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Malignant Hematology > ALL > Flashcards

ALL Flashcards

1
Q

What is the immunophenotype of B-cell ALL?

A

CD19+, CD79+, CD22+
Usually positive: CD10, surface CD22, PAX5, and TdT
CD20 and Cd34 is variable

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2
Q

What is the immunophenotype of T-cell ALL?

A

TdT+, CD3+, CD7+
Often Cd1a+, CD4+, CD8+

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3
Q

What is the immunophenotype of early T-cell ALL?

A

CD7+, but CD8-, CD1a-
CD34+, CD117+, HLA-DR+, CD33+, CD13+

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4
Q

Early T precursor ALL has what prognosis?

A

More treatment resistant

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5
Q

What supportive care medication should not be used with vincristine based chemotherapy regimens because it exacerbates neurotoxicity?

A

Azoles like posaconazole and voriconazole

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6
Q

What is the mechanism of Inotozumab ozogamicin?

A

CD22 Ab-drug conjugate

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7
Q

What is the mechanism of Blinatumumab?

A

CD19 BiTE

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8
Q

Four unique toxicities of asparaginase?

A

Thrombosis
pancreatitis
hepatitis
anhedonia

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9
Q

Unique toxicities (2) of inotuzumab ozogamicin

A

Hepatotoxic
VOD/SOS

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10
Q

You see a patient with ALL treated with POMP. They have severe, profound cytopenias greater than what they experienced with induction chemo. Why?

A

TMPT polymorphism, meaning they can’t metabolize 6-MP well

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11
Q

You see patient with Ph- ALL who is MRD+ after induction chemotherapy. What is treatment of choice?

A

Blinatumomab

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12
Q

What is the preferred induction chemotherapy for younger adults with Ph-negative ALL?

A

CALGB 10403: Vincristine, daunorubicin, Prednisone, peg-asparaginase with IT MTX and cytarabine

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13
Q

What is the preferred induction chemotherapy for older adults with Ph-negative ALL?

A

Mini hyperCVAD + Inotuzumab
(Cyclophosphamide, Vincristine, Dex alternating with MTX and cytarabine) No daunorubicin

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14
Q

Preferred induction chemotherapy for T-ALL?

A

Nelarabine + cyclophosphamide and methotrexate

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15
Q

Preferred induction treatment for fit patient with Ph+ B-ALL?

A

HyperCVAD + Dasatinib or Ponatinib
Then alloHCT in CR1

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16
Q

Preferred induction treatment for older patient with Ph+ B-ALL?

A

TKI + Blinatumomab

17
Q

What is Ph-like ALL?

A

Similar gene expression to BCR/ABL+ ALL but it doesn’t have the BCR/ABL fusion protein
Associated with poor clinical outcomes

18
Q

4 treatment options for relapsed/refractory B-ALL?

A

Blinatumomab
Inotuzumab ozogamicin
CAR-T (Brexucabtagene)
Salvage chemo (not very good)

–Used as a bridge to alloHCT

19
Q

Treatment for relapsed T-ALL?

A

Nelarabine (if not used in front line). Only FDA approved agent
Venetoclax + chemo
Bortezomib?

20
Q

What two genetic changes is commonly seen in Ph-like ALL?

A

CRLF2 overexpression
ABL1 fusions

21
Q

How do we treat Ph-like ALL with ABL1 or PDGFRB translocations?

A

BCR/ABL TKIs

22
Q

What is the preferred maintenance therapy for adults with ALL?

A

POMP x2-3 years
6-MP, MTX, VCR, steroids

23
Q

patient with Ph+ ALL treated with hyperCVAD+ponatinib and is now in MRD- CR1. What now?

A

Allo SCT

24
Q

What BCR/ABL mutation confers resistance to imatinib or dasatinib?

A

T315I

25
Q

Teratment for Ph+ ALL that has T315I mutation?

A

Ponatinib

26
Q

What cytogenetic changes are sen in Burkitt like ALL?

A

t)8;14)
t(8;2)
t(8;22)

27
Q

Induction treatment for Burkitt like ALL?

A

R-HyperCVAD or DA R-EPOCH with no maintenance

28
Q

Who should get alloHCT in ALL?

A

ALL with t(11q23)
Precursor T-ALL
Complex karyotype

29
Q

Ph-negative B-ALL with t(12;21) ETV6-RUNX1 translocation confers what prognosis?

A

Good prognosis

30
Q

What maintenance therapy should be given to patients with Burkitt leukemia?

A

None

31
Q

Consolidation treatment options (4) for Ph+ ALL who obtain a MRD- CR after induction

A

Chemo+TKI
TKI alone
Blina + TKI
Allo HCT

32
Q

What are poor risk cytogenetic/molecular groups in ALL? (11)

A

Hypodiploidy
TP53mut
KMT2A rearranged (t)4;11))
IgH rearranged
HLF rearranged
ZNF384 rearranged
MEF2D rearranged
MYC rearranged
PAX5alt
Complex karyotype

33
Q

For patients with Ph+ B-ALL and are MRD negative after induction, who shouldn’t go to alloHCT?

A

Younger patients (<21)

34
Q

How do you manage a patient with clinical pancreatitis from pegasparaginase?

A

permanently discontinue pegasparaginase

35
Q

What is the difference in ALL indication for Brexucabtagene autoleucel and Tisagenleucleucel?

A

Brexa: Approved for adults
Tisa: Approved for patients <26 years old

36
Q

Management of a patient with ALL with isolated extramedullary relapse? (4)

A

Blina
Ino
Brexucabtagene autoleucel
Combination chemotherapy
–This is a harbinger of BM recurrence, so local therapy alone isn’t good enough

37
Q

Management of a patient with ALL with residual testicular mass after completing induction chemotherapy?

A

Testicular RT

38
Q

Treatment of T-LGL

A

Immunosuppression
Cyclophosphamide, MTX, cyclosporine

39
Q
A

Malignant Hematology (13 decks)

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