AML/ALL KEY FACTS

Question 1

Intermediate risk of relapse in AML

Answer 1

normal cytogenetics

Question 2

Poor risk of relapse in AML

Answer 2

• >60 yo
• WBC > 100,000
• CNS involvement
• > 5 genetic abnormalities
• FLT3 mutation

Question 3

< 60 years old AML induction treatment

Answer 3

7+3

Question 4

< 60 years old AML residual disease treatment

Answer 4

5 + 3

Question 5

< 60 years old AML FLT3 mutation

Answer 5

midostaurin

Question 6

< 60 years old AML CD 33

Answer 6

gemtuzumab

Question 7

< 60 years old AML difficult to treat patient, poor outcomes, previous exp to chemo

Answer 7

Vyxeos

Question 8

7+3 regimen

Answer 8

• 7 days continuous cytarabine 100 mg/m2 IV
• 3 days anthracycline:

Daunorubicin

Idarubicin

Question 9

Daunorubicin for AML

Answer 9

Higher CR with 90 mg < 60 years old

90 mg ONLY in < 60 years old

Question 10

Main toxicity of gemtuzumab

Answer 10

Hepatotoxicity

Question 11

Who do you use Vyxeos in?

Answer 11

AML patients

• difficult to treat
• poor outcomes
• previous exposure to chemo
• older patients

Question 12

T/F if a patient is started on 7+3 they can switch to Vyxeos if it is not working?

Answer 12

FALSE

NOT interchangeable

Question 13

T/F you can use Vyxeos in older AML patients

Answer 13

True

Question 14

Main toxicity ofr venetoclax

Answer 14

Monitor for TLS

Question 15

Which AML drug do you decrease the dose of when using anti-fungal therapies?

What substrate is it?

Answer 15

Venetoclax

C34 substrate

Question 16

> 60 years old AML treatment if unfavorable cytogenetics

Answer 16

Venetoclax daily + decitabine/azacitidine

or decitabine/azacitidine alone

Question 17

Consolidation treatment for AML

Answer 17

• Cytarabine 3000 mg/m2 IV BID on days 1, 3, 5: <60 yo
• Cytarabine 1000 - 1500 mg/m2
• Vyxeos
• Decitabine/azacitidine + venetoclax

Question 18

Cytrabine dose in AML differences

Answer 18

< 60 years induction: 100 mg/m2

< 60 years consolidaiton: 3000 mg/m2

>60 years consolidation: 1000 - 1500 mg/m2

renal dysfunction: decrease dose

Question 19

Low dose cytrabine adverse reactions

Answer 19

• pancytopenia (neutorpenia, anemia thrombocytopenia)
• N/V/D
• Cardiotoxicity
• mucositis

Question 20

High dose cytrabine adverse reactions

Answer 20

• Pancytopenia
• N/V/D

- Hand-foot syndrome: reversible

• Conjunctivitis: reversible
• Neurotoxicity (cerebellar): irreversible

Question 21

What drugs can you use for APL?

Answer 21

Tretinoin (ATRA)

Arsenic (ATO)

Question 22

What is APL diagnosed by?

Answer 22

t(15;17)

Question 23

T/F ATRA causes QTc prolongation

Answer 23

False!

Arsenic (ATO) causes

Question 24

T/F Arsenic is pregnancy category X

Answer 24

False!

ATRA is category X

Question 25

Tretinoin and arsenic ADEs

Answer 25

Both: APL differentiation syndrome ATRA: category X, not myelosuppressive ATO: QT prolongation

Question 26

T/F never give vincristine intrathecally

Answer 26

true

Question 27

What is the backbone treatment for adult ALL?

Answer 27

- vincristine - antracycline - corticosteroids +/- cyclophosphamide, asparginase

Question 28

T/F AML is associated with t(9;22)

Answer 28

False ALL

Question 29

What do you add if an adult with ALL has philadelphia +?

Answer 29

add TKI - imatinib - desatinib - nilotinib

Question 30

Which drug is very difficult to compound and what is it used for?

Answer 30

Blinatumomab for ALL

Question 31

Major adverse reactions of blinatumab

Answer 31

- Cytokine relase syndrome - Neurologic toxicity - TLS

Question 32

Who uses risk adapated therapy?

Answer 32

Pediatric ALL

Question 33

Who is very high risk in pediatric ALL risk adapted therapy?

Answer 33

Ph+

Question 34

Asparginase toxicities

Answer 34

- pancreatitis - coagulation disorders - anaphylactic reactions - hyperglycemia

Question 35

T/F pediatric protocols for ALL use higher doses of myelotoxic agents

Answer 35

False - non-myelotoxic agents Vincristine, steroids, asparginase

Question 36

T/F pediatric protocols for ALL use higher doses of MTX

Answer 36

True

Question 37

T/F pediatric protocols for ALL has more intermittent exposure to chemo

Answer 37

False! continuous

Question 38

T/F adult protocols for ALL generally have prolonged neutropenia

Answer 38

True! less continuous exposure to chemo

Question 39

T/F adult protocols for ALL use higher doses of antracyclines and cytrabine

Answer 39

true

Question 40

\_\_\_\_\_ protocols of ALL have a delay in HSCT and _____ protocols of ALL have early HSCT

Answer 40

pediatric adult