Results of S9346 (INT-0162), an international phase III trial. |
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Definition
I
Take-home message: A total of1535 patients with newly diagnosed metastatic prostate cancer and PSA levels >5 ng/mL prior to androgen deprivation (AD) received 7 months of goserelin + bicalutamide and then were randomized to continuous vs intermittent AD. In the latter arm, treatment was resumed if PSA levels rose >20 or if symptoms emerged. No significant differences in treatment-related adverse effects were seen, but the primary endpoint of overall survival was 5.8 vs 5.1 years in favor of continuous therapy. The relative risk of death with intermittent AD was 1.09 (95% CI, 0.95–1.24) such that intermittent treatment was not proven to be non-inferior. Continuous AD remains the standard of care for patients with metastatic disease. |
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Term
| Final analysis of intergroup randomized phase III study of androgen deprivation therapy plus radiation therapy in locally advanced prostate cancer |
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Definition
| 1205 patients with locally advanced or organ-confined prostate cancer who were randomized to androgen deprivation therapy (ADT) alone or ADT + radiation therapy (RT), and, after a median follow-up of 8 years and 465 deaths, the primary endpoint of overall survival favored ADT + RT (10-year overall survival, 55% vs 49%; HR, 0.7; 95% CI, 0.57–0.85; P = .00003). Disease-specific survival (DSS), a secondary endpoint, was also improved in ADT + RT (10-year DSS, 26% vs 15%; HR, 0.46; 95% CI, 0.34–0.61; P < .0001), more than halving the risk of death from prostate cancer, with early but not longstanding radiation-related decrements in quality of life. |
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Term
| Updated analysis of the phase III, double-blind, randomized, multinational study of radium-223 chloride in castration-resistant prostate cancer patients with bone metastases (ALSYMPCA). Presented by Chris Parker, MD, MRCP. |
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Definition
| Take-home message: A total of 921 patients with symptomatic castration-resistant prostate cancer (CRPC) and two or more bone metastases (without known visceral involvement) who had either received or were unfit for docetaxel were randomized 2:1 between the alpha-emitter radium-223 and placebo. The primary endpoint of overall survival showed a significant 3.6 month benefit from radium therapy (14.9 vs 11.3 months; HR, 0.695; 95% CI, 0.58–0.83; the survival benefit was consistent across all subgroups, including prior vs no prior docetaxel exposure and current vs no current bisphosphonate use. There was a signal that radium might be more effective in patients with a high alkaline phosphatase level—ie, ≥220 U/L. The safety profile of radium was favorable, with modestly increased thrombocytopenia. |
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