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HEM TEST 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 LP

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 Ph+ ALL

A

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

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16
Q

ALL classification

A

B-ALL- with recurrent genetic abnormalities (Hypodiploid (usually p53) BCR:ABL1, KM2TA, ph-like, ETV6:RUNX1)
B- ALL/LBL-NOS
T-ALL/LBL (ETP)

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17
Q

B-ALL immunophenotype

A

Defining: CD19 + CD22/CD79a/CD10
PAX5, TdT positive

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18
Q

T-ALL immunophenotype

A

TdT, CD3,CD7, CD1a, CD4/CD8

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19
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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20
Q

Ph+ B-ALL incidence by age

A

increases with age

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21
Q

Azoles toxicity in ALL

A

Posaconazole and voriconazole can exacerbate neurotoxicity of vincristine

22
Q

Agents used in Tx of ALL

A

Steroids
PEG
MTX
CY
vincristine
cytarabine
6-MP
Anthracyclines

23
Q

Inotuzumab ozigomycin

A

CD22 conjugated
SE: VOD

24
Q

Deep cytopenias after 6-MP

A

check TMPT polymorphism

25
Q

Pediatric inspired protocols

A

GMALL
GRALL
BFM

26
Q

Rituximab in ALL Tx

A

improves OS if CD20+
(20% pts)

27
Q

Blinatumomab in ALL Tx

A

improves OS in MRD+ and MRD- pts
TOWER
Litzow 2024
In research for 1st line combined with pediatric inspired pts

28
Q

Tx of MRD- B-ALL pts

A

ASCT in CR1 might not be effective

29
Q

Tx of older adults with B-ALL

A

mini-Hyper CVAD- Blina/Ino
Blina+INO (ALLIANCE)

30
Q

CAR-T in B-ALL

A

ZUMA3
Brexucabtagene autoleucel
Brexu-cell
(similar to axi-cell)
Analysis was not ITT
Very rapidly progressive patients were excluded

31
Q

2nd line T-ALL

A

nelarabine
navitoclax
venetoclax
Dara
Velcade

32
Q

nelarabine in 1st line T-ALL

A

in pts < 30
improves OS

33
Q

CR def in ALL

A

<5% blasts in BM and PB
No extramedullary disease

34
Q

CNS relapse in ALL

A

30% if not guided CNS Tx

35
Q

ASO PCR sensitivity for MRD in ALL

A

10^-4 - 10^-5

36
Q

RR B ALL Tx

A

CART
Blina
Ino

37
Q

Tx of ND T ALL newer agents

A

Mini HYPER CVD VEN
also as 2nd line

38
Q

Hyperleukocytosis risk factor in ALL

A

100K in T ALL
30K in B ALL

39
Q

Mutations in T ALL

A

NOTCH1
FBWX7
good prognosis

MLL, PTEN, RAS, NF1
poor prognosis

40
Q

Differences between pediatric and older protocols in ALL

A

In pediatric:
More cytostatic drugs ( PEG vincristine)
Less cytotoxic ( anthracicline, CY)
More IT
Less cranial RT

41
Q

Differences between pediatric and adult protocols in ALL

A

More cytostatic drugs ( PEG vincristine)
Less cytotoxic ( anthracicline, CY)
More IT
Less cranial RT

42
Q

Ph like %

A

33%

43
Q

Infusion reaction ro PEG ASP clinical significance

A

Predicts Ab to PEG

44
Q

BLAST trial

A

Blina for MRD positive after induction
80%
Usually after 1-2 cycles

45
Q

ECOG1910 trial

A

Blina during induction
3rd phase
Effective also in MRD negative

46
Q

Prognostic risk factors in B ALL

A

MLL
Phase like
Hypodiploid

47
Q

Prognostic risk factors in B ALL

A

MLL
Phase like
Hypodiploid

48
Q

Post transplant TKI benefit in Ph+ ALL

A

Improves PFS

49
Q
A
50
Q
A

HEM TEST 2024 (32 decks)

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