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ALL Flashcards

1
Q

Immunophenotype of b cell ALL

A

Positive for CD10, CD19, CD20, CD22, CD79a, PAX5, TDT

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1
Q

Immunophenotype of T cell ALL

A

Positive for CD3, CD6,
Also often - CD1a, CD4, CD8
*all single digits

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2
Q

Immunophenotype of precursor T cell ALL

A

CD7, negative for CD8 and CD1a

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3
Q

Clinical significance of precursor T cell ALL

A

More drug resistant

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4
Q

Gene rearrangement in philadelphia-like ALL

A

CRLF2 overexpression (80%)
***the rest of ABL translocations managed similarly to ph+ ALL

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5
Q

Translocation associated with ALL with numerous eosinophils

A

t(5;14)

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6
Q

poor prognostic features in ALL

A
  • hypodiploidy
  • MLL
  • mixed lineage myeloid/lymphoid leukemias (KMT2A0, t(4;11)
  • philadelphia like
  • MRD during CR1
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7
Q

Worst prognostic factor in ALL

A

MRD during CR1

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8
Q

Additional workup required for T cell ALL

A

CT chest to rule out mediastinal mass

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9
Q

inotuzumab ozogamicin target

A

CD22

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10
Q

blinatumumab mechanism/target

A

BiTe therapy targeting CD19

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11
Q

inotuzumab ozogamicin SE to know

A

VOD

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12
Q

Management of philadelphia like ALL

A

IF ABL1, ABL2, CSF1R, or PDGFR, add BCR/ABL TKI like PH+
IF JAK2, can treat w/ JAKi

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13
Q

Consolidation for Ph- ALL

A

IF CR and MRD+ → blinatumomab then allo-HSCT
IF CR and MRD- →
IF high risk (WBC count or poor risk cytogenetics) – Allo-HSCT

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14
Q

High risk features in ALL

A

WBC count or poor risk cytogenetics

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15
Q

Conditioning regimens for transplant in ALL

A
  • TBI
  • TBI + cytoxan
  • TBI + high dose etoposide
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16
Q

relapsed/refractory options for b cell ALL

A

Blinatumomab (blincyto)
If young → CAR-T (tiso-cel + brexu-cel) then allo-HSCT
IF CD22+ → inotuzumab

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17
Q

1) relapsed/refractory options for t cell ALL 2) preferred option

A
  • Nelarabine (preferred)
    bortezomib
    daratumumab
    venetoclax
18
Q

nelarabine mechanism

A

prodrug of arabinosylguanine nucleotide triphosphate (araGTP), a type of purine nucleoside analog,

19
Q

asparaginase SE’s

A
  • VTE
  • pancreatitits
20
Q

blinatumumab SE to know

A

CRS

21
Q

inotuzumab SE to know

A

VOD

22
Q

VOD treatment

A

defibrotide

23
Q

T-cell ALL markers

A
  • TdT, cCD3, CD7
24
Q

Early t-precursor ALL immunophenotype

A

CD7+
CD8-
CD1a-
Also positive for myeloid/stem cell markers, including CD34, CD117(KIT), HLA-DR, CD33, CD13

25
Q

Adverse prognostic genetic features

A
  • hypodiploid
  • KMT2A (MLL) (11q23 fusions)
  • PH like ALL
26
Q

Prophylactic medication you can’t use with vincristine

A

azoles (posa, vori) - exacerbate neurotoxicity

27
Q

asparaginase SE’s

A
  • VTE
  • pancreatitis
  • hepatoxic
  • anhedonia
28
Q

Vincristine SE’s

A
  • neuropathy
  • myopathy
  • constipation
29
Q

Methotrexate SE’s

A
  • CNS toxicity
  • mucositis
  • chemical hepatitis
  • renal failure
30
Q

6MP SE’s

A
  • transaminitis
  • myelosuppression
31
Q

blinatumomab SE’s

A
  • neurotoxicity
  • CRS
32
Q

IF severe 6MP toxicity, what is cause?

A

TMPT polymorphism

33
Q

Role of transplant in ALL now

A

MRD guided
Regardless of PH status, MRD- are no longer taken to transplant

34
Q

Newer strategy for older adults with B-ALL

A

Inotuzumab + blinatumomab w/ IT chemo for CNS prophylaxis
(Chemo free)

35
Q

Group with worst outcomes in Ph like ALL

A

CRLF2

36
Q

Management of first relapse in ALL

A

IF early relapse (resistant disease) -> Car-T with brexicel or tiso-cel bridge to Allo- HSCT
IF later relapse –>
Blinatumomab (blincyto) (TOWER - superior ot salvage chemo)
IF CD22+ → inotuzumab
Then allo-HSCT (Still prob best option since CAR-T not durable. CR rates high)

37
Q

CAR-T products approved for ALL

A

Brexi-cell (for adults - Zuma-3) (high response but not durable)
Tisa-cel (for pediatric/young adult pts)

38
Q

Hepatic SOS (VOD) clinical features

A

fulminant liver failure + painful hepatomegaly + weight gain/edema/ascites + renal/respiratory failure
thrombocytopenia (earliest sign, refractory to transfusion) + elevated serum aminotransferases and/or alkaline phosphatase + hyperbilirubinemia (mostly conjugated bilirubin, develops later)
Risk factors:
transplant patient who’s been treated with cyclophosphamide/busulfan OR gemtuzumab
Transplant related – within 3 weeks of HSCT + heavy chemo exposure

39
Q

Prognostic significance of 11q23/KMT2A

A

adverse, poor prognosis

40
Q

Management of PH negative management in CR1 after consolidation

A

POMP maintenance for 2-3 years

41
Q

hypo or hyper diploidy prognostic significance in ALL?

A

hyperdiploidy = favorable

42
Q

Significance of t(4;11)(q21;q23)

A
  • KMLT2A - aggressive disease with high risk

Heme boards (59 decks)

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