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oncology > AML & CML > Flashcards

AML & CML Flashcards

1
Q

Risk factors AML

A

Increasing Age
Prior Chemo= therapy related AML
-anthracyclines, alkylator (ex. cyclophosphamide, melphalan)
-much poorer outcomes than de novo AML
Prior pelvic radiation
Cigarette smoking
Radiation exposure
Benzene exposure
Pesticide exposure
Petrochemical exposure

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2
Q

AML signs & symptoms

A

Anemia- fatigue, SOB
Thrombocytopenia- bleeding risk
Neutropenia- infection risk
Spontaneous TLS
CNS involvement rare

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3
Q

Hyperleukocytosis

A

Oncologic emergency
Management
-Hydroxyurea
-leukopheresis

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4
Q

AML Diagnostic &work up

A

-H&P
-CBC w diff
-CMP
DIC panel
TLS screening
bone marrow biopsy
CNS imaging/ spinal tap

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5
Q

AML chemo management assessment

A

fitness assessment
HLA typing
ECHO + EKG
Cytogenetic and molecular analysis

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6
Q

AML diagnostic criteria

A

> 20% blasts isolated on bone marrow biopsy or peripheral blood
-t(8;21), t(15;17), inv(16) (acts like leukemia)

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7
Q

AML prognostic markers

A

cytogenetics
molecular abnormalities
age
primary vs secondary AML
performance status
availability of stem cell donor
WBC at diagnosis
extramedullary disease

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8
Q

Criteria for high intensity induction chemotherapy

A

<60y OR >60 without sig co-morbidities and good performance status
Aggressive disease course
Candidates for allogeneic stem cell transplant

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9
Q

7 + 3 induction therapy

A

Cytarabine CIVI x7days
daunorubicin or idarubicin x 3 days

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10
Q

Response criteria in AML

A

Leukemia free state - day 14 bmbx
Goal <5% blasts, hypocellular

Complete response
-remission and count recovery

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11
Q

AML Post remission therapy (intensive chemo only)

A

*High dose cytarabine
Liposomal daunorubicin + cytarabine

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12
Q

Low dose chemo

A

HMA (azacitidine or decitabine) + venetoclax
Low dose cytarabine + venetoclax
Ivosidenib + venetoclax - IDH1 only

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13
Q

Quizartinib

A

FLT3-ITD
Many dose adjustments for drug interactions
Cardiac + QTC prolongation

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14
Q

Midostaurin

A

FLT3 TKD
Smells bad–> vomiting

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15
Q

Gilteritinib

A

Dual inhibitor of FLT3 and AXL
ONLY relapse/refractory

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16
Q

Ivosidenib

A

IDH1 mutation
Initial or relapsed/refractory

17
Q

Enasidenib

A

IDH2 refractory/relapsed

18
Q

Anthracyclines (Daunorubicin, Idarubicin, Mitoxantrone) clinical pearls

A

Myelosuppression
Cardiac toxicity-lifetime cumulative dose

19
Q

Cytarabine clinical pearls

A

Neurotoxicity- motor coordination
Neuro checks prior to each dose
Hand-foot syndrome
Conjunctivitis
-dex 0.1% eyedrops q6h during and for 3 days after HiDAC is complete

20
Q

Gemtuzumab Ozogamicin

A

Infusion-related reactions–> premedicate with acetaminophen, diphenhydramine and methylprednisolone
Hepatotoxicity, including fatal veno-occlusive disease (VOD): boxed warning -cumulative doses

21
Q

Low intensity chemo clinical pearls

A

HMAs- constipation –> standing bowel medication (can cause ileus)
Low- moderate emetogenicity
-premedicate with ondansetron
Myelosuppression drops to 0

22
Q

CML lab findings

A

leukocytosis- WBC > 25 x 10^9
thrombocytosis
bone marrow findings- different phases of CML
PH+ chromosomes- should be present

23
Q

CML classification

A

Chronic Phase
Accelerated phase
Blast phase

24
Q

Responses to CML therapy

A

Hematologic response- blood draw
-partial or complete hematologic response
Cytogenetic response- # of Ph+ on bmbx
-minor, partial, complete
Molecular response- fusion protein in blood
-major or complete

25
Q

Imatinib

A

1st gen TKI
Selective inhibitor of BCR-ABL tyrosine kinase
-c-KIT and PDGFR (off target effects)
peripheral edema

26
Q

Resistance to TKIs

A

OCT1
Pgp
T315I- gate keeper mutation

27
Q

Dasatinib

A

2nd gen TKI
BCR-ABL &Src inhibitor
More potent than imatinib
pleural effusions

28
Q

Nilotinib

A

2nd gen TKI
more potent than imatinib
Cardiac conduction abnormalities
QTc prolongation
arrhythmias

29
Q

Bosutinib

A

3rd gen TKI
Activity against BCR-ABL, Src, Lyn and HCk kinases
Diarrhea

30
Q

Ponatinib

A

3rd gen TKI
active against all BCR-ABL point mutations including T315I
Boxed warning for vascular occlusion, HF & hepatotoxicity
-blood clots- heart attacks + stroke

31
Q

Asciminib

A

STAMP inhibitor
targets myristoyl pocket
Indication: pts who have previously revieved 2+ TKIs or have the T315I mutation
Muscle pain, fatigue- well tolerated

32
Q

Additional considerations for TKIs

A

Adherence!!!!!!
DDI- CYP3A4
Food-drug interactions
Dasatinib needs acidic environment for absorption
Nilotinib & asciminib- empty stomach
Dose adjustments
imatinib- renal & hepatic
nilotinib, bosutinib, ponatinib- hepatic

33
Q

Accelerated Phase treatment

A

TKIs at a higher dose
allogeneic transplant may be considered

34
Q

Blast Crisis

A

TKI +/- chemo followed by allogeneic HSCT
AML or ALL based induction regimens

oncology (9 decks)

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