APHON Overview Exam UPDATED
QUESTIONS AND CORRECT ANSWERS
Biotherapy - CORRECT ANSWER modality of tx: agents that resemble body's own defense
and surveillance systems. Can augment/modulate/restore host's immune response, direct antitumor
activity, other biological effects. Side effects typically hypersensitivity rx
Immune surveillance - CORRECT ANSWER tumor cells express abnormal tumor antigens on
surface that can be recognized/destroyed by immune system
Natural killer cells - CORRECT ANSWER lymphocyte that recognizes/kills malignant cells
Cytotoxic t cells - CORRECT ANSWER recognize tumor-assosiated antigens and kills cells
Interferons - CORRECT ANSWER multiple moa's & produced w/ recombinant dna.
Protein capable of protecting other cells from viral infections by interfering w/ viral replication.
Family of glycoproteins include: antiviral, antiproliferative, potent immunomodulatory effects
Cytokines - CORRECT ANSWER products of immune cells to enhance cytotoxic activity of
cells and increase immune response
Alpha-interferon - CORRECT ANSWER leukocyte-derived. Tx: hairy cell leukemia,
melanoma, chronic myeloid leukemia, follicular lymphoma, multiple myeloma, cutaneous t-cell
lymphoma
Beta-interferon - CORRECT ANSWER fibroblast-derived. Tx MS
Gamma-interferon - CORRECT ANSWER t-lymphocyte derived. Tx chronic granulomatus
disease
Interleukin-2 - CORRECT ANSWER produced by t-helper cells & stimulate growth/maturation
of t-cell subsets, cytotoxic t-cells, production of lymphokines & cytokines.
,Act as chemical signals b/w wbc's (revs up immune system)
Retinoids - CORRECT ANSWER immunomodulators that facilitate differentiation & suppress
proliferation of cancer cells
All-trans retinoic acid (atra) - CORRECT ANSWER tx: aml, aml m3 subtype, apl
Increase maturation of promyelocytic blasts and rapid resolution of coagulopathy r/t tx.
Isotretinoin (accutane) - CORRECT ANSWER retinoid tx neuroblastoma.
Have antitumor activity unknown moa. TERATOGENIC. Male/female pt must register ipledge (fetal
exposure). Can also affect hearing & vision
Antibodies - CORRECT ANSWER proteins produced by b-lymphocytes. Part of humoral
immunity of adaptive system. Includes immunoglobulins (igg, iga, igm, ige, igd)
Murine - CORRECT ANSWER mouse-derived moabs. Pt develops human antimouse
antibodies creating high risk of hypersensitivity rx
End in -momab
Monoclonal antibodies - CORRECT ANSWER very specific. Directed against single antigenic
determinant on cell surface causing antibody-dependent cellular toxicity, direct cell death, elimination
of antigen/target cell that expresses the antigen
Low toxicity
-ximab - CORRECT ANSWER moab combo of human & mouse antibodies
-zumab - CORRECT ANSWER moab humanized, small part of mouse antibody fused w/
human antibody
-umab - CORRECT ANSWER fully humanized moabs
Chimeric moab - CORRECT ANSWER murine variable & human constant coupled using
recombinant dna
,Purpose of moabs - CORRECT ANSWER attach low-dose radioisotopes to image residual
disease. Target chemo, radiation, biotherapy to tumor
Purge autologous bone marrow of cancer cells before transplant
Selectively remove t cells responsible for gvhd from marrow prior to allogenic transplant
Efficacy increased w/ chemo or radioactive substances
Rituximab - CORRECT ANSWER tx relapsed/refractory b-cell lymphoma, cd20+, non-
hodgkins lymphoma (w/ chop), posttransplant lymphoproliferative d/o, & chronic gvhd
Rituximab moa - CORRECT ANSWER act on CD20 antigen on surface of normal/malignant b
lymphocytes and works w/ immune system to induce b-cell lysis
Radiopharmaceuticals - CORRECT ANSWER moabs that have radioactive source attached for
cancer killing effect
Ibritumomab tiuxetan (zevalin) - CORRECT ANSWER radiopharmaceutical tx
relapse/refractory low-grade follicular or transformed b-cell non-hodgkins lymphoma
Rituximab + ibritumomab tiuxetan - CORRECT ANSWER target cd20 protein on b-cells.
Given prior to high dose of radiation. Causes increased toxicity and severe infusion rx
Tositumomab + iodine 131 tositumomab (bexxar) - CORRECT ANSWER tx cd20+ follicular
non-hodgkin's lymphoma. Moa: recognizes marker and signals immune response then radioactive
source locks on to moab, delivers radiation directly to cd20 marked cells and kills lymphoma b-cells
Hematopoietic growth factors - CORRECT ANSWER regulate different levels of hematopoietic
cascade. Aka colony stimulating factors. Primarily used for symptom management & expedited
recovery from chemo-induced bone marrow suppression
Colony Stimulating Factors - CORRECT ANSWER ptns that support hematopoiesis. Decrease
myelosuppression, accelerate recovery from bmt, tx infections/parasitic diseases, help w/
pancytopenia
, Gcsf (filgrastim) - CORRECT ANSWER stimulates neutrophil colonies to enhance phagocytic
activity and antibody-dependent killing tendency. Starting dose 5 mcg/kg/day
Neulasta (pegfilgrastim) - CORRECT ANSWER long-acting gcsf. Given 24h post chemo.
Given once per chemo cycle. Max dose is 6mg. Kids <45kg dose is 0.1mg/kg
Gm-csf (granulocyte macrophage csf; sargramostim) - CORRECT ANSWER given post bmt w/
non-hodgkins lymphoma, all, hodgkins disease. Dose: 250 mcg/kg/day. Typically iv over 2h for 21
days. Broader prod of neutrophil & monocyte colonies
Epoetin alfa - CORRECT ANSWER hormone produced naturally by kidneys in response to
decrease O2 levels. Stimulates precursor cells in marrow to produce rbcs. Dose 150 u/kg 3x/week
Darbepoetin (aranesp) - CORRECT ANSWER long-acting epoetin. Given weekly. Dose
0.45mcg/kg sq. Titrate dosing to not get hgb >12
ESA APPRISE - CORRECT ANSWER risk management system associated w/ erythropoiesis-
stimulating factors. Increase risk of tumor growth/progression, cv events, decreased survival rates
when hgb >12
Oprelvekin (neumega) - CORRECT ANSWER thrombopoietic growth factor. Stim hsc &
megakaryocyte precursurs to pvt severe thrombocytopenia. Dosing: qd sc @ 50mcg/kg 24h post
chemo until platelets >50k
Tyrosine kinase inhibitors - CORRECT ANSWER interfere w/ cell comms & growth. Primarily
block epidermal growth factor receptors to pvt cell proliferation, promo apoptosis & inh
antiangiogenesis
Angiogenesis - CORRECT ANSWER growth of new blood vessels from existing vessels.
Tumor viability is dependent for growth. Vascular endothelial growth factors (vegf) cascade major
factor
Bevacizumab (avastin) - CORRECT ANSWER vegf inhibitor. Pvt angiogenesis. Tx in
relapse/refractory solid tumors
QUESTIONS AND CORRECT ANSWERS
Biotherapy - CORRECT ANSWER modality of tx: agents that resemble body's own defense
and surveillance systems. Can augment/modulate/restore host's immune response, direct antitumor
activity, other biological effects. Side effects typically hypersensitivity rx
Immune surveillance - CORRECT ANSWER tumor cells express abnormal tumor antigens on
surface that can be recognized/destroyed by immune system
Natural killer cells - CORRECT ANSWER lymphocyte that recognizes/kills malignant cells
Cytotoxic t cells - CORRECT ANSWER recognize tumor-assosiated antigens and kills cells
Interferons - CORRECT ANSWER multiple moa's & produced w/ recombinant dna.
Protein capable of protecting other cells from viral infections by interfering w/ viral replication.
Family of glycoproteins include: antiviral, antiproliferative, potent immunomodulatory effects
Cytokines - CORRECT ANSWER products of immune cells to enhance cytotoxic activity of
cells and increase immune response
Alpha-interferon - CORRECT ANSWER leukocyte-derived. Tx: hairy cell leukemia,
melanoma, chronic myeloid leukemia, follicular lymphoma, multiple myeloma, cutaneous t-cell
lymphoma
Beta-interferon - CORRECT ANSWER fibroblast-derived. Tx MS
Gamma-interferon - CORRECT ANSWER t-lymphocyte derived. Tx chronic granulomatus
disease
Interleukin-2 - CORRECT ANSWER produced by t-helper cells & stimulate growth/maturation
of t-cell subsets, cytotoxic t-cells, production of lymphokines & cytokines.
,Act as chemical signals b/w wbc's (revs up immune system)
Retinoids - CORRECT ANSWER immunomodulators that facilitate differentiation & suppress
proliferation of cancer cells
All-trans retinoic acid (atra) - CORRECT ANSWER tx: aml, aml m3 subtype, apl
Increase maturation of promyelocytic blasts and rapid resolution of coagulopathy r/t tx.
Isotretinoin (accutane) - CORRECT ANSWER retinoid tx neuroblastoma.
Have antitumor activity unknown moa. TERATOGENIC. Male/female pt must register ipledge (fetal
exposure). Can also affect hearing & vision
Antibodies - CORRECT ANSWER proteins produced by b-lymphocytes. Part of humoral
immunity of adaptive system. Includes immunoglobulins (igg, iga, igm, ige, igd)
Murine - CORRECT ANSWER mouse-derived moabs. Pt develops human antimouse
antibodies creating high risk of hypersensitivity rx
End in -momab
Monoclonal antibodies - CORRECT ANSWER very specific. Directed against single antigenic
determinant on cell surface causing antibody-dependent cellular toxicity, direct cell death, elimination
of antigen/target cell that expresses the antigen
Low toxicity
-ximab - CORRECT ANSWER moab combo of human & mouse antibodies
-zumab - CORRECT ANSWER moab humanized, small part of mouse antibody fused w/
human antibody
-umab - CORRECT ANSWER fully humanized moabs
Chimeric moab - CORRECT ANSWER murine variable & human constant coupled using
recombinant dna
,Purpose of moabs - CORRECT ANSWER attach low-dose radioisotopes to image residual
disease. Target chemo, radiation, biotherapy to tumor
Purge autologous bone marrow of cancer cells before transplant
Selectively remove t cells responsible for gvhd from marrow prior to allogenic transplant
Efficacy increased w/ chemo or radioactive substances
Rituximab - CORRECT ANSWER tx relapsed/refractory b-cell lymphoma, cd20+, non-
hodgkins lymphoma (w/ chop), posttransplant lymphoproliferative d/o, & chronic gvhd
Rituximab moa - CORRECT ANSWER act on CD20 antigen on surface of normal/malignant b
lymphocytes and works w/ immune system to induce b-cell lysis
Radiopharmaceuticals - CORRECT ANSWER moabs that have radioactive source attached for
cancer killing effect
Ibritumomab tiuxetan (zevalin) - CORRECT ANSWER radiopharmaceutical tx
relapse/refractory low-grade follicular or transformed b-cell non-hodgkins lymphoma
Rituximab + ibritumomab tiuxetan - CORRECT ANSWER target cd20 protein on b-cells.
Given prior to high dose of radiation. Causes increased toxicity and severe infusion rx
Tositumomab + iodine 131 tositumomab (bexxar) - CORRECT ANSWER tx cd20+ follicular
non-hodgkin's lymphoma. Moa: recognizes marker and signals immune response then radioactive
source locks on to moab, delivers radiation directly to cd20 marked cells and kills lymphoma b-cells
Hematopoietic growth factors - CORRECT ANSWER regulate different levels of hematopoietic
cascade. Aka colony stimulating factors. Primarily used for symptom management & expedited
recovery from chemo-induced bone marrow suppression
Colony Stimulating Factors - CORRECT ANSWER ptns that support hematopoiesis. Decrease
myelosuppression, accelerate recovery from bmt, tx infections/parasitic diseases, help w/
pancytopenia
, Gcsf (filgrastim) - CORRECT ANSWER stimulates neutrophil colonies to enhance phagocytic
activity and antibody-dependent killing tendency. Starting dose 5 mcg/kg/day
Neulasta (pegfilgrastim) - CORRECT ANSWER long-acting gcsf. Given 24h post chemo.
Given once per chemo cycle. Max dose is 6mg. Kids <45kg dose is 0.1mg/kg
Gm-csf (granulocyte macrophage csf; sargramostim) - CORRECT ANSWER given post bmt w/
non-hodgkins lymphoma, all, hodgkins disease. Dose: 250 mcg/kg/day. Typically iv over 2h for 21
days. Broader prod of neutrophil & monocyte colonies
Epoetin alfa - CORRECT ANSWER hormone produced naturally by kidneys in response to
decrease O2 levels. Stimulates precursor cells in marrow to produce rbcs. Dose 150 u/kg 3x/week
Darbepoetin (aranesp) - CORRECT ANSWER long-acting epoetin. Given weekly. Dose
0.45mcg/kg sq. Titrate dosing to not get hgb >12
ESA APPRISE - CORRECT ANSWER risk management system associated w/ erythropoiesis-
stimulating factors. Increase risk of tumor growth/progression, cv events, decreased survival rates
when hgb >12
Oprelvekin (neumega) - CORRECT ANSWER thrombopoietic growth factor. Stim hsc &
megakaryocyte precursurs to pvt severe thrombocytopenia. Dosing: qd sc @ 50mcg/kg 24h post
chemo until platelets >50k
Tyrosine kinase inhibitors - CORRECT ANSWER interfere w/ cell comms & growth. Primarily
block epidermal growth factor receptors to pvt cell proliferation, promo apoptosis & inh
antiangiogenesis
Angiogenesis - CORRECT ANSWER growth of new blood vessels from existing vessels.
Tumor viability is dependent for growth. Vascular endothelial growth factors (vegf) cascade major
factor
Bevacizumab (avastin) - CORRECT ANSWER vegf inhibitor. Pvt angiogenesis. Tx in
relapse/refractory solid tumors
