CML & CLL

Question 1

Side effects of 2nd generation CML TKIs

Answer 1

Dasatinib: QTC, pleural effusion, pericardial effusion

Nilotinib: QTC, pancreatitis, hyperglycemia/lipidemia

Bosutinib: rash, diarrhea, gi toxicity

Question 2

Side effects of 3rd generation CML TKI

Answer 2

Ponatinib: QTC, thrombosis, CHF, liver toxicity, fluid retention, pancreatitis

Question 3

PCR Monitoring

3 months, 6 months, 12 months

Answer 3

3 months: PCR > 10%, check for resistance mutations

6 months: PCR > 10% = tx failure, switch TKI

12 months: PCR > 1% = tx failure, switch TKI, consider ASCT

Question 4

CLL flow cytometry

Answer 4

Monoclonal B cell population
CD5+, CD23+ (CD23 can be negative in atypical CLL)
CD19+, CD20 dim (B-cell markers)
Single immunoglobulin light chain: kappa or lambda

• Don’t need bone marrow for diagnosis

Question 5

CLL Poor Risk

Answer 5

Del 17p (TP53)
Dep 11q (ATM)

Question 6

CLL Good Risk

Answer 6

Del 13q

IgVH

Question 7

When to treat CLL

Answer 7

Cytopenias
Organ damage
B symptoms
AIHA
Lymphocyte doubling time <12 months

Question 8

CLL Rai staging

Answer 8

Stage 0: lymphocytosis alone
Stage 1: +LAD
Stage 2: + HSM
Stage 3: +Anemia <11
Stage 4: +Thrombocytopenia < 100K

*Anemia or thrombocytopenia from autoimmune cause should not be classified as stage 3 or 4

Question 9

CLL treatment for poor PS or del 17/TP53 disease

Answer 9

ibrutinib
acalabrutinib + obinutuzumab
venetoclax + obinutuzumab (12 months)
chlorabucil + obinutuzumab

Question 10

Hg cut off for PV

Answer 10

Males hg > 16.5

Females hg > 16