Chapter 101 CML Flashcards

1
Q

CML chimeric gene product

A

BCR-ABL1

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2
Q

Philadelphia chromosome

A

t(9;22)(q34.1;q11.2)

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3
Q

Phases of CML when untreated

Biphasic/triphasic

A

Early indolent or chronic phase
Accelerated phase
Terminal blastic phase

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4
Q

First BCR-ABL1 TKI approved in 2000

A

Imatinib mesylate

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5
Q

Criteria of accelerated-phase CML

Median survival <1.5 years

A

Presence of 15% or more peripheral blasts

30% or more peripheral blasts plus promyelocytes

20% or more peripheral basophils

Cytogenetic clonal evolution (presence if chromosomal abnormalities in addition to Ph)

Thrombocytopenia <100 x 10^9/L

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6
Q

Blastic-phase CML definition

A

Presence of 30% or more peripheral or marrow blasts or the presence of sheets of blasts in extramedullary disease

Commonly myeloid (60%)

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7
Q

Lymphoid markers of lymphoblasts in lymphoid blastic phase CML

A

CD10
CD19
CD20
CD22

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8
Q

Importance of identifying lymphoid blastic-phase CML

A

Quite responsive to anti-ALL-type chemotherapy (e.g. hyper-CVAD + TKIs)

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9
Q

6 agents approved by the US FDA for the treatment of CML

A
Imatinib
Nilotinib
Dasatinib
Bosutinib
Ponatinib

Omacetaxine

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10
Q

The only TKI active against T315I, a gatekeeper mutation resistant to the other oral TKIs

A

Ponatinib

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11
Q

Acceptable frontline therapies in CML

A

Imatinib
Nilotinib
Dasatinib

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12
Q

Approved for the treatment of chronic and accelerated phase CML after failure of two or more TKIs

A

Omacetaxine

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13
Q

Second generation TKIs

A

Dasatinib
Nilotinib
Bosutinib

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14
Q

Third generation TKI

A

Ponatinib

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15
Q

Imatinib dose

A

Imatinib 400mg daily

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16
Q

Nilotinib dose
First line
Salvage

A

Nilotinib 300mg BID on an empty stomach

Nilotinib 400mg BID

17
Q

Dasatinib dose
First line
Salvage

A

100mg daily

100mg daily in chronic phase
140mg daily in transformation

18
Q

Bosutinib dose

Except frontline

A

500mg daily

19
Q

Ponatinib dose

A

45mg daily

Reduce to 15-30mg daily after a response is achieved

20
Q

Omacetaxine dose

A

1.25mg/m^2 subcutaneously BID x 14 days for induction, 7 days for consolidation-maintenance