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Erez's HEM TEST notes 2024 > ALL facts > Flashcards

ALL facts Flashcards

1
Q

CNS involvement in ALL diagnosis

A

5-10%

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2
Q

CNS relapse rates in ALL

A

15%
25% isolated
75% with full blown disease

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3
Q

Risk factors for CNS involvement in ALL diagnosis

A

Elevated WBC (>30K B-ALL, >100K T-ALL)
LDH
High risk cytogenetics
T-ALL

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4
Q

Timing of 1st LP in ALL

A

Debate between at diagnosis or after eradication of peripheral blasts

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5
Q

PLT threshold for epidural

A

50-75K

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6
Q

CNS penetrating agents in ALL

A

MTX, cytarabine, dexamethasone, PEG-asp, 6-MP, and dasatinib

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7
Q

CNS presence of disease grading

A

CNS1- no blasts in CSF
CNS2 < 5 blasts in CSF
CNS3 >5 blasts in CSF

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8
Q

Tx of ALL with CNS disease at presentation

A

1/w or 2/w IT (MTX/Cytosar)
until clearance of blasts from CSF

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9
Q

TKI choice for Ph+ B-ALL with CNS involvement

A

Dasatinib has the most robust data
but ponatinib also crosses BBB

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10
Q

Dose of intra Ommaya chemo

A

50% than IT

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11
Q

Transplant decision in ALL with CNS involvement

A

Allo HCT at CR1

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12
Q

Ph+ ALL %

A

20-25%
increases to 50% after age 50

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13
Q

OS and PFS after D-ALBA in Ph+ ALL

A

90-95% in 18 months
70-80% after 3 years

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14
Q

IKZF1plus

A

IKZF1+
PAX5 or CDKN2A/2B

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15
Q

Agents effective in RR B ALL

A

Inotuzumab- CD22 conjugated ab-toxin
Blinatumomab- CD19 BiTE
Brexu cell

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16
Q

B-ALL immunophenotype

A

Defining: CD19 + CD22/CD79a/CD10
PAX5, TdT positive
No kappa/lambda restriction

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17
Q

T-ALL immunophenotype

A

TdT, CD3,CD7, CD1a +/-, CD4/CD8 +/-

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18
Q

ETP T-ALL immunophenotype

A

CD3+, CD5 weak, CD7+-
CD1a, CD4, CD8 neg
Myeloid/SC markers: HLA-DR, CD34, CD33, CD13, CD117 positive

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19
Q

Ph+ B-ALL incidence by age

A

Increases with age

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20
Q

Azoles toxicity in ALL

A

Posaconazole and voriconazole can exacerbate neurotoxicity of vincristine

21
Q

Agents used in induction of ALL

A

Steroids
PEG
MTX
CY
Vincristine
Cytarabine
6-MP
Anthracyclines

22
Q

Inotuzumab ozigomycin

A

CD22 conjugated
SE: VOD

23
Q

Deep cytopenias after 6-MP

A

Check TMPT polymorphism

24
Q

Pediatric inspired protocols

A

GMALL
GRALL
BFM

25
Rituximab in ALL Tx
Improves OS if CD20+ (20% pts)
26
Blinatumomab in ALL Tx
improves OS in MRD+ (BLAST) and MRD- pts (Litzow 2024) after induction Improves OS inRR ALL with MRD relapse (TOWER) In research for 1st line combined with pediatric inspired induction
27
Tx of MRD- B-ALL pts
Blina ASCT in CR1 might not be needed
28
Tx of older adults with B-ALL
mini-Hyper CVAD- Blina/Ino Blina+INO (ALLIANCE)
29
CAR-T in B-ALL
ZUMA 3 Brexu-cell Phase II Primary refractory, early relapse, 2nd relapse Analysis was not ITT Very rapidly progressive patients were excluded
30
2nd line T-ALL
Nelarabine Navitoclax Venetoclax Dara Velcade
31
Nelarabine in 1st line T-ALL
In pts < 30 Tx with BFM Improves DFS
32
CR def in ALL
<5% blasts in BM and PB No extramedullary disease
33
CNS relapse in ALL
30% if no guided CNS Tx
34
RR B ALL Tx
CART Blina Ino
35
Tx of eldrely pts with ND T ALL using newer agents
Mini HYPER CVD VEN also as 2nd line Nelarabine or velcade added to AYA protocols
36
Leukostasis risk factor in ALL
200K
37
Mutations in T ALL
NOTCH1 FBWX7- Good prognosis MLL, PTEN, RAS, NF1- Poor prognosis
38
Differences between pediatric and older protocols in ALL
In pediatric: More cytostatic drugs ( PEG, vincristine, dexa) Less cytotoxic ( anthracicline, CY) More IT Less cranial RT
39
Ph like %
33%
40
Infusion reaction ro PEG ASP clinical significance
Predicts Ab to PEG If significant switch to Erwinia
41
Blina for MRD positive B-ALL pts after induction
BLAST trial 80% conversion to MRD negative Usually after 1-2 cycles
42
Blina consolidation in MRD negative Ph neg B ALL pts
OS
43
Poor prognostic cytogenetic risk factors in B ALL
MLL Ph like Hypodiploid Complex karyotype (5)
44
Prognostic risk factors in B ALL
MLL Ph like Hypodiploid
45
Post transplant TKI benefit in Ph+ ALL
Improves PFS and OS
46
Pretreatment consideration before Blina/Ino in ALL
Cytoreduction to 10-15K to avoid toxicity
47
Indications to permanantly discontinue PEG-Asp
G3/4 pancreatitis G4 CNS bleeding/thrombosis (sinus vein thrombosis)
48
Time period between Ino and HSCT in ALL
At least 4 weeks To prevent SOS
49
Most important time to measure MRD in ALL
Week 16 If positive- switch Tx

Erez's HEM TEST notes 2024 (35 decks)

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