ALL

Question 1

What is the immunophenotype of B-cell ALL?

Answer 1

CD19+, CD79+, CD22+
Usually positive: CD10, surface CD22, PAX5, and TdT
CD20 and Cd34 is variable

Question 2

What is the immunophenotype of T-cell ALL?

Answer 2

TdT+, CD3+, CD7+
Often Cd1a+, CD4+, CD8+

Question 3

What is the immunophenotype of early T-cell ALL?

Answer 3

CD7+, but CD8-, CD1a-
CD34+, CD117+, HLA-DR+, CD33+, CD13+

Question 4

Early T precursor ALL has what prognosis?

Answer 4

More treatment resistant

Question 5

What supportive care medication should not be used with vincristine based chemotherapy regimens because it exacerbates neurotoxicity?

Answer 5

Azoles like posaconazole and voriconazole

Question 6

What is the mechanism of Inotozumab ozogamicin?

Answer 6

CD22 Ab-drug conjugate

Question 7

What is the mechanism of Blinatumumab?

Answer 7

CD19 BiTE

Question 8

Four unique toxicities of asparaginase?

Answer 8

Thrombosis
pancreatitis
hepatitis
anhedonia

Question 9

Unique toxicities (2) of inotuzumab ozogamicin

Answer 9

Hepatotoxic
VOD/SOS

Question 10

You see a patient with ALL treated with POMP. They have severe, profound cytopenias greater than what they experienced with induction chemo. Why?

Answer 10

TMPT polymorphism, meaning they can’t metabolize 6-MP well

Question 11

You see patient with Ph- ALL who is MRD+ after induction chemotherapy. What is treatment of choice?

Answer 11

Blinatumomab

Question 12

What is the preferred induction chemotherapy for younger adults with Ph-negative ALL?

Answer 12

CALGB 10403: Vincristine, daunorubicin, Prednisone, peg-asparaginase with IT MTX and cytarabine

Question 13

What is the preferred induction chemotherapy for older adults with Ph-negative ALL?

Answer 13

Mini hyperCVAD + Inotuzumab
(Cyclophosphamide, Vincristine, Dex alternating with MTX and cytarabine) No daunorubicin

Question 14

Preferred induction chemotherapy for T-ALL?

Answer 14

Nelarabine + cyclophosphamide and methotrexate

Question 15

Preferred induction treatment for fit patient with Ph+ B-ALL?

Answer 15

HyperCVAD + Dasatinib or Ponatinib
Then alloHCT in CR1

Question 16

Preferred induction treatment for older patient with Ph+ B-ALL?

Answer 16

TKI + Blinatumomab

Question 17

What is Ph-like ALL?

Answer 17

Similar gene expression to BCR/ABL+ ALL but it doesn’t have the BCR/ABL fusion protein
Associated with poor clinical outcomes

Question 18

4 treatment options for relapsed/refractory B-ALL?

Answer 18

Blinatumomab
Inotuzumab ozogamicin
CAR-T (Brexucabtagene)
Salvage chemo (not very good)

–Used as a bridge to alloHCT

Question 19

Treatment for relapsed T-ALL?

Answer 19

Nelarabine (if not used in front line). Only FDA approved agent
Venetoclax + chemo
Bortezomib?

Question 20

What two genetic changes is commonly seen in Ph-like ALL?

Answer 20

CRLF2 overexpression
ABL1 fusions

Question 21

How do we treat Ph-like ALL with ABL1 or PDGFRB translocations?

Answer 21

BCR/ABL TKIs

Question 22

What is the preferred maintenance therapy for adults with ALL?

Answer 22

POMP x2-3 years
6-MP, MTX, VCR, steroids

Question 23

patient with Ph+ ALL treated with hyperCVAD+ponatinib and is now in MRD- CR1. What now?

Answer 23

Allo SCT

Question 24

What BCR/ABL mutation confers resistance to imatinib or dasatinib?

Answer 24

T315I

Question 25

Teratment for Ph+ ALL that has T315I mutation?

Answer 25

Ponatinib

Question 26

What cytogenetic changes are sen in Burkitt like ALL?

Answer 26

t)8;14) t(8;2) t(8;22)

Question 27

Induction treatment for Burkitt like ALL?

Answer 27

R-HyperCVAD or DA R-EPOCH with no maintenance

Question 28

Who should get alloHCT in ALL?

Answer 28

ALL with t(11q23) Precursor T-ALL Complex karyotype

Question 29

Ph-negative B-ALL with t(12;21) ETV6-RUNX1 translocation confers what prognosis?

Answer 29

Good prognosis

Question 30

What maintenance therapy should be given to patients with Burkitt leukemia?

Answer 30

None

Question 31

Consolidation treatment options (4) for Ph+ ALL who obtain a MRD- CR after induction

Answer 31

Chemo+TKI TKI alone Blina + TKI Allo HCT

Question 32

What are poor risk cytogenetic/molecular groups in ALL? (11)

Answer 32

Hypodiploidy TP53mut KMT2A rearranged (t)4;11)) IgH rearranged HLF rearranged ZNF384 rearranged MEF2D rearranged MYC rearranged PAX5alt Complex karyotype

Question 33

For patients with Ph+ B-ALL and are MRD negative after induction, who shouldn't go to alloHCT?

Answer 33

Younger patients (<21)

Question 34

How do you manage a patient with clinical pancreatitis from pegasparaginase?

Answer 34

permanently discontinue pegasparaginase

Question 35

What is the difference in ALL indication for Brexucabtagene autoleucel and Tisagenleucleucel?

Answer 35

Brexa: Approved for adults Tisa: Approved for patients <26 years old

Question 36

Management of a patient with ALL with isolated extramedullary relapse? (4)

Answer 36

Blina Ino Brexucabtagene autoleucel Combination chemotherapy --This is a harbinger of BM recurrence, so local therapy alone isn't good enough

Question 37

Management of a patient with ALL with residual testicular mass after completing induction chemotherapy?

Answer 37

Testicular RT

Question 38

Treatment of T-LGL

Answer 38

Immunosuppression Cyclophosphamide, MTX, cyclosporine