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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

21
Q

inotuzumab SE to know

22
Q

VOD treatment

A

defibrotide

23
Q

T-cell ALL markers

A
  • TdT, cCD3, CD7
24
Early t-precursor ALL immunophenotype
CD7+ CD8- CD1a- Also positive for myeloid/stem cell markers, including CD34, CD117(KIT), HLA-DR, CD33, CD13
25
Adverse prognostic genetic features
- hypodiploid - KMT2A (MLL) (11q23 fusions) - PH like ALL
26
Prophylactic medication you can't use with vincristine
azoles (posa, vori) - exacerbate neurotoxicity
27
asparaginase SE's
- VTE - pancreatitis - hepatoxic - anhedonia
28
Vincristine SE's
- neuropathy - myopathy - constipation
29
Methotrexate SE's
- CNS toxicity - mucositis - chemical hepatitis - renal failure
30
6MP SE's
- transaminitis - myelosuppression
31
blinatumomab SE's
- neurotoxicity - CRS
32
IF severe 6MP toxicity, what is cause?
TMPT polymorphism
33
Role of transplant in ALL now
MRD guided Regardless of PH status, MRD- are no longer taken to transplant
34
Newer strategy for older adults with B-ALL
Inotuzumab + blinatumomab w/ IT chemo for CNS prophylaxis (Chemo free)
35
Group with worst outcomes in Ph like ALL
CRLF2
36
Management of first relapse in ALL
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
CAR-T products approved for ALL
Brexi-cell (for adults - Zuma-3) (high response but not durable) Tisa-cel (for pediatric/young adult pts)
38
Hepatic SOS (VOD) clinical features
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
Prognostic significance of 11q23/KMT2A
adverse, poor prognosis
40
Management of PH negative management in CR1 after consolidation
POMP maintenance for 2-3 years
41
hypo or hyper diploidy prognostic significance in ALL?
hyperdiploidy = favorable
42
Significance of t(4;11)(q21;q23)
- KMLT2A - aggressive disease with high risk

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