SET5 Flashcards
(47 cards)
Which requires a longer maintenance tx, AML or ALL?
ALL- often get HyperCVAD alternating with HD MTX + Ara-C w/ intrathecal tx then followed by POMP maintenance Tx for 2-3 YEARS
What kind of consolidation should be done in AML t(6;9)?
Allo-HSCT in first remission due to poor risk cytogenetic; if no donor can do HiDAC but really try for alloHSCT asap
What CD markers are associated with AML M7?
CD 41 + CD61, note these are also associated with GpIIb/IIIa which is the target of plavix; makes sense as M7 is megakaryoblastic AML
What percent of quantitative BCR-ABL transcript predicts for relapse in in Ph + ALL?
>0.1 %; if this is the case then the patient should undergo an allo-HSCT
This class of drug is notorious for causing mutations in the MLL (Mixed Lineage Leukemia) gene at the 11q23 locus leading ot MDS 1-3 years later
Topoisomerase II inhibitor (Etoposide)
Deletions of chromosome 5 and 7 are often seen in AML with what previous treatement?
Anthracyclines
What is HyperCVAD?
Hyperfractionated Cyclophosphamide, Vincristine, Adriamycin, and dexamethasone alternating with HD MTX and cytarabine
ALL with EPOR or JAK2 rearrangements is a type of Philadelphia-positive-like ALL sensitive to _______
Ruxolitinib
Why is Blinatumumab only used in B cell ALL
It is a BiTE (Bispecific T cell engager) it directs CD8 T cells to destory the B cell. Wouldn’t work if the T cells were the problem
What are the two well known extramedullary presentations of AML?
Leukemia cutis and Myeloid Sarcoma (Chloroma)
ALL with ABL1, ABL2, CSF1R, PDGFRB fusions is a type of philadelphia-positive-like ALL sensitive to ______
Dasatinib
What is the dosing of HiDAC?
3g/m2 q12h as a bolus rather than infusional (i.e. infusional intermediate dose Ara-C is in 7+3)
What are some molecular mutations that guide therapy in AML with normal cytogenetics (5)?
NPM1, CEBPA, KIT, FLT3-ITD, FLT3-TKD
How should you manage a CR in Ph- ALL who achieve CR and have no MRD?
Can continue maintenance chemo; if MRD present or bad risk cytogenetics go with alloHSCT
How should all patients with FLT3-ITD be consolidated?
Consolidate with allo-HSCT; obviously if no donor can do HiDAC
What type of AML is associated with CD235a?
Erythroleukemia, M6
Who is Blinatumumab used in?
Blinatumumab is used in Philadelphia negative precursor B cell ALL who have refractory or relapsed disease
What type of ALL does NOT require maintenance?
Burkitt lymphoma does not require long maintenance period. But all other types require 2-3 year maintenance period.
Why would chronic GVHD lead to increased risk of infection with encapsulated organisms?
Can lead to hyposplenia and compromised splenic macrophage function; also often causes hypogammaglobulinemia
ALL with ETV6-NTRK3 is a type of Philadelphia-positive-like ALL that is senstive to ______
Crizotinib (also used in ALK lung adeno)
What is AML-M3v?
Hypogranular variant of APML (20% of APML)
What do you do if you have a patient on Ara-C and they develop cerebellar toxicity which resolves?
Do NOT give another trial of cytarabine; consider another consolidative tx such as autoHSCT if good cytogenetics; allo if bad
Which types of AML should have an LP performed during remission due to increased risk of CNS disease?
M4 (myelomonocytic) and M5 (monocytic) as well as Biphenotypic (myeloid + lymphoid features)
What WBC count confers a higher risk of differentation syndrome in APML?
>10,000
