AML

Question 1

Median age AML

Answer 1

65 yo (rare in general, mostly elderly)

Question 2

Risk factors AML

Answer 2

benzene, XRT, Downs, prior chemo (sp etoposide and alkylating agents), Faconi, Diamond Blackfan

Question 3

What is Sweet syndrome

Answer 3

Inflammatory rxn with fever and painful violaceous scutaneous lesions

Question 4

How can a pt be diagnosed

Answer 4

1. Genetics
   or
   2a. 20%+ blasts in marrow or peripheral blood AND
   2b. Myeloid origin proven by Auer rods or flow cyometry

Question 5

Defining genetic mutations for AML

Answer 5

t(8,21)
inv(16)
t (16,16)
t(15,17)

Question 6

What’s the general name of test for molecular markers?

Answer 6

Rapid heme panel testing

Question 7

Poor prognostic markers

Answer 7

Mutations:
FLT3-ITD
RUNX1/ASXL1/TP53

Question 8

Induction Tx: <60 yo

Answer 8

Induction with goal of CR
“7+3”: cytarabine cont infusion x 7d; daunorubicin bolus on d1-3

Check BMBx @ d14 w/ goal of <5% blasts, if not, re-induce with 5+2

Question 9

2nd line tx: <60

Answer 9

HiDAC

Question 10

1st line consolidation tx <60 yo

Answer 10

Goal: Eliminate undetectable residual dz.

3-4 cycles HiDAC.

Question 11

Adverse risk consolidation tx

Answer 11

allo HCT

Question 12

What tx would you add to induction if FLT3 positive

Answer 12

midostaurin

Question 13

1st line consolidation tx >60 yo

Answer 13

“5+2” cytarabine + daunorubicin or IDAC

Question 14

Onc emergency that occurs early in consolidation tx when pt has high WBC

Answer 14

TLS

Question 15

Older pt not eligible for chemo tx

Answer 15

Venetoclax + hypomethylating agent

Question 16

Hypomethylating agents include

Answer 16

decitabine (dacogen), azactitdine (vidaza)

Question 17

HiDAC main AEs to monitor for

Answer 17

cerebellar toxicity (daily neuro checks), conjunctivitis (dex drops)

Question 18

What is the use for hydrea (hydroxyurea)

Answer 18

off-label, cytoreduction of WBC

Question 19

Dose of cytarabine for 7+3 induction

Answer 19

100-200 mg/m2 IVCI

Question 20

Dose of daunorubicin for 7+3

Answer 20

90 mg/m2 IVP

Question 21

Be mindful of this toxicity with daunorubicin

Answer 21

cardiotoxicity; ensure EF >45% at start

Question 22

What anti-emetic to rx with 7+3

Answer 22

Zofran 16 mg qd

Question 23

Ppx for TLS includes…

Answer 23

allopurinol 300 mg qd

sufficient IVF for UOP >100cc/h

Question 24

How many patients need the 5+2 induction phase

Answer 24

1/4 - 1/3

Question 25

Length of stay in hospital for treatment

Answer 25

4-6 weeks

Question 26

SE of typical tx:

Answer 26

myelosuppression, aloppecia, rash, mucosititis, n/v/d

Question 27

When ok to d/c

Answer 27

ANC >500

Question 28

d/c instructions

Answer 28

• Need for antiemetics?

- f/u onc 5-7d

Question 29

How many cycles does someone typically get of HiDAC for consolidation

Answer 29

3-4

Question 30

For how long does one use the dex eye drops for HiDAC

Answer 30

prior to chemo until 72 hours post final dose

Question 31

Length of stay for consolidation

Answer 31

5-6 days

Question 32

Ppx hand-foot syndrome with consolidation

Answer 32

Nicotine patch + oral steroids

Question 33

Dispo following HiDAC consolidation

Answer 33

1. dex eye drops
2. anti-nausea meds
3. mouth care
4. ppx abx (cipro/levo - up to onc)
5. 2x weekly labs

Question 34

When do counts recover following d/c for HIDAC

Answer 34

~28d

Question 35

Whats the tx for relapse/refractotry AML

Answer 35

ME/MEC/HAM

Question 36

Goal of ME/MEC/HAM

Answer 36

Induce remission prior to allo SCT

Question 37

What to check before starting ME/MEC/HAM (specific to mitoxantrone)

Answer 37

TTE, ensure EF > 45%