AML & CML Flashcards
Risk factors AML
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
AML signs & symptoms
Anemia- fatigue, SOB
Thrombocytopenia- bleeding risk
Neutropenia- infection risk
Spontaneous TLS
CNS involvement rare
Hyperleukocytosis
Oncologic emergency
Management
-Hydroxyurea
-leukopheresis
AML Diagnostic &work up
-H&P
-CBC w diff
-CMP
DIC panel
TLS screening
bone marrow biopsy
CNS imaging/ spinal tap
AML chemo management assessment
fitness assessment
HLA typing
ECHO + EKG
Cytogenetic and molecular analysis
AML diagnostic criteria
> 20% blasts isolated on bone marrow biopsy or peripheral blood
-t(8;21), t(15;17), inv(16) (acts like leukemia)
AML prognostic markers
cytogenetics
molecular abnormalities
age
primary vs secondary AML
performance status
availability of stem cell donor
WBC at diagnosis
extramedullary disease
Criteria for high intensity induction chemotherapy
<60y OR >60 without sig co-morbidities and good performance status
Aggressive disease course
Candidates for allogeneic stem cell transplant
7 + 3 induction therapy
Cytarabine CIVI x7days
daunorubicin or idarubicin x 3 days
Response criteria in AML
Leukemia free state - day 14 bmbx
Goal <5% blasts, hypocellular
Complete response
-remission and count recovery
AML Post remission therapy (intensive chemo only)
*High dose cytarabine
Liposomal daunorubicin + cytarabine
Low dose chemo
HMA (azacitidine or decitabine) + venetoclax
Low dose cytarabine + venetoclax
Ivosidenib + venetoclax - IDH1 only
Quizartinib
FLT3-ITD
Many dose adjustments for drug interactions
Cardiac + QTC prolongation
Midostaurin
FLT3 TKD
Smells bad–> vomiting
Gilteritinib
Dual inhibitor of FLT3 and AXL
ONLY relapse/refractory
Ivosidenib
IDH1 mutation
Initial or relapsed/refractory
Enasidenib
IDH2 refractory/relapsed
Anthracyclines (Daunorubicin, Idarubicin, Mitoxantrone) clinical pearls
Myelosuppression
Cardiac toxicity-lifetime cumulative dose
Cytarabine clinical pearls
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
Gemtuzumab Ozogamicin
Infusion-related reactions–> premedicate with acetaminophen, diphenhydramine and methylprednisolone
Hepatotoxicity, including fatal veno-occlusive disease (VOD): boxed warning -cumulative doses
Low intensity chemo clinical pearls
HMAs- constipation –> standing bowel medication (can cause ileus)
Low- moderate emetogenicity
-premedicate with ondansetron
Myelosuppression drops to 0
CML lab findings
leukocytosis- WBC > 25 x 10^9
thrombocytosis
bone marrow findings- different phases of CML
PH+ chromosomes- should be present
CML classification
Chronic Phase
Accelerated phase
Blast phase
Responses to CML therapy
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
