AML/ALL Other Flashcards
What is the most common cause of cancer in children?
Acute leukemia
T/F complete remission is higher in adult patients with acute leukemias than children
False!
>85% CR in children/young adults
65-85% in adults
Does AML or ALL have more estimated new cases?
AML
Does AML or ALL have more estimated deaths?
AML
T/F in acute leukemia cells continue to differentiate
False!
Do not continue to differentiate
T/F ALL has a higher survival rate in pediatrics and adults compared to AML
TRUE!
Etiology of acute leukemias
- most times don’t know!
- Genetic conditions
- Socioeconomic
- Immunologic factors
- Environmental exposure
- Toxins (
- Family history (high birth rate?)
What is the median age of diagnosis of ALL?
10 years
What is the median age of AML?
67 years
T/F leukemia is more common in females
False!
Males
T/F ALL has a higher incidence in caucasians
True
In acute leukemia diagnosis what blast % will they have?
What is a normal blast %?
>20% - leukemia
<5% - normal
S/S of acute leukemia
- anemia
- thrombocytopenia
- neutorpenia
- CNS (seizures, HA, visual disturbances)
- gingival hyperplasia
- bone pain
- extra-medullary disease (leukemia cutis, chloromas)
S/S of anemia in acute leukemia
fatigue
malaise
CNS
cardiac
S/S of thrombocytopenia in acute leukemia
bleeding
bruising
petechiae
S/S of neutropenia in acute leukemia
infection
fever
What labs should you get to diagnose acute leukemia?
- CBC with differential
- Uric acid, K, P, SCr
- Peripheral blood smear (blasts)
- Coagulation studies
- Bone marrow biopsy
- Cytogenetic analysis
What is the main goal of treatment in acute leukemia?
Cure!
What are the 3 things needed to achieve complete remission in acute leukemias?
- < 5% blasts in bone marrow
- Recovery of platelets to > 100,000
- Recovery of ANC >1500
What are all the goals of treatment for acute leukemias
- cure
- rapidly achieve CR
- maintain CR- prevent recurrence
- minimize toxicity
What is treatment based on in AML?
risk of relapse
T/F if you have features associated with a good response in AML you would give a more intensive chemotherapy regimen
False!
good response: less chemo
poor response: more chemo
Goal of remission induction in AML
attain complete remission
- restore normal hematopoesis
How do you look for residual disease after induction in AML?
look at bone marrow
empty: no further treatment
What is pancytopenia comprised of?
- neutropenia: ~30 days
- anemia
- thrombocytopenia
T/F you premedicate with gemtuzumab
True!
APAP, benadryl, methylpred
- risk of infusion reaction
What is Vyxeos?
liposomal cytarabine + daunorubicin
Which drug contains copper and monitor for toxicity?
What is it used to treat?
Vyxeos for AML
What drug class do you use to treat > 60 year olds with AML?
hypomethylating agents
What are the 2 hypomethylating agents used to treat AML?
Decitabine
Azacitidine
What is venetoclax target?
BCL-2 protein
Goal of consolidation in AML
achieve durable remission
In AML who do you use HSCT for?
poor-risk cytogenetics if chance of cure
relapse
T/F the risk of AML relapse is related to duration of 1st remission
true
T/F APL has a poor prognosis
False!
Good prognosis!
What is APL characterized by?
severe coagulopathies
S/S of APL differentiation syndrome
fever
respiratory distress
interstitial pulm infiltrates
pleural effusions
weight gain
DEATH
How can you prevent or treat APL differentiation syndrome?
Dexamethasone
What do you monitor when taking arsenic (ATO)?
K and Mg
- risk of QT prolongation
T/F B cell ALL is less common than T cell ALL
False
B cell more common
T/F CNS involvement is more common in AML than ALL
False!
More common in ALL
What are the risk features associated with relapse in ALL?
- WBC > 50,000
- chromosome abnormalities (Ph+, t(4;11)
- < 1 yo; > 10 yo
- extra-medullary involvement
- no remission within 4 weeks of tx
- male
Which drugs are used intrathecally for CNS issues in ALL?
MTX
Cytarabine
Hydrocortisone
**NOT vincristine**
T/F you only do CNS prophylaxis in ALL treatment during induction
False
Due during remission induction and consolidation/intensification
Goal of induction in ALL
reduce tumor burden
Goal of consolidation in ALL
eliminate leukemic cells remaining after induction
Goal of maintenance therapy in ALL
prevent disease relapse after post remission induction and consolidation
What are CALGB 811 and Hyper-CVAD used for?
ALL
T/F CART can be used in ALL
True
What is used in standard induction in pediatric ALL?
Vincristine
Prednisone/dexameth
asparginase/PEG/asp
What is added to high risk induction in pediatric ALL?
daunorubicin
