101 - Chronic Myeloid Leukemia

Question 1

CML (chronic myeloid leukemia) is a clonal hematopoietic stem cells disorder producing the chimeric gene ____ due to ___ (Philadelphia gene)

Answer 1

BCR-ABL 1

t(9:22)

Question 2

Thanks to the ___ treatment, survival rates have gone up to ___% of patients reaching ___ years

Answer 2

TKI (tyrosine kinase inhibitors)
85%
10

Question 3

CML makes up to ___% of leukemia cases, slightly more common in __. Medial age is ___, and it is uncommon in ___

Answer 3

15
Male
55
Children

Question 4

Name the first, second, and third gens of TKI

Answer 4

Imatinib
Dasatinib
Ponatinib

Question 5

Most patients present in the ____ stage. Common symptoms may include: (3)

Answer 5

Indolent/chronic
Anemia
Splenomegaly
B-symptoms

Question 6

Less common symptoms of CML may include ___, leading to: (4)

Answer 6

Thrombotic/vaso occlusive events

1. CV disorders
2. MI
3. Priapism
4. Vision impairment

Question 7

Untreated CML may show in CBC ___ with left shift and ___ dominance, ____, and ___ (1/3 of patients).

Answer 7

Leukocytosis
Neutrophils
Thrombocytosis
Anemia

Question 8

BM in CML patients will be ___ with myeloid ___

Answer 8

Hypercellular

Hyperplasia

Question 9

The percentage of BM blasts < ___ %. if higher than the prognosis worsen. When it is >___% than the patient is in the ___ phase

Answer 9

5%
15%
Accelerated

Question 10

Diagnosis is based on cytogenic and molecular findings of ____. Now days we use ___ and ___ to diagnose the disease. We can use ___ blood

Answer 10

t(9:22)(q34:q11.2)
FISH
PCR
Peripheral

Question 11

Partial cytogenic reaction is defined by

Answer 11

35%

Complete lack

Question 12

What is the most important prognostic feature to CML prognosis?

Answer 12

Response to treatment

Question 13

Ponatinib (__ gen), is optimal to the mutation __. Remember the __-__ S/E, and reduce dosage accordingly after a good response has been achieved

Answer 13

3rd
T315I
vaso-occlusive

Question 14

__ gen such as __/__/__ are __ times more potent than imatinib.

Answer 14

2nd

dasatinib/nilotinib/bosutinib

Question 15

__ is indicated after failure of 2 lines of treatment. It is an SC drug, and has __ S/E

Answer 15

synribo

myelosuppression

Question 16

___ used to be standard therapy, but today is given in combination with TKI or during pregnancy

Answer 16

interferon alpha

Question 17

Chemotherapy such as __ is given to reduce the ___ of the primary disease between treatments.

Answer 17

hydroxyurea

load

Question 18

Other treatment for CML may include __ or __ it.

Answer 18

splenectomy

radiating

Question 19

Pregnant women with CML should __ using TKI, as it is __

Answer 19

stop

teratogenic