PHR 957 Midterm Test Study Guide
Rituximab mechanism of action - ANSWER Anti-CD20 monoclonal antibody
Mutations that lead to favorable outcomes in CLL - ANSWER Mutated IGHV and 13q-
Indications for treatment in CLL (5) - ANSWER -Advanced stage
-Symptomatic at presentation (fatigued, weight loss, night sweats, fever)
-End organ dysfunction
-Enlarged spleen or lymph nodes
-Progressive anemia or thrombocytopenia
What is the first line treatment for patients without 17p-/TP53 mutation that are <65 year
with no significant comorbidities in patients with CLL? (Preferred option with 3 other
options) - ANSWER -Preferred: ibrutinib
-Other options: FCR, PCR, and BR
What is the first line treatment for patients without 17p-/TP53 mutation that are 65 and
older OR are younger and have significant comorbidities in patients with CLL? (2
preferred agents and 5 other options) - ANSWER -Preferred: ibrutinib OR venetoclax +
obinutuzumab
-Other options: BR, ibrutinib + obinutuzumab, chlorambucil, rituximab, and
obinutuzumab (monotherapy)
What are the treatments for patients WITH 17p-/TP53 mutations regardless of age group
in patients with CLL? (2 preferred and some other considerations) - ANSWER Preferred:
clinical trial OR ibrutinib
Venetoclax + obinutuzumab is also an option
Consider lenalidomide maintenance after initial therapy to prevent relapse
What are preferred regimens for relapsed/refractory treatments in patients with CLL?
(4) - ANSWER -Ibrutinib
-Venetoclax + rituximab
-Duvelisib
-Idelalisib + rituximab
Two staging systems used for CLL - ANSWER Rai staging system and Binet staging
,system
Unique aspects of rituximab - ANSWER -Fatal infusion related reactions for those whom
this is their first infusion, high malignant cell burden, pre-existing cardiac or pulmonary
conditions or prior cardiopulmonary reactions
-Pre-medicate with APAP and benadryl
-Should be stopped if patient presents with HepB reactivation or infection
Rituximab BBW (3) - ANSWER -infusion reactions
-HepB reactivation
-PML
Bendamustine drug class - ANSWER alkylating agent (nitrogen mustard)
Bendamustine mechanism of action (3 parts) - ANSWER (1) p53 dependent activation of
DNA damage stress response and apoptosis, (2) inhibition of mitotic checkpoints, (3)
induction of mitotic catastrophe
Bendamustine unique aspects - ANSWER Can cause infections like pneumoia, herpes
zoster and candida however is a relatively tolerable drug
Venetoclax drug class - ANSWER BCL2 inhibitor
Venetoclax mechanism of action - ANSWER selective small molecule inhibitor of BCL2,
which is an antiapoptotic protein
Unique aspects of venetoclax - ANSWER -Many patients will experience TLS (follow
rules of hydrating and initiating allopurinol)
-Premedicate before infusion
Toxicity associated with ibrutinib - ANSWER -Afib
-Hypertension
-Skin cancer
-TLS
Ibrutinib drug glass - ANSWER Bruton's tyrosine kinase inhibitor
Unique aspects of ibrutinb - ANSWER -Can cause transient lymphocytosis
-Oral medication (420 mg once daily)
Fludarabine drug class - ANSWER antimetabolite
Fludarabine mechanism of action - ANSWER purine analog that inhibits DNA synthesis
, by interfering with ribonucleotide reductase and DNA polymerase
Toxicity of fludarabine - ANSWER -autoimmune effects (hemolytic anemia, autoimmune
thrombocytopenia)
-neurotoxicity at high doses
Unique aspects of fludarabine - ANSWER neurotoxicity in higher than recommended
doses
cannot be taken with pentostatin
PML risk
Cyclophosphamide drug class - ANSWER alkylating agent (nitrogen mustard)
Cyclophosphamide mechanism of action - ANSWER cytotoxic effect due to cross-linking
of strands of DNA and RNA to inhibit protein synthesis
Cyclophosphamide toxicity - ANSWER *Myelosuppression is a dose limiting toxicity*
-hemorrhagic cystitis
-alopecia
-sterility
-Secondary malignancies
-N/V (high emetic potential with other agents)
-Cardiotoxicity in high doses
Unique aspects of cyclophosphamide - ANSWER -Prodrug
-Acrolein causes hemorrhagic cystitis (administer with Mesna which inactivates
acrolein in the bladder)
-Patients should be advised to maintain good fluid intake and empty bladder often
-moderate to high emetic potential
Pentostatin drug class - ANSWER antimetabolite (purine analog)
Mechanism of action of pentostatin - ANSWER purine analog that mimics adenosine and
inhibits the enzyme adenosine deaminase, interfering with cell's ability to process DNA
Toxicity of pentostatin - ANSWER long lasting myelosuppresion, GI symptoms, skin rash,
abnormal liver function
Hepato, pulmonary, renal, and CNS toxicity in higher than recommended doses
Rituximab mechanism of action - ANSWER Anti-CD20 monoclonal antibody
Mutations that lead to favorable outcomes in CLL - ANSWER Mutated IGHV and 13q-
Indications for treatment in CLL (5) - ANSWER -Advanced stage
-Symptomatic at presentation (fatigued, weight loss, night sweats, fever)
-End organ dysfunction
-Enlarged spleen or lymph nodes
-Progressive anemia or thrombocytopenia
What is the first line treatment for patients without 17p-/TP53 mutation that are <65 year
with no significant comorbidities in patients with CLL? (Preferred option with 3 other
options) - ANSWER -Preferred: ibrutinib
-Other options: FCR, PCR, and BR
What is the first line treatment for patients without 17p-/TP53 mutation that are 65 and
older OR are younger and have significant comorbidities in patients with CLL? (2
preferred agents and 5 other options) - ANSWER -Preferred: ibrutinib OR venetoclax +
obinutuzumab
-Other options: BR, ibrutinib + obinutuzumab, chlorambucil, rituximab, and
obinutuzumab (monotherapy)
What are the treatments for patients WITH 17p-/TP53 mutations regardless of age group
in patients with CLL? (2 preferred and some other considerations) - ANSWER Preferred:
clinical trial OR ibrutinib
Venetoclax + obinutuzumab is also an option
Consider lenalidomide maintenance after initial therapy to prevent relapse
What are preferred regimens for relapsed/refractory treatments in patients with CLL?
(4) - ANSWER -Ibrutinib
-Venetoclax + rituximab
-Duvelisib
-Idelalisib + rituximab
Two staging systems used for CLL - ANSWER Rai staging system and Binet staging
,system
Unique aspects of rituximab - ANSWER -Fatal infusion related reactions for those whom
this is their first infusion, high malignant cell burden, pre-existing cardiac or pulmonary
conditions or prior cardiopulmonary reactions
-Pre-medicate with APAP and benadryl
-Should be stopped if patient presents with HepB reactivation or infection
Rituximab BBW (3) - ANSWER -infusion reactions
-HepB reactivation
-PML
Bendamustine drug class - ANSWER alkylating agent (nitrogen mustard)
Bendamustine mechanism of action (3 parts) - ANSWER (1) p53 dependent activation of
DNA damage stress response and apoptosis, (2) inhibition of mitotic checkpoints, (3)
induction of mitotic catastrophe
Bendamustine unique aspects - ANSWER Can cause infections like pneumoia, herpes
zoster and candida however is a relatively tolerable drug
Venetoclax drug class - ANSWER BCL2 inhibitor
Venetoclax mechanism of action - ANSWER selective small molecule inhibitor of BCL2,
which is an antiapoptotic protein
Unique aspects of venetoclax - ANSWER -Many patients will experience TLS (follow
rules of hydrating and initiating allopurinol)
-Premedicate before infusion
Toxicity associated with ibrutinib - ANSWER -Afib
-Hypertension
-Skin cancer
-TLS
Ibrutinib drug glass - ANSWER Bruton's tyrosine kinase inhibitor
Unique aspects of ibrutinb - ANSWER -Can cause transient lymphocytosis
-Oral medication (420 mg once daily)
Fludarabine drug class - ANSWER antimetabolite
Fludarabine mechanism of action - ANSWER purine analog that inhibits DNA synthesis
, by interfering with ribonucleotide reductase and DNA polymerase
Toxicity of fludarabine - ANSWER -autoimmune effects (hemolytic anemia, autoimmune
thrombocytopenia)
-neurotoxicity at high doses
Unique aspects of fludarabine - ANSWER neurotoxicity in higher than recommended
doses
cannot be taken with pentostatin
PML risk
Cyclophosphamide drug class - ANSWER alkylating agent (nitrogen mustard)
Cyclophosphamide mechanism of action - ANSWER cytotoxic effect due to cross-linking
of strands of DNA and RNA to inhibit protein synthesis
Cyclophosphamide toxicity - ANSWER *Myelosuppression is a dose limiting toxicity*
-hemorrhagic cystitis
-alopecia
-sterility
-Secondary malignancies
-N/V (high emetic potential with other agents)
-Cardiotoxicity in high doses
Unique aspects of cyclophosphamide - ANSWER -Prodrug
-Acrolein causes hemorrhagic cystitis (administer with Mesna which inactivates
acrolein in the bladder)
-Patients should be advised to maintain good fluid intake and empty bladder often
-moderate to high emetic potential
Pentostatin drug class - ANSWER antimetabolite (purine analog)
Mechanism of action of pentostatin - ANSWER purine analog that mimics adenosine and
inhibits the enzyme adenosine deaminase, interfering with cell's ability to process DNA
Toxicity of pentostatin - ANSWER long lasting myelosuppresion, GI symptoms, skin rash,
abnormal liver function
Hepato, pulmonary, renal, and CNS toxicity in higher than recommended doses
