7. Drug therapy problems
Additional drug therapy needed
for treating NHL
Unnecessary drug therapy
Esomeprazole
Epoetin alfa
Temazepam
Ineffective dose
Lisinopril 10 mg po daily (BP=145/100mm Hg)
Furisemide 20 mg po daily
11. Information consistent with the diagnosis of NHL
Symptoms clinically observed on patient:
(fever, night sweats, weight loss)
Chest x ray:
Large heterogeneous mass at the apex of the left lung
Abnormal laboratory results:
elevated levels of uric acid and LDH
unexpected anaemia
22. Class of drug Name of drugs Mechanism of
action
Adverse effect
Immunosuppressive Cyclophosphamide
Taken Orally , tablet
or capsule
Is an alkylating agent
That prevent cell
division by cross-
linking DNA strands
and decreasing DNA
synthesis
Bone marrow
suppression , Cardio
toxicity , fertility
defect ,
Hepatotoxicity ,
Hypersensitivity,
pulmonary toxicities
Anthracyclines Doxorubicin
Taken By IV injection
Inhibits DNA and
RNA synthesis by
intercalation
between DNA base
pairs by inhibition of
topoisomerase II
and by steric
obstruction
Cardiotoxicity ,
Genitourinary ,
Leukopenia , post
injection flare ,
23. Class of drug Name of drugs Mechanism of
action
Adverse effect
Anti inflammatory /
Immunosuppressive
Prednisone
Taken Orally
Decreases
inflammation by
suppression of
migration of
polymorphonuclear
leukocytes and
reversal of increased
capillary permeability
Anaphlactoid
reaction
Phsychatric
disturbances
Antineoplastic (
antimicrotubular)
Vincristine
Taken Orally
Bind to tubulin and
inhibits microtubule
formation
Extravasation
Neurotoxicity
Respiratory effect
24. Class of drug Name of drugs Mechanism of
action
Adverse effect
Biological
(Immunosuppressive)
Rituximab
Taken By IV injection
Is a monoclonal
antibody directed
against CD20 antigen
on the surface of B
lymphocytes
Bowel obstruction,
Cytopenias,
Hepatitis B
reactivation, Infusion
reaction
Immunosuppressive Bendamustine
Taken By IV injection
Alkylating agent
(nitrogen mustard
derivative) with
benzimidazol ring
(purine) Which
demonestrate only
partial cross-
resistance with other
alkylating agent
Myelosuppression
Dermatologic toxicity ,
Extravasation , GI
toxicities,
Hepatotoxicity ,
hypersensivity
25. ?
4a
What drug, dosage form, schedule,
and duration of therapy are best for
treating this patient's NHL
27. Optimal plan
Drug therapy:
1-Rituximab 375 mg/m2 IV in day 1
2-Cyclophosphamide 750 mg/m2 IV Day 1
3-liposomal doxorubicin 30mg/m2 IV Day 1
4-Vincristine 1.4 mg/m2 IV Day 1
5-Prednisone 100 mg orally Day 1 to 5
Repeat the cycle for 6 times
29. ?
4cWhat are the Non pharmacological therapy to Non
Hodgkin Lymphoma
30. Non pharmacological therapy to NHL
Depending on the type and stage (extent) of the lymphoma and other
factors, treatment options for people with NHL might include:
Radiation therapy
Stem cell transplant
Surgery
31. When radiation use
It can be used as the main treatment for some types of NHL if they are
found early (stage I or II), because these tumors respond very well to
radiation.
For more advanced lymphomas and for some lymphomas that are more
aggressive, radiation is sometimes used along with chemotherapy.
33. High-Dose Chemotherapy and Stem Cell Transplant for Non-Hodgkin
A stem cell transplant (also known as a bone marrow transplant) lets
doctors give higher doses of chemotherapy, sometimes along with
radiation therapy
The doses of chemotherapy drugs are normally limited by the side
effects these drugs can cause. Higher doses can’t be used, even if they
might kill more cancer cells, because they would severely damage the
bone marrow
But with a stem cell transplant, doctors can give high doses of chemo
because the patient receives a transplant of blood-forming stem cells to
restore the bone marrow afterwards
34. Types of stem cell transplants
In an autologous stem cell transplant, the patient’s own stem cells are
used.
They are collected several times in the weeks before treatment. The
cells are frozen and stored while the person gets treatment (high-dose
chemo and/or radiation) and then are given back into the patient’s
blood by an IV.
In an allogeneic stem cell transplant, the stem cells come from
someone else (a donor).
Usually this is a brother or sister. The donor’s tissue type (also known as
the HLA type) needs to match the patient’s tissue type as closely as
possible to help prevent the risk of major problems with the transplant.
36. Surgery for Non-Hodgkin Lymphoma
Surgery isn’t often used to treat non Hodgkin lymphoma. This is
because other treatments such as chemotherapy, biological
therapy or radiotherapy usually work well and are the main treatments
You might have surgery to:
1-remove a lymph node for testing (a lymph node biopsy)
2-remove the spleen (splenectomy) in a rare type of lymphoma called
splenic marginal zone lymphoma
37. ?
5aHow is the response to the treatment regimen for
NHL assessed
38. Response assessment
Conventional response criteria for NHL define response categories:
complete or partial response, stable, and progressive disease
Based on.. history, physical examination, laboratory studies, CT scan,
bone marrow evaluation, and PET/CT, which are incorporated into the
Lugano Classification
39. Response assessment
Some research studies utilize the International Working Group RECIL
2017 criteria, but this approach is not currently applied to clinical
practice
The increasing use of biologic agents with immune mechanisms
requires flexibility in interpreting disease response to account for
seemingly paradoxical or atypical responses, sometimes referred to as
"tumor flare
42. ?
5bWhat acute adverse effects are associated with the
chemotherapy regimen, and what parameters
should be monitor
43. Monitoring parameterAdverse EffectsDrug
CBC prior to each dose
Neurological examination
Hepatic function
Constipation, N/V
Alopecia
Antidiuretic hormone secretion
Neurotoxicity
Ototoxicity
Vincristine
CBC with differential
Signs of infection
N/V
BM toxicity with opportunistic
infections
Temporary infertility
Hemorrhagic cystitis
Cyclophosphamide
CBC with differential
LV cardiac function
PE of the extremities
Presence of ulceration
Hand-foot syndrome
Cardiotoxicity
Hematologic abnormalities
Liposomal Doxorubicin
CBC with differential
Fluid balance
Renal function
Cardiac monitoring
Peripheral edema
Nephrotoxicity & UTI
Cardiac complication & Hypotension
Rituximab
44. ?
5cWhat pharmacologic measures should be instituted
to treat or prevent the acute toxicities associated
with chemotherapy regimen
45. MonitoringToxicityDrug
tumor response and resolution
or improvement
CBC
infusion reaction
Treatment is symptomatic and
supportive. Infusion reactions
have been reported. In
patients with acute allergic
reaction, oxygen therapy,
bronchodilators,
diphenhydramine maybe
required
Rituximab
tumor response or clinical
improvement
CBC
Cardio toxicity
Pulmonary toxicity
Cyclophosphamide
Treat patients with heart
failure with diuretics,
vasodilators, ACE inhibitors,
and inotropic agents as
indicated
CardiotoxicityDoxorubicin
CBC
uric acid levels
Neurotoxicity
Glutamic acid may be effective
in reducing neurotoxicity
vincristine
46. Solutions
Neutopenia : if developed after first cycle give ( filgrastim ) before
subsequent cycles
Nausea : ( ondansteron )
Tumor lysis syndrome : hyperuricemia , hypercalcemia
Retoximab infusion related reaction : give him steriod
47. ?
5dWhat are potential late complications of the
chemotherapy regimen, and how can they be
detected and prevented
48. Heart problems
Congestive heart failure (CHF)—weakening of the heart muscle:
People with CHF may experience shortness of breath, dizziness, and
swollen hands or feet
Coronary artery disease—heart disease:
People who have heart disease may experience chest pain or shortness of
breath
Arrhythmia—irregular heartbeat:
People who have an arrhythmia may experience lightheadedness, chest
pain, and shortness of breath
Other heart tests:
may include a physical examination, an electrocardiogram (EKG or ECG),
and a multigated acquisition scan (MUGA) scan
High blood pressure: testing blood pressure, losing weight, eating less
salt, taking medicine, and being active
49. Lung problems + Hormone problems
Lung problem= The late effects may include the following:
A change in how well the lungs work
Thickening of the lining of the lungs
Inflammation of the lungs
Difficulty breathing
Hormone problems for men= receive treatments to raise their testosterone levels
Fertility =Protecting the testes from radiation therapy
Sperm banking
Testicular sperm extraction and epididymal sperm aspiration.
Testicular-tissue freezing
