Devita, Hellman, and Rosenberg's Cancer

LWBK1006-42 LWW-Govindan-Review December 12, 2011 20:38

532 DeVita, Hellman, and Rosenberg’s CANCER: Principles and Practice of Oncology Review

Answer 42.6. The answer is C.

TBI-containing regimens are associated with an increased risk of several

regimen-related toxicities, including cataracts, growth retardation, and

secondary malignancies. The incidence of VOD, however, is higher among

patients receiving busulfan conditioning, particularly among those with

high busulfan area under the concentration-time curve. The use of intra-

venous busulfan has been shown to lower the incidence of VOD because

of its more predictable pharmacokinetics than the traditional oral formu-

lation.

Answer 42.7. The answer is C.

It was primarily on the basis of retrospective studies of outcomes among

patients with chronic-phase CML that the GVL effect was first recognized,

and a majority of patients treated with DLI for posttransplant relapse of

CML achieve a durable molecular remission. In contrast with CML, only

a minority of patients with relapsed acute leukemias or more advanced

CML are rendered long-term disease-free survivors after DLI.

Answer 42.8. The answer is D.

Posttransplant disease relapse risk is inversely related to the incidence

of acute and chronic GVHD. HLA-mismatched transplants, with a cor-

respondingly higher risk of GVHD, also confer a lower risk of relapse.

T-cell depletion, although an effective strategy for lowering the risk of

GVHD, confers an increased risk of disease relapse.

Answer 42.9. The answer is D.

G-CSF administration after stem cell infusion has been shown in ran-

domized studies to shorten the time to sustained myeloid engraftment

but has not been shown to affect treatment-related mortality. Hemor-

rhagic cystitis, resulting from urinary secretion of acrolein, a metabolite

of cyclophosphamide, can be prevented by its inactivation with concur-

rent mesna administration or by dilution through hyperhydration with

intravenous fluids. High-dose busulfan is known to lower the threshold

for developing seizures, which can be effectively prevented by the pro-

phylactic use of phenytoin. Concurrent ondansetron and dexamethasone

is an effective and widely used regimen for nausea prophylaxis during

highly emetogenic conditioning.

Answer 42.10. The answer is D.

The incidence of VOD, thought to result from chemotherapy or radiation-

induced injury to the small venules in the liver, is associated with advanced

age, prior exposure to gemtuzumab, oral busulfan conditioning, and pre-

existing liver disease.

Answer 42.11. The answer is D.

The typical presentation of VOD includes isolated hyperbilirubinemia in

the context of tender liver enlargement, ascites, and weight gain during