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PHM703 Heme/Onc/Crit Care > Exam 2 - Leukemia > Flashcards

Exam 2 - Leukemia Flashcards

(47 cards)

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1
Q

List characteristics of acute leukemias?

A

rapid onset, symptomatic, rapid fatality, immature cells (“blasts”), usually leukopenia

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2
Q

List characteristics of chronic leukemias?

A

slowly progressive, mostly asymptomatic, higher survival, immature and mature cells

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3
Q

Myeloid cancers usually involve? (3) Lymphoid usually involve?

A

basophils, neutrophils, and eosinophils; B and T cells

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4
Q

How is AML diagnosed?

A

bone marrow aspirate and biopsy demonstrating 20% isolated blasts

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5
Q

List risk factors for AML?

A

increasing age, prior chemotherapy (therapy-related), cigarette smoke, radiation/benzene/pesticide/petrochemical exposures

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6
Q

List signs and symptoms of AML?

A

hyperleukocytosis, anemia (fatigue, SOB), thrombocytopenia (higher bleeding), neutropenia (infections), spontaneous tumor lysis syndrome, CNS involvement is rare

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7
Q

What is the treatment for hyperleukocytosis?

A

hydroxyurea

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8
Q

What is the MOA of hydroxyurea?

A

ribonucleotide reductase inhibitor

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9
Q

What are AEs of hydroxyurea?

A

GI, tumor lysis, toxicities (cutaneous vasculitic ulcerations, mucositis, alopecia, hyperpigmentation)

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10
Q

What are prognostic markers for AML?

A

cytogenetics, age, primary vs secondary AML, performance status, donor availability, WBC count at diagnosis, extramedullary disease

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11
Q

List the FMS-like-tyrosine kinase (FLT3) mutations? (2)

A

those involving internal tandem duplication, tyrosine kinase domain

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12
Q

List the other common AML mutations? (5)

A

those to isocitrate dehydrogenase, DNA methyltransferase 3A, RUNX1, TET2, spliceosomal

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13
Q

What is days 1-7 for induction chemotherapy? Adverse effects during this time?

A

chemotherapy administration; N/V, GI

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14
Q

What is days 8-24 for induction chemotherapy? Adverse effects and what occurs during this time?

A

cell count nadir and recovery; fatigue, fever/infection, high red blood cell and platelet transfusion requirement

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15
Q

What is days 25+ for induction chemotherapy? What occurs during this time?

A

complete cell count recovery; discharge from hospital once ANC >500 and no longer platelet transfusion dependent

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16
Q

What is treatment for induction chemotherapy in AML? (2)

A

cytarabine 100 mg/m^2 IV x7 days plus daunorubicin 60 mg/m^2/d x3 days OR idarubicin 12 mg/m^2/d x3 days

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17
Q

What is treatment for FLT3-ITD+ AML?

A

quizartinib (Vanflyta)

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18
Q

What is treatment for FLT3-ITD+/TKD+ AML?

A

midostaurin (Rydapt)

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19
Q

What is treatment for favorable/intermediate cytogenetics in AML?

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A

gemtuzumab ozogamicin (Mylotarg)

20
Q

What is treatment for secondary or therapy-related AML?

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A

liposomal daunorubicin with cytarabine (Vyxeos)

21
Q

List goal treatment response criteria in AML? (3)

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A

“leukemia-free state” by day 14, complete remission/complete response by day 28, complete remission with incomplete count recovery

22
Q

What is treatment for AML post-remission therapy in those receiving intensive chemo? (2)

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A

high dose cytarabine (HiDAC) or liposomal daunorubicin with cytarabine (Vyxeos)

23
Q

What is treatment for intermediate and poor risk diseased AML patients?

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A

allogeneic stem cell transplant

24
Q

What is used in “low-intensity chemo” for AML? (4)

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A

hypomethylating agents (decitabine (Dacogen) or azacitidine (Vidaza)) plus venetoclax, low-dose cytarabine (LDAC) plus venetoclax, ivosidenib plus venetoclax, LDAC plus glasdeglib

25
What are AEs of quizartinib (Vanflyta)?
needs dose adjustments for DDIs
26
List the IDH inhibitors? (2)
ivosidenib (Tibsovo), enasidenib (IDHIFA)
27
What does supportive care entail in AML? (2)
transfusions (pRBCs, platelets), infection prophylaxis
28
What are AEs of anthracyclines (daunorubicin, idarubicin, mitoxantrone)? (3)
reddish or blueish urine/sclerae, myelosuppression, cardiac toxicity
29
What are AEs of cytarabine?
neurotoxicity (cerebellar syndrome), conjunctivitis
30
What are AEs of gemtuzumab ozogamicin (Mylotarg)? (2)
infusion-related reactions (premedicate with APAP, diphenhydramine, and methylprednisone), hepatotoxicity (including veno-occlusive disease)
31
What are AEs of low-intensity chemo?
constipation (give standing bowel medications), low-moderate emetogenicity (premedicate with ondansetron), myelosuppression (venetoclax)
32
What is treatment for bone pain as an AE from myeloid growth factors? (2)
loratadine, hydroxyzine
33
Explain the Philadelphia chromosome?
fusion chromosome of 9 and 22 via a translocation that involves the upregulation of bcr by abl which leads to a constitutively active expression
34
List signs and symptoms for CML?
asymptomatic (up to 50%), leukocytosis (WBC > 25x10^9/L), Philadelphia chromosome, anorexia, bone pain, weight loss, fatigue
35
What is the first generation tyrosine kinase inhibitor (TKI)? Second? Third?
1st = imatinib (Gleevec), 2nd = dasatinib (Sprycel) and nilotinib (Tasigna), 3rd = bosutinib (Bosulif) and ponatinib (Iclusig)
36
What is the MOA of imatinib (Gleevec)?
inhibits BCR-ABL tyrosine kinase (1st gen), inhibits c-KIT and platelet-derived growth factor receptor (PDGFR)
37
What are AEs of imatinib (Gleevec)? (4)
edema, myalgias, hypophosphatemia, GI
38
List mechanisms of resistance to TKIs? (3)
organic cation transporter 1, P-gp, point mutations in ABL kinase domain
39
What are AEs of dasatinib (Sprycel)? (3)
pleural/pericardial effusions, bleeding risk, pulmonary arterial hypertension
40
What are AEs of nilotinib (Tasigna)?
elevated pancreatic enzymes, hyperbilirubinemia, QTc prolongation, CV events
41
What are AEs of bosutinib (Bosulif)?
GI, HA, rash
42
If there are no contraindicated mutations, which treatments are recommended? (5)
asciminib (Scemblix), ponatinib (Iclusig), omacetaxine mepesuccinate (Synribo), allogeneic stem cell transplant, clinical trial
43
What are AEs of ponatinib (Iclusig)? (3)
vascular occlusion (hypertension, heart failure, ischemic reactions), skin toxicity, hepatotoxicity
44
What is the MOA of asciminib (Scemblix)?
STAMP inhibitor, targets myristoyl pocket
45
What is the MOA of omacetaxine mepesuccinate (Synribo)?
reversible inhibitor of protein synthesis
46
What are AEs of omacetaxine mepesuccinate (Synribo)?
myelosuppression, nausea, diarrhea, fever
47
What is the most important factor contributing to relapse and TKI failure?
poor medication adherence

PHM703 Heme/Onc/Crit Care (18 decks)

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