Oncology Presentation

Oncology Pharmacy Services Small Lymphocytic Lymphoma (SLL) Presenter: Muhammad Hafiz Bin Zulkifli 019300.

[Audio] SLL, or Small Lymphocytic Lymphoma, is a form of cancer that affects the blood and bone marrow. Specialised Oncology Pharmacy knowledge is required for the treatment of SLL. This presentation aims to explore SLL and relevant services in great detail, so that the best results can be achieved in terms of the patient's treatment. We will look into the patient's history and laboratory results, the diagnosis process, treatment alternatives, and essential counselling points. Let us now start by examining the patient's background..

Patient’s Information.

[Audio] The patient is a 68 year-old male of the Malay race with a height of 170 cm and a weight of 53 kg, giving him a Body Mass Index of 18.3 kg/m2. His occupation is stated as “unknown”. He has been diagnosed with Small Lymphocytic Lymphoma, or SLL, a type of non-Hodgkin's lymphoma. He was admitted to our hospital on December 23rd, 2023, at 8:34 pm, with registration number 2282399..

[Audio] The patient was initially referred from KK Kuala Selangor due to a Thoracic Right Oblique Mediastinal Mass. Admitted to Hospital Tanjong Karang due to a malignant effusion in the lower limb, the patient had recurrent right-sided chest pain radiating to the back, and shortness of breath, persisting for three days in seven. Main complaints included chest pain, epigastric discomfort and shortness of breath..

[Audio] Small Lymphocytic Lymphoma, or SLL, is a type of cancer that affects the white blood cells in our body. It causes the blood cells to become abnormal and divide rapidly, resulting in a buildup of cells in the lymph nodes or other organs. Symptoms can include swollen lymph nodes, fatigue, and anemia. Treatment for this cancer is usually chemotherapy, radiation therapy, or biological therapy. It is important to work with a pharmacist or doctor to ensure the best treatment regimen for each individual patient..

[Audio] The diagnosis is Small Lymphocytic Lymphoma (SLL), a cancer of the lymphocytes, a type of white blood cell. There is no family or social history related to the illness. The patient has no known history of smoking, alcohol use, or drug use, and is currently unemployed..

[Audio] Regarding small lymphocytic lymphoma (SLL), it is essential to consider a patient's past medication history and reasons for taking medication. SLL is a type of non-Hodgkin's lymphoma identified by the presence of small lymphocytes in the lymph nodes and other organs. Patients may not have known drug allergies, so any medications taken must be carefully considered. Additionally, if no medications are being taken, it is pertinent to identify why and if preventive measures should be taken..

[Audio] SLL, a type of cancer of the lymphatic system, was reviewed for the patient's vital sign parameters. Blood pressure was 109/75 millimeters of mercury, which is within normal ranges. Respiratory rate was 28 breaths per minute, temperature was 37 degrees Celsius, also normal, and oxygen saturation level was 99% under room air..

[Audio] SLL is a form of cancer that affects a particular type of white blood cell in the lymphatic system. Common symptoms include general fatigue, decreased air intake rate, a soft, non-tender abdomen, and abnormal heart rhythms. Treatment options may include one or a combination of chemotherapy, radiation, or other treatments..

Laboratory Investigations.

Blood Pressure.

Heart Rate.

Respiratory Rate.

Temperature.

Pain Score.

SPO2.

[Audio] The slide displays the results of a hematology analysis for a patient with Small Lymphocytic Lymphoma (SLL). It illustrates the variety of cell components in the patient’s blood, such as WBC, NEUT, LYMP, MONO, EOSI, and BASO. The amount of each cell component changed during the test period. This information helps us observe the disease's progress and create an effective treatment plan..

[Audio] I want to talk about oncology pharmacy services for small lymphocytic lymphoma, or SLL. I will be discussing some of the key indicators of SLL, such as red blood cell count, hemoglobin, hematocrit, platelet count, mean corpuscular volume, and mean corpuscular hemoglobin concentration. To assess the severity of the disease and determine the appropriate course of treatment, I will compare the normal values for each one of these indicators against the values for a person suffering from SLL..

[Audio] In order to ensure high-quality care for patients suffering from Small Lymphocytic Lymphoma (SLL), a complete renal profile needs to be done on a regular basis. This entails running tests for BUN, Na+, K+ and Cl98 levels. These tests help determine if any issues with renal function require attention. Depending on the results, more tests and medications may have to be prescribed to preserve the patient's renal health..

[Audio] Results of the renal profile show the levels of minerals like calcium, magnesium, and phosphate measured over a two-week period. Uric acid was within the normal range of 220-547 umol/L. Calcium levels ranged from 1.91 to 2.60 umol/L. Magnesium levels ranged from 0.84 to 1.63 mmol/L and inorganic phosphate level was within the normal range of 0.78-1.65 mmol/L. Above results indicate that the renal profile is normal..

[Audio] A range of measurements was taken from a liver profile from a patient with Small Lymphocytic Lymphoma (SLL) which included total proteins, albumin, total bilirubin, alkaline phosphatase, alanine transaminase, and aspartate transaminase. The measurements taken from a 24/12 to 4/1 period were all within the normal range of values, showing that the patient's SLL has not had a major effect on their liver health..

[Audio] We will be looking at the Coagulation Profile for treatments related to Small Lymphocytic Lymphoma. The PT, INR and APPT levels were tested and measured 12 times over a 24 day period, from December 24th to January 4th, with results ranging from 11.7 to 15.3 sec., 2.0 to 3.0 and 31.5 to 46.7 sec. respectively. The APTT Ratio ranged from 1.16 to 0.91. These results provide us with valuable information regarding the treatment of Small Lymphocytic Lymphoma..

[Audio] SLL is a type of non-Hodgkin's lymphoma identified by an abnormal increase of lymphocytes in the bone marrow. Upon examination of the patient's lipid profile, the results showed total cholesterol level of 5.1 mmol per liter, triglyceride level of 1.6 mmol per liter, HDL level of 1.2 mmol per liter, and LDL level of 1.7 mmol per liter, all of which were within normal range..

[Audio] SLL requires specialized care and regular testing of blood gases. The chart shows 12 readings of blood gases taken from a patient with SLL. All the readings are within the normal range for pH, pCO2, PO2, SO2, BE, and HCO3, suggesting that the treatment regime is effective and the patient's condition is stable..

[Audio] SLL is an aggressive cancer of the lymphatic system and maintaining glycemic control is key to successful treatment. The chart illustrates the patient's glucose levels monitored daily, displaying positive results which suggests the successfulness of the medication regiment. This is a great exemplification of precision medication aiding patients in their fight against cancer..

[Audio] SLL, or Small Lymphocytic Lymphoma, is a type of cancer which affects lymphocytes in the body. In order to keep glycemic control for patients facing this condition, it is essential to regularly monitor their blood glucose levels. As depicted in the table, blood glucose levels were taken at six in the morning and at six in the evening on four distinct days. The data demonstrates that generally, blood glucose levels remained mostly stable over the four-day span..

INPUT/OUTPUT CHART Input/Output Chart Date Input (ml) Output (ml) Balance (ml) 24/12 1800 1200 +600 25/12 1800 1000 +800 26/12 1500 PU in pampers - 27/12 1702 600 +1162 28/12 2340 2100 +240 29/12 2628 1200 +1428 30/12 2648 1950 +698 31/12 2873 1500 +1373.

[Audio] SLL, or Small Lymphocytic Lymphoma, is a form of cancer with its own set of care requirements. Close supervision and monitoring of fluid levels is necessary to ensure the most effective treatment. The balance of input and output of fluids must be continually adjusted and monitored, as evidenced by the chart. This demonstrates how vital it is to track inputs and outputs for optimal outcomes in treating SLL patients..

[Audio] Cardiac enzymes have a normal range, but abnormal results may indicate complications related to small lymphocytic lymphoma (SLL). The second slide shows high sensitivity troponin I levels, along with C-reactive protein (CRP), which may indicate inflammation or other cardiac issues associated with SLL..

OTHERS Others Normal 25/12 28/12 29/12 LDH 120-246 U/L 258 264 381.

[Audio] Discussing the oncology pharmacy services for small lymphocytic lymphoma, or SLL, which typically occurs in the lymph nodes and is characterized by a malignant effusion in the pleural cavity of the right lung. The case study provided shows the patient experienced septic shock, non-ST segment elevation myocardial infarction, healthcare-associated pneumonia, and non-oliguric acute kidney injury during their course of care. The current diagnosis is SLL with a malignant right pleural effusion..

CURRENT MEDICATION Current Medication Chart Medication Indication 23/1 2 24/ 12 25/1 2 26/1 2 27/1 2 28/1 2 29/1 2 30/1 2 31/1 2 1/1 2/1 3/1 4/1 5/1 IV TAZOSIN 4.5G QID HAP IV DEXAMETHASONE 4MG BD ADRENAL INSUFFICIE NCY IV PANTOPRAZOLE 40MG OD GASTRITIS T. ALLOPURINOL 300MG OD PREVENTI ON HYPERURI CEMIA T. ALLOPURINOL 150MG OD SYR LACTULOSE 15ML TDS CONSTIPA TION SYR LACTULOSE 15ML BD CONSTIPA TION S/C ARIXTRA 2.5MG OD NSTEMI.

[Audio] SLL, or Small Lymphocytic Lymphoma, requires a comprehensive medical treatment in order to be effectively managed. A medication chart has been compiled which contains drugs used to address the various symptoms and indications of the condition. This includes T. Cardiprin 100mg for NSTEMI, T. Plavix 75mg for dyslipidemia, Benadryl 10ml for cough, and Prednisolone 45mg to manage nausea and vomiting. Other drugs listed on the chart include Atorvastatin 40mg, Kytril 3mg, Kalimate 10g, and Cardiprin 100mg. All of these medications are a necessary part of the comprehensive treatment of SLL..

[Audio] Regarding the treatment of small lymphocytic lymphoma, the medication chart includes various drugs tailored to specific needs. These are sterile talc 4g for malignant pleural effusion, furosemide 40mg for non-oliguric acute kidney injury, bactrim for PCP prophylaxis, rituximab 500mg for CD20 positive, and hydrocoritison 100mg as premedication to rituximab. Furthermore, Piriton 10mg is given as a STAT dose to assist with the condition's management..

[Audio] SLL is a type of cancer that typically affects the lymph nodes in the neck, armpit, or groin. Symptoms can vary greatly from person to person and may be nonspecific. Treatment options may include chemotherapy, radiation therapy, or targeted therapies. As oncology pharmacists, it is essential to understand and be able to discuss with the patient the risks and benefits of these treatments, as well as to provide them with educational support throughout their journey. This is why it is important that we take the time to ensure that each patient receives the best and most appropriate treatment available so that we can make a positive difference in their care..

[Audio] SLL is a type of Non-Hodgkin’s Lymphoma, typically seen in adults and characterized by a germ-cell-like B-cell proliferation which involves mostly the lymph nodes. This type of lymphoma is often accompanied by painless localized lymphadenopathy. Risk factors associated with SLL include acquired/congenital immunodeficiency or endemic Burkitt lymphoma which has close ties to EBV..

[Audio] SLL, or Small Lymphocytic Lymphoma, is a type of cancer that affects the body's B-cells, which are white blood cells that help the body fight infections. Cancerous B-cells start to replace less mature cells in the lymph nodes. It is a slow-growing cancer and may not present any symptoms in its early stages. Later, however, signs such as lymphadenopathy, easy bruising, a feeling of fullness in the abdomen, along with B-symptoms such as fatigue, fever, night sweats, and weight loss can occur..

Ann Arbor Staging.

[Audio] The main objective in managing small lymphocytic lymphoma is to arrest the disease's advancement and reduce the accompanying symptoms. Additionally, we aim to improve the patient's lifestyle and postpone more aggressive treatments like chemotherapy and radiation therapy..

[Audio] R-CHOP-21 has been identified as the optimal management for Small Lymphocytic Lymphoma based on Evidence-Based Medicine. This chemotherapy regimen is composed of five drugs - cyclophosphamide, doxorubicin, vincristine, and prednisolone. If rituximab is to be prescribed, the prescription should be for IV 375mg/m2 or 500 mg, with premedication of chlorpheniramine 10mg IV and PCM 1000mg PO given 30 minutes prior to administering rituximab. Furthermore, a Bactrim® tablet taken orally once a day should be provided for PCP prophylaxis throughout the duration of the treatment. Rituximab should be omitted in cases where the patient is CD20-negative. It is recommended that the patient receive 6 cycles of treatment, which can be extended as long as the neutrophil count is higher than 1 x 109/L and the platelet count above 50 x 109/L..

R-CHOP 21.

[Audio] Regarding small lymphocytic lymphoma in ward medication, cyclophosphamide 600mg stat, vincristine 2mg stat, prednisolone 45mg bd, rituximab 500mg stat, hydrocortisone 100mg stat, pcm 1g stat, piriton 10mg stat, and bactrim 1/1 od are the medications currently prescribed..

02 Septic shock 2° to HAP.

[Audio] Identifying the pathogen that caused the infection, rapidly eliminating the source of infection, initiating aggressive antimicrobial therapy early, interrupting the pathogenic sequence that leads to septic shock, and avoiding organ failure are all key goals of treatment for Small lymphocytic lymphoma (SLL), which is a type of cancer characterized by the proliferation of a type of lymphocyte. Early detection and treatment of this cancer is important for successful outcomes..

[Audio] Discussing the ideal management of small lymphocytic lymphoma based on the Evidence Based Medicine guideline, it is suggested an intravenous broad-spectrum antibiotic be administered within one hour of diagnosis of septic shock and severe sepsis against likely bacterial or fungal pathogens. Vasopressor therapy should be initiated to maintain a Mean Arterial Pressure of at least 65 mmHg, with norepinephrine being the first choice vasopressor. Stress ulcer prophylaxis should be administered to patients with a bleeding risk, favoring proton pump inhibitors over H2 receptor blockers..

Pharmacokinetic Handbook.

NAG 2019.

[Audio] Slide number 49 focuses on oncology pharmacy services for small lymphocytic lymphoma. Medication for this type of lymphoma must be administered within a ward setting. On the 23rd of January, a two-week course of tazosin and pantoprazole is initiated, with two doses prescribed each day. From the 1st to the 5th of February, four and a half grams of tazosin and forty milligrams of pantoprazole is prescribed daily..

03 Non oliguric AKI.