AML/ALL KEY FACTS Flashcards
Intermediate risk of relapse in AML
normal cytogenetics
Poor risk of relapse in AML
- >60 yo
- WBC > 100,000
- CNS involvement
- > 5 genetic abnormalities
- FLT3 mutation
< 60 years old AML induction treatment
7+3
< 60 years old AML residual disease treatment
5 + 3
< 60 years old AML FLT3 mutation
midostaurin
< 60 years old AML CD 33
gemtuzumab
< 60 years old AML difficult to treat patient, poor outcomes, previous exp to chemo
Vyxeos
7+3 regimen
- 7 days continuous cytarabine 100 mg/m2 IV
- 3 days anthracycline:
Daunorubicin
Idarubicin
Daunorubicin for AML
Higher CR with 90 mg < 60 years old
90 mg ONLY in < 60 years old
Main toxicity of gemtuzumab
Hepatotoxicity
Who do you use Vyxeos in?
AML patients
- difficult to treat
- poor outcomes
- previous exposure to chemo
- older patients
T/F if a patient is started on 7+3 they can switch to Vyxeos if it is not working?
FALSE
NOT interchangeable
T/F you can use Vyxeos in older AML patients
True
Main toxicity ofr venetoclax
Monitor for TLS
Which AML drug do you decrease the dose of when using anti-fungal therapies?
What substrate is it?
Venetoclax
C34 substrate
> 60 years old AML treatment if unfavorable cytogenetics
Venetoclax daily + decitabine/azacitidine
or decitabine/azacitidine alone
Consolidation treatment for AML
- Cytarabine 3000 mg/m2 IV BID on days 1, 3, 5: <60 yo
- Cytarabine 1000 - 1500 mg/m2
- Vyxeos
- Decitabine/azacitidine + venetoclax
Cytrabine dose in AML differences
< 60 years induction: 100 mg/m2
< 60 years consolidaiton: 3000 mg/m2
>60 years consolidation: 1000 - 1500 mg/m2
renal dysfunction: decrease dose
Low dose cytrabine adverse reactions
- pancytopenia (neutorpenia, anemia thrombocytopenia)
- N/V/D
- Cardiotoxicity
- mucositis
High dose cytrabine adverse reactions
- Pancytopenia
- N/V/D
- Hand-foot syndrome: reversible
- Conjunctivitis: reversible
- Neurotoxicity (cerebellar): irreversible
What drugs can you use for APL?
Tretinoin (ATRA)
Arsenic (ATO)
What is APL diagnosed by?
t(15;17)
T/F ATRA causes QTc prolongation
False!
Arsenic (ATO) causes
T/F Arsenic is pregnancy category X
False!
ATRA is category X
Tretinoin and arsenic ADEs
Both: APL differentiation syndrome
ATRA: category X, not myelosuppressive
ATO: QT prolongation
T/F never give vincristine intrathecally
true
What is the backbone treatment for adult ALL?
- vincristine
- antracycline
- corticosteroids
+/- cyclophosphamide, asparginase
T/F AML is associated with t(9;22)
False
ALL
What do you add if an adult with ALL has philadelphia +?
add TKI
- imatinib
- desatinib
- nilotinib
Which drug is very difficult to compound and what is it used for?
Blinatumomab
for ALL
Major adverse reactions of blinatumab
- Cytokine relase syndrome
- Neurologic toxicity
- TLS
Who uses risk adapated therapy?
Pediatric ALL
Who is very high risk in pediatric ALL risk adapted therapy?
Ph+
Asparginase toxicities
- pancreatitis
- coagulation disorders
- anaphylactic reactions
- hyperglycemia
T/F pediatric protocols for ALL use higher doses of myelotoxic agents
False
- non-myelotoxic agents
Vincristine, steroids, asparginase
T/F pediatric protocols for ALL use higher doses of MTX
True
T/F pediatric protocols for ALL has more intermittent exposure to chemo
False!
continuous
T/F adult protocols for ALL generally have prolonged neutropenia
True!
less continuous exposure to chemo
T/F adult protocols for ALL use higher doses of antracyclines and cytrabine
true
_____ protocols of ALL have a delay in HSCT and _____ protocols of ALL have early HSCT
pediatric
adult
