Quiz Questions 6 Flashcards
(16 cards)
The following are all treatment options in CML Except:
- Imatinib
- Dasatinib
- Sunitinib
- Nilotinib
Sunitinib
Sunitinib is a receptor tyrosine kinase inhibitor used to treat renal cell carcinoma and gastrointestinal stromal tumors.
- Imatinib
- Imatinib was the first tyrosine kinase inhibitor introduced for the treatment of CML.
- Dasatinib
- Dasatinib is a tyrosine kinase inhibitor used to treat CML.
- Nilotinib
- Nilotinib is a tyrosine kinase inhibitor used to treat CML.
Diagnosis of Chronic Myelogenous Leukemias made by clonal expansion of translocation between which of the following chromosomes AND what is the resultant fusion protein?
- Chromosome 9 & 21 and BCR-ABL protein
- Chromosome 9 & 22 and RET protein
- Chromosome 8 & 22 and BCR-ABL
- Chromosome 9 & 22 and BCR-ABL protein
Chromosome 9 & 22 and BCR-ABL protein
Translocations involving chromosome 9 and 22 are associated with BCR-ABL protein.
- Chromosome 9 & 21 and BCR-ABL protein
- Translocations from chromosome 9 and 21 are not typically associated with BCR-ABL protein.
- Chromosome 9 & 22 and RET protein
- Translocations from chromosome 9 and 22 are not associated with BCR-ABL protein.
- Chromosome 8 & 22 and BCR-ABL
- Translocations from chromosome 8 and 22 are not associated with BCR-ABL protein.
Treatment with Allogeneic Stem Cell transplant in CML is curative in nature.
True or false
true
Hematopoietic stem cell transplantation remains the only “proven” curative therapy for CML.
Multiple myeloma is responsible for 1% of malignant disorders and makes up 10% of hematological malignancies. Which of the following is not a classic clinical feature seen in these patients?
- Hypercalcemia from bone involvement
- Bone pain
- Hypercalcemia from increased parathyroid hormone related peptide.
- Anemia
- Acute renal impairment
- Bleeding complications in IgA myeloma patients
Hypercalcemia from increased parathyroid hormone related peptide.
PTHrP (parathyroid hormone related peptide) is a protein similar to parathyroid hormone which is produced at an ectopic site associated with a paraneoplastic hypercalcemia and malignancy. It is not the cause of the hypercalcemina seen in patients with multiple myeloma. Multiple myeloma, a cancer of plasma cells, is associated with excessive tumor-induced, osteoclast-mediated bone destruction. Key mediators of the osteoclastic bone resorption in myeloma include receptor activator of nuclear factor-êB ligand (RANKL) and macrophage inflammatory protein-1á. Available data suggest that RANKL is the final common mediator of osteoclastic bone resorption.
- Hypercalcemia from bone involvement
- Hypercalcemia from bone involvement is one of the CRAB criteria for end organ involvement with multiple myeloma.
- Bone pain
- Bone pain is often seen in myeloma patients do to the involvement of weight bearing bones with lytic lesion and accompanying microfractures.
- Anemia
- Anemia is one the CRAB criteria for end organ involvement with myeloma.
- Acute renal impairment
- Renal impairment is one the CRAB criteria for end organ involvement with myeloma.
- Bleeding complications in IgA myeloma patients
- A bleeding diathesis in a case of IgA myeloma was found to be associated with at least two abnormalities in the hemostatic mechanism. Both are related to the presence of the abnormal myeloma protein. The first abnormality stems from interference with fibrinogen polymerization and is responsible for prolonging the clotting time, acting as an anticoagulant. This abnormality is partially, but not completely, corrected by calcium; it has previously been described in other patients with multiple myeloma. The second abnormality results from coating of collagen (as well as other surfaces) by the abnormal protein and causes the prolonged bleeding time and poor in vivo adhesion of platelets.
Bone Scan can be used to visualize osteolytic bone lesions.
True or False
false
The radionuclide bone scan detects areas of the bone that has increased osteoblastic activity. This is often seen in areas of involvement with malignancy or healing fractures. A characteristic of multiple myeloma is that cortical bone involvement causes either osteoporosis or purely lytic lesions which cannot be detected by a radionuclide bone scan.
Diagnosis of Myeloma includes all of the following apart from:
- 10% plasma cell involvement in bone marrow
- Osteolytic bony lesions
- Elevation in serum M protein >3g/dL
- Elevation in urine M protein >3g/dL
Elevation in urine M protein >3g/dL
The is not a criteria for the diagnosis of multiple myeloma: Multiple Myeloma Classifications: Asymptomatic Myeloma (Smoldering): 1. Serum M protein > to 3.0 g/dL and/or Bone marrow clonal plasma cells ¡Ý 10%; 2. No Symptoms; and 3. No related tissue or organ impairment or symptoms. Symptomatic Myeloma (Active): Requires the addition of one or more of the following to the M protein and plasma cells: 1. Bone disease (lytic lesions or osteoporosis or osteopenia with compression fractures); 2. Increased calcium (>11.5 g/dL); 3. Anemia (hemoglobin, 2 mg/dL). The acronym CRAB can be used to remember the characteristics of symptomatic myeloma: Calcium increased, Renal insufficiency, Anemia, Bone lesions.
- 10% plasma cell involvement in bone marrow
- Myeloma patients typically have at least 10% plasma cells in the bone marrow.
- Osteolytic bony lesions
- Osteolytic lesions are a characteristic of myeloma.
- Elevation in serum M protein >3g/dL
- Myeloma is characterized by serum M protein > 3g/dL.
Graft vs. leukemia effect seen in stem cell transplant is characteristic of:
- Allogeneic transplantation
- Autologous transplantation
- Non-myeloablative chemotherapy
- Radiation therapy
Allogeneic transplantation
Allogeneic transplantation involves taking cells from a donor and giving them to a recipient. As a result, the engrafted cells recognize the leukemic cells in the recipient as “foreign” and destroy them.
- Autologous transplantation
- In autologous transplantation, the donor and recipient are the same and a graft versus leukemia effect does not occur.
- Non-myeloablative chemotherapy
- With non-myeloablative chemotherapy alone stem cell transplantation does not occur. Graft versus leukemia effect does not occur.
- Radiation therapy
- Radiation therapy does not cause a graft vs. leukemia effect.
Autologous stem cell transplantation is used for the following malignancies EXCEPT:
- Multiple myeloma
- Hodgkin’s lymphoma
- Germ cell tumour
- Acute leukemia
- Neuroblastoma
Acute leukemia
Auto SCT is not used in this setting. Since the donor is also the recipient, leukemic cells would be reinfused in the patient.
- Multiple myeloma
- Auto stem cell transplantation is commonly used for patients with multiple myeloma.
- Hodgkin’s lymphoma
- Although not used as commonly as in patients with non-Hodgkin’s lymphoma, auto stem cell transplantation is used in patients with recurrent or otherwise refractory Hodgkin’s lymphoma.
- Germ cell tumour
- Auto stem cell transplant is useful in patients with germ cell tumors that do not attain a complete remission with chemotherapy alone.
- Neuroblastoma
- Auto SCT plays a role in this disease.
The following are all advantages of Peripheral Blood SCT EXCEPT:
- Faster engraftment
- Lower risk of GVHD chronically
- Same outcome after SCT as bone marrow stem cell transplantation
- Less invasive procedure than bone marrow SCT
Lower risk of GVHD chronically
Peripheral blood SCT does not have a lower risk of chronic GVHD than bone marrow SCT.
- Faster engraftment
- Peripheral blood SCT results in faster engraftment than bone marrow SCT.
- Same outcome after SCT as bone marrow stem cell transplantation
- Peripheral blood SCT has the same outcome as bone marrow SCT.
- Less invasive procedure than bone marrow SCT
- Peripheral blood SCT is less invasive than bone marrow SCT.
Apart from GVHD, infection is one of the most common causes of mortality after SCT. Which of the following is not seen post engraftment period?
- Mucositis
- CMV viremia
- Acute GVHD
- Bacterial infection
- Candida
Mucositis
Mucositis is almost always due to the conditioning regimen and is seen early in the course of SCT.
- CMV viremia
- CMV viremia is expected to occur after the engraftment period.
- Acute GVHD
- Acute GVHD occurs after the engraftment period.
- Bacterial infection
- Bacterial infections tend to occur before and after engraftment, but are most commonly before engraftment.
- Candida
- Candida infections are seen both pre and post engraftment.
There are 2 major classes of HLA antigens. Which of the following is appropriate for Class I antigens:
- HLA A, DR, B
- HLA A,B,C
- HLA DQ, DR, DP
- HLA DQ, A, B, C, DR, DP
HLA A,B,C
These are class I antigens.
- HLA A, DR, B
- These are a mixture of both class I and class II antigens.
- HLA DQ, DR, DP
- These are class II antigens.
- HLA DQ, A, B, C, DR, DP
- These are a mixture of both class I and class II antigens.
In GVHD, the following are all true, EXCEPT:
- Mediated by major HLA antigen mismatch
- Patients receive Prophylaxis with immunosuppression
- Acute GVHD affects liver, skin, GI tract
- Risk of GVH is highest for the first 50 days when immunosuppresion is used
Risk of GVH is highest for the first 50 days when immunosuppresion is used
- Mediated by major HLA antigen mismatch
- The HLA complex plays a major role in GVHD.
- Patients receive Prophylaxis with immunosuppression
- Patients receiving allogeneic SCT require immunosuppressive prophylaxis.
- Acute GVHD affects liver, skin, GI tract
- Multiple organ systems, including these, can be affected by GVHD.
Regarding Conditioning regimens which of the following is true:
- Allows for engraftment of donor stem cell with appropriate immunosuppression
- Increase tumour cells
- Increase transfusion requirements
- Is not myelosuppressive
Allows for engraftment of donor stem cell with appropriate immunosuppression
- Increase tumour cells
- The conditioning regimen is used to prepare the patient for engraftment and to help reduce the leukemic burden.
- Increase transfusion requirements
- The conditioning regimen has no impact on the overall transfusion requirements of the patient.
- Is not myelosuppressive
- The conditioning regimen is highly myelosuppressive in order to ablate the bone marrow and eradicate the leukemia.
HLA system mediates donor and recipient immune responses. HLA loci are found on:
- Chromosome 5
- Chromosome 16
- Chromosome 6
- Chromosome 9
Chromosome 6
All HLA loci are located on chromosome 6.
Favourable Prognostic factors associated with AML include all of the following EXCEPT:
- T(15,17)
- Monosomy-5
- Inv (16)
- T (8;21)
Monosomy-5
-5, -7, del(5q), Abnormal 3q, complex cytogenetics are poor prognostic factors in patients with acute myelocytic leukemia.
- T(15,17)
- This translocation is a favorable prognostic factor in acute myelocytic leukemia
- Inv (16)
- t(8;21), t(15;17), inv(16) are favorable prognostic factors in patients with AML
- T (8;21)
- (8;21), t(15;17), inv(16) are favorable prognostic factors in patients with AML
Treatment of leukemia involves an induction phase followed by a consolidation phase with cytarabine based chemotherapy.
True or False
true
Induction phase therapy reduces leukemic burden with the intention of achieving a clinical complete remission. Consolidation phase therapy is intended to maximally reduce the presence of any residual leukemic cells present after the induction phase of therapy.
