Leukemia

Question 1

t(15;17)

Answer 1

PML:RARa; M3; APL

Question 2

t(8;21) or inv(16)

Answer 2

CBF:RUNX1T1; M2; abnl eosinophilia; good prog

Question 3

favorable prognosis markers: no need for trx

Answer 3

inv(16); t(8;21); t(15;17)

Question 4

poor prognosis markers, need transplant

Answer 4

del(5q), -5, del(7q), -7, complex, 11q23

Question 5

11q23

Answer 5

MLL gene: translocation with 11q23 bad

Question 6

del5q del7q

Answer 6

associated with alkylators, poor prognosis group AML

Question 7

FLT3 mutation

Answer 7

FLT-internal tandem repeat; poor prognosis ,

Question 8

CEBPA mutation

Answer 8

favorable prognosis

Question 9

induction

Answer 9

7+3: 90 dauno + 200 cytarabine x 7 days;

Question 10

idarubicin

Answer 10

12mg/m2 for 3 days equivalent to 90 dauno

Question 11

daunorubicin

Answer 11

90x3d = 50x5d

Question 12

del5q MDS

Answer 12

lenalidomide if low/int-I risk

Question 13

MDS cytopenia treatment

Answer 13

can use EPO

Question 14

allotSCT for MDS

Answer 14

recommended for INT-2: cases include: poor karyotype and 5-10 blasts; poor karyotype and 2/3 cytopenias; good karyotype, 2/3 cytopenias and 11-20 blasts; 11-20 blasts;

Question 15

IPSS

Answer 15

% blasts: 5-10- 0.5; 11-20: 1.5, 21+ 2. karyotype: intermediate 0.5; poor 1; cytopenia: 2/3 gets another 0.5 points.

Question 16

MDS karyotypes

Answer 16

poor: complex or chromosome 7; good: 5q-, y-, 20q-

Question 17

CLL karyotyping

Answer 17

13q- good

Question 18

11- CLL

Answer 18

massive LAD out of proportion

Question 19

17- CLL

Answer 19

higher richter transformation, resistance; consider up-front transplant

Question 20

imatinib dosing

Answer 20

400mg/day; higher doses lead to increased cytogenetic CR but no difference in OS, PFS at 24mo

Question 21

T315I

Answer 21

CML resistance mutation–> dasatinib/nilotinib doesn’t work

Question 22

nilotinib dosing

Answer 22

400mg BID, higher CR compared to imatinib

Question 23

dasatinib dosing

Answer 23

100mg day, higher CR compared to imatinib

Question 24

gleevec failure

Answer 24

no heme response at 3 mo, no cytogenetic response at 6month, no partial at 12 month, no complete by 18 months

Question 25

alkylating agent heme malignancies

Answer 25

del5q, del7q--> poor prognosis, 5-7yr latencies, also MDS

Question 26

topoII associated maligngnices

Answer 26

11q23, 21q22, poor prognosis

Question 27

ALL cells

Answer 27

+CD19 +CD200; 1/2 CD10+,

Question 28

p190

Answer 28

ALL Ph translocation

Question 29

ALL high risk types

Answer 29

t(4;11), t(8;14), t(1;19). Ph-positive(922)

Question 30

gleevec response

Answer 30

major response: <35% metaphase in marrow

Question 31

CML resistance

Answer 31

if no T315 or P-looop mutation, can consider increasing dose or using another TKI

Question 32

Primary resistance in AML

Answer 32

if resistance following 7+3-->HIDAC, you can still proceed to transplant with 10-20% success rate

Question 33

HTLV-1

Answer 33

T-cell leukemia causative- endemic in Caribbean, Japan (sexual contact, blood, mat/fet). 2-4% of infected will get leukemia

Question 34

benzene

Answer 34

can cause AML or myelodysplasia

Question 35

alkylator-associated MDS/AML cytogenetics

Answer 35

-5, -7, +8; develop 4-6 years after exposure, low response rates

Question 36

topoisomerase inhibitor AML

Answer 36

no MDS phase, 1-2 year latency, 11q23 abel, or 21q22 translocation.

Question 37

NPM1 mutation without FLT3 mut

Answer 37

good risk

Question 38

Preparative regimens for AML for AlloSCT

Answer 38

1) CY 60mg/kg x 2 + TBI 10-14Gy/3-6D. or 120mg/kg with oral busulifan 16mg/kg

Question 39

reduced intensity conditioning AlloSCT for >60

Answer 39

cannot use if active relapsed disease. otherwise encouraging with less toxicity

Question 40

APL treatment by risk factor

Answer 40

WBC give ATRA-->consolidate with ATRA/ArO3 (consider omitting chemo); if WBC>10--> high risk need all three

Question 41

anthracycline-associated AML

Answer 41

APL type, t(15;17)

Question 42

topoisomerase associated AML

Answer 42

no MDS, 11q23/21q22, short latency (6mo-3yr)

Question 43

myeloperox or nonspecific esterase

Answer 43

AML stains. Negative in ALL

Question 44

p190bcr-abl

Answer 44

associated with ALL

Question 45

p210bcr-abl

Answer 45

associated with CML (and some ALL)

Question 46

ALL standard therapy

Answer 46

vincristine, prednisone, anthracycline, asparaginase

Question 47

Ph-positive ALL

Answer 47

add a TKI.

Question 48

mature B-cell ALL

Answer 48

add rituximab

Question 49

ALL CNS prophylaxis

Answer 49

necessary. high risk: high WBC count or high LDH. trophy reduces risk to

Question 50

ALL consolidation therapy

Answer 50

high dose MTX, cytarabine, CY and anthracycline

Question 51

ALL maintenance therapy

Answer 51

low dose MTX, 6-MP, vincristine, predinsone

Question 52

good risk ALL

Answer 52

hyperdiploidy, or del(9p)

Question 53

ALL risk factors

Answer 53

Poor risk: age>35, >30WBC, pro B-cell, bad cytogenetics, >wks to CR

Question 54

transplant for ALL

Answer 54

all patients should get if

Question 55

elderly with Ph-positive ALL

Answer 55

can consider dasatinib+prednisone

Question 56

recurrent T-cell ALL therapy

Answer 56

nelarabine-->40% CR

Question 57

mature B-cell ALL (Burkitt's)

Answer 57

improved prognosis with high dose MTX, cytarabine, rituximab