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Chronic Leukemia Flashcards

1
Q

CHRONIC LEUKAEMIAS

(Rapidly or Slowly?) progressing malignancy that starts in blood- forming tissue and causes the production and accumulation of abnormal blood cells.

A

Slowly

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2
Q

CHRONIC LEUKAEMIAS

Accumulated blood cells are ________ cells . cells in (early or late?) stages of myeloid or lymphoid cell production

A

matured white

Late

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3
Q

CHRONIC LEUKAEMIAS

There are two main types: _________ and ________ , both of which primarily affect (children or adults?) .

A

chronic lymphocytic leukaemia (CLL) and chronic myeloid leukaemia (CML)

Adults

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4
Q

CHRONIC LYMPHOCYTIC LEUKAEMIA (CLL)

____clonal disorder characterized by a progressive accumulation of __________ lymphocytes

  • Characterized by chronic persistent lympho_____.
A

Mono

functionally incompetent

cytosis

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5
Q

CHRONIC LYMPHOCYTIC LEUKAEMIA (CLL)

In the case of CLL, B-cell CLL derives from the _____________ B cell.

They express CD___, CD__ and CD___ and have (elevated or reduced ?) levels of membrane immunoglobulins (IgM, IgD), CD79b & FMC7.

A

antigen- experienced

19; 5; 23

Reduced

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6
Q

CHRONIC LYMPHOCYTIC LEUKAEMIA (CLL)

CLL cells are monoclonal because they _____________________

A

express only one form of light chain (lambda or kappa) on their cell surface.

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7
Q

In CLL

All normal stages of lymphoid development are postulated to have a malignant counterpart.

T/F

A

T

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8
Q

CHRONIC LYMPHOCYTIC LEUKAEMIA (CLL)
B cell CLL is characterized by a progressive accumulation within the marrow and blood of long-lived mature leukaemic lymphocytes due to:

stimulation of ______ by ______

due to reduced ______

not because of _______

A

growth by external signals

apoptosis

rapid production

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9
Q

CHRONIC LYMPHOCYTIC LEUKAEMIA (CLL)
B cell CLL is characterized by a progressive accumulation within the marrow and blood of long-lived mature leukaemic lymphocytes due to:

•stimulation of growth by external signals e.g _____,_____ and ligands binding to ________, and

•due to reduced apoptosis felt to be largely mediated by overexpression of ___, a protein known to inhibit cellular apoptosis.

A

cytokines, chemokines; B cell receptors

bcl-2

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10
Q

T-CLL is a common disease.

T/F

A

F

T-CLL is a rare disease, therefore Much less is known about

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11
Q

_____ is the most common form of leukaemia in the western hemisphere

It makes up ___-__% of all leukaemias.

A

B-CLL

25-30

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12
Q

The peak incidence of CLL is in the ___ decade of life.

The overall incidence is 20 per 100,000 in persons >___ years of age.

A

6th

70

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13
Q

The male to female ratio of CLL is __:___

A

2:1.

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14
Q

95% of CLL is of ___ cell origin.

___-CLL is a rare disease.

A

B

T

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15
Q

CLL - Epidemiology

Overall median survival of patients is about ___-___ years.

A

10 to 20

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16
Q

CLL - Epidemiology

Individual prognosis can be quite variable – _____ in some patients and life expectancy is not shortened, _____ in others and can progress rapidly and survival from diagnosis may be __-__ years.

A

indolent

aggressive

2-3

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17
Q

CLL - Epidemiology

Mortality often due to:

•overwhelming _____ with marked ____ and ——-

•Overwhelming ______
•_______
•transformation to an aggressive ______, so called a _______

A

tumour burden; adenopathy and splenomegaly

infection

bleeding

Lymphoma; Richter’s transformation.

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18
Q

CLL – Clinical features

Incidental finding on _____, where there is isolated _____ and the patient is asymptomatic.

If complaints are present, they are usually:____,_______, night sweats, fever and ________

A

CBC; lymphocytosis

weakness, easy fatigue

weight loss.

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19
Q

CLL – Clinical features

• There may be frequent bacterial and viral infections because of ________.

•Patients with CLL may report ________ to _________ or _______

A

hypogammaglobulinemia

an exaggerated response

mosquito or other insect bites.

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20
Q

CLL – Clinical features

On physical examination, (symmetrical or asymmetrical?) peripheral ______ is most frequent abnormal finding involving the neck, axillae and inguinal regions.

Nodes are usually (painful or painless?) .

A

symmetrical; lymphadenopathy

Painless

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21
Q

CLL – Clinical features

_________ and ______ are variably present.

__________ and __________ are associated with CLL and can result in severe anaemia and thrombocytopenia.

A

Splenomegaly and hepatomegaly

Autoimmune haemolytic anaemia (AIHA) and immune thrombocytopenic purpura (ITP)

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22
Q

CLL – Clinical features

_____ occurs 10-25% of the time, while ___ is seen in 2% of patients.

A

AIHA; ITP

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23
Q

CLL – Clinical features

________,______,_______, and _______ result from the immune dysregulation which occurs in CLL.

A

AIHA, ITP, hypogammaglobulinemia and an exaggerated response to mosquito bites

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24
Q

Which occurs more in CLL patients

AIHA or ITP

A

AIHA

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25
Q

Lymph gland involvement in CLL

•may be _____ or ____, but generally it is ____________

•________ or ______ but not ______

A

subtle or spectacular ; only within nodes

unsightly or uncomfortable; invasive

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26
Q

CLL – Laboratory findings

Lymphocytosis: diagnosis of CLL requires evidence of lymphocytosis, at least ____ × 109/L, and lymphocytic infiltration in the ______ of at least ___%.

A

10

bone marrow

40

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27
Q

CLL – Laboratory findings

With immunological methods, particularly the detection of monoclonal B-cell populations by _______, it is possible to diagnose the disease with lymphocyte counts below this threshold. (Absolute clonal B cell lymphocyte count >___ × 109/L)

A

light-chain restriction

5

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28
Q

CLL – Laboratory findings

30% of CLL patients have _______ or _______ secondary to an immune process or marrow infiltration.

A

anaemia or thrombocytopenia

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29
Q

CLL – Laboratory findings

Morphologically, the lymphocytes in blood films are (small or large?) and show scanty cytoplasm and a characteristic pattern of ________, nucleolus is ______

A

Small

nuclear chromatin clumping

inconspicuous

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30
Q

Azurophil granules are seen on all normal T cells

T/F

A

F

Azurophil granules are seen only in a minority of normal T cells.

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31
Q

CLL – Laboratory findings

The presence of ____/____ cells, literally _____, destroyed cells on a regular blood smear, is consistently seen with CLL

A

smudge/smear

flattened

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32
Q

CLL cells morphologicallu indistinguishable from normal lymphocytes.

T/F

A

T

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33
Q

CLL – Laboratory findings

•Peripheral film usually shows ____cytic _____chromic anaemia in (early or later?) stages.

•If AIHA is present, _____ and _____ can be seen on the blood smear.

•Bone marrow: cellularity is ___eased and 30-99% of nucleated cells are (mature or immature?) lymphocytes.

A

normo; normo; later

spherocytes and polychromasia

incr; mature

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34
Q

CLL in blood counts of 50x109/l (or more) are often with symptoms

T/F

A

F

As cells are small, non-functional and largely “inert”, CLL in blood counts of 50x109/l (or more) are often without symptoms

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35
Q

CLL – Laboratory findings

Immunophenotyping: CLL cells co-express CD___ and CD__.

A

19 ; 5

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36
Q

CLL – Laboratory findings

CD19 is a __ cell marker, and CD5 is a __-cell marker.

A

B

T

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37
Q

The expression of a T cell marker on a B cell is an example of _______

A

lineage infidelity

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38
Q

lineage infidelity is seen in only CLL

T/F

A

F

lineage infidelity that is seen not only in CLL but in AML and ALL as well.

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39
Q

CLL – Laboratory findings Immunophenotyping:

CLL cells are also positive for CD___, negative for CD____ (or dim+), are either ________ or _______ restricted and have a dim level of expression of the immunoglobulin heavy chains IgM and IgD.

A

23

79b

kappa or lambda light chain

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40
Q

Which is more normally, Bcell or Tcell

A

Tcell

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41
Q

The normal T-cell/B-cell ratio is reversed in CLL.

T/F

A

T

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42
Q

Normally, T lymphocytes constitute approximately ____% of the total lymphoid population and B lymphocytes, ____% of the lymphoid cells.

A

80

20

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43
Q

In B-cell CLL, B cells account for nearly ____% of all lymphocytes.

A

90

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44
Q

Cytogenetics and molecular diagnostics are needed to make the diagnosis of CLL.

T/F

A

F

They are not

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45
Q

CLL – Laboratory findings

Cytogenetics and molecular diagnostics are useful in _____________.

A

determining the survival of patients

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46
Q

CLL – Laboratory findings
Cytogenetics and molecular diagnostics:

In particular,___________, corresponding to a mutation in the _____ gene, is associated with a very short survival, as are ___________.

A

17p deletions; p53

11q deletions

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47
Q

CLL – Laboratory findings
Cytogenetics and molecular diagnostics:

Other markers of poor prognosis include the presence of the ____ mutation (with or without chromosome deletions), and an _________ gene.

A

p53

unmutated Vh

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48
Q

Vh corresponds to the _____ portion of the immunoglobulin _____ chain.

A

variable

heavy

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49
Q

CLL – Diagnostic criteria

•>__ x 109/L absolute blood lymphocytosis and cells morphologically _____ in appearance, sustained over at least a _____ period.

•___% lymphocytes in a _________ bone marrow.

•A monoclonal B-cell phenotype simultaneously showing CD__ positivity (dual positivity CD__, CD__-__ and CD___).

A

5; mature; 4 week

30; normocellular or hypercellular

5; 5; 19-20; 23

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50
Q

CLL – Differential Diagnosis

_______
_______
_______
_______
________
________

A

B-PLL B cell prolymphocytic leukaemia
T-PLL/CLL
Hairy cell leukaemia (HCL)
Non-Hodgkin’s lymphoma Mononucleosis and other viral infections

Acute lymphoblastic leukaemias

51
Q

CLL – Differential Diagnosis

B-PLL – B cell prolymphocytic leukaemia:

clonal disorder of B cells where 55% or more of cells have a _____ when examined morphologically. (More or less?) aggressive leukaemia.

A

nucleolus

More

52
Q

CLL – Differential Diagnosis

T-PLL/CLL

– may be indistinguishable from ____ or ____ morphologically.

-_____distinguishes the T cell origin of this malignancy from its B cell counterpart.

-(More or less?) aggressive leukaemia.

A

B-CLL or B-PLL

Immunophenotyping

More

53
Q

CLL – Differential Diagnosis

Hairy cell leukaemia (HCL)

– also produces a clonal lymphocytosis but the lymphocytes have ________ .

-Usually associated with more profound _______, and with marked ________.

A

hair-like projections

pancytopenia

splenomegaly

54
Q

CLL – Differential Diagnosis

Non-Hodgkin’s lymphoma with circulating lymphoma cells:

-In ______ lymphoma and _____ lymphoma there may be circulating malignant lymphocytes.

-____lymphoma with ___ lymphocytes (SLVL) (or splenic marginal zone lymphoma) may also present with a clonal lymphocytosis.

A

follicular; mantle cell

Splenic; villous

55
Q

CLL – Differential Diagnosis

Mononucleosis and other viral infections:

-Mononucleosis can cause ____,_____, and ______.
- Usually it is an illness of ______, in whom CLL is quite (common or rare?) .

-Unlike CLL, mononucleosis and other viral infections are _____ and the lymphocytosis _____________

A

lymphocytosis, splenomegaly and adenopathy

younger adults;rare

self-limited ; resolves spontaneously.

56
Q

CLL – Differential Diagnosis

Acute lymphoblastic leukaemias are usually very (difficultly or easily?) distinguished from CLL by their presentation and by the morphology of the _______.

A

easily

blasts

57
Q

Also, lymphocytes in mononucleosis are usually atypical.
They are irregularly shaped, _______ size , and sometimes resemble ______.

A

medium to large

monocytes

58
Q

CLL – Staging (Rai)

0-_______: >___ x 10^9 in blood and >__% in bone marrow

1-stage 0 with ______

2- stage 1 with _______

3- stage 2 with _____

4- stage 3 with ________

A

lymphocytosis; 15; 40

enlarge lymph node

hepatomegaly, splenomegaly, or both

Anaemia

thrombocytopenia

59
Q

CLL – Staging (Binet)

Binet Staging classifies CLL according to the ____________ as well as presence of ________ or _______

A

number of lymphoid tissues that are involved

low red blood cell count (anaemia) or low number of platelets (thrombocytopenia):

60
Q

CLL – Staging (Binet)

Binet Stage A patients have _______ areas of enlarged lymphoid tissue and _______ anaemia or thrombocytopenia.

Binet Stage B patients have _______ areas of enlarged lymphoid tissue and ________ anaemia or thrombocytopenia.

Binet Stage C patients _______ anaemia and/or thrombocytopenia

A

fewer than three ; do not have

three or more ; do not have

have

61
Q

CLL –

Secondary causes of anaemia eg iron def.,or AIHA or ITP must be treated after staging.

T/F

A

F

Before

62
Q

CLL – Treatment and outcome
The Rai staging system, developed in the 1980s, predicts ______ from the time of diagnosis and reflects the ____ of disease.

A

median survival

burden

63
Q

The Rai staging system aids in determining who should be treated.

T/F

A

T

64
Q

CLL – Treatment and outcome

Indications for treatment: Unlike AML and ALL which are uniformly fatal shortly after diagnosis, CLL may have an indolent course. Thus, not all patients ______________.
In fact, _____ patients, in particular, may die of another illness before they have any complications related to their CLL.

A

require therapy at diagnosis

elderly

65
Q

CLL – Treatment and outcome

Decision to treat is guided by ______, the presence of _______, and ______ activity.

A

clinical staging

symptoms

disease

66
Q

CLL – Treatment and outcome

Evidence that treatment can improve outcome is only available for patients with Rai stage ________

A

III and IV

67
Q

Patients in earlier stages of CLL (Rai 0-II, Binet A) are generally treated

T/F

A

F

Are generally not treated but monitored with a “watch and wait” strategy.

68
Q

CLL – Treatment and outcome

In early stages, treatment is necessary only if _____________ occur

A

symptoms associated with the disease

69
Q

CLL – Treatment and outcome

Some early stage patients will be treated if they have a lymphocyte doubling time of _______, which reflects (more or less ?) aggressive disease.

A

less than 6 months

More

70
Q

Indications for therapy in CLL:

________
________
____-related symptoms

Markedly enlarged or ——— _____

Symptomatic ________

Blood lymphocyte count doubling time <________

_______ transformation
_______ transformation

A

Anaemia; Thrombocytopenia

Disease

painful spleen; lymphadenopathy

6 months; Prolymphocytic; Richter

71
Q

CLL – Treatment and outcome
The main categories of treatment include:

____therapy
_____therapy
___________ transplantation
___________
Intravenous ________

A

Chemo

Immuno

Allogeneic stem cell

Glucocorticoids

gammaglobulin

72
Q

CLL – Treatment and outcome

Chemotherapy: The ____ analog ,______ is the most active agent used to treat CLL.

Other agents that are used are the alkylating agents, ______ and _____

•These drugs are given ___ or in ____ with ______ and/or with the ______

A

purine; fludarabine

chlorambucil and cyclophosphamide.

alone; combination; one another

monoclonal antibodies

73
Q

CLL – Treatment and outcome

• Immunotherapy:

_____, a monoclonal antibody targeting CD___, which has (weak or strong?) expression on CLL cells, has more recently been added to the treatment of CLL.
Alemtuzumab, a monoclonal antibody against CD___, which is expressed on ___ lymphocytes, is also effective in CLL.

A

Rituximab

20; weak

53; all

74
Q

CLL – Treatment and outcome

Allogeneic stem cell transplantation: This intensive therapy is reserved for (younger or older ?) patients with aggressive disease that may be ______ or may have _____ after treatment with _____.

It may cure up to ____% of patients but is associated with about a ____% chance of treatment related mortality, and a significant risk of ———— disease.

A

Younger

resistant; relapsed; fludarabine

30-40; 20

graft versus host

75
Q

CLL – Treatment and outcome

Glucocorticoids (Prednisone) are used to treat ______ and _____

A

AIHA and ITP.

76
Q

CLL – Treatment and outcome

Intravenous gammaglobulin (pooled, multi-donor immunoglobulins) are used to reduce the rate of _____ in patients with _________ and __________.

A

infections

hypogammaglobulinemia

recurrent infections.

77
Q

Allogeneic stem cell transplantation in CLL

It offers the potential of the immune-mediated ____________ effect (adoptive immunotherapy).

A

graft-versus leukaemia

78
Q

CLL – Late complications

Richter Syndrome:___ % of patients with CLL will transform to an aggressive ___________, which is often (easy or difficult?) to treat.

A

1-10

large B cell lymphoma

Difficult

79
Q

CLL – Late complications

Prolymphocytic transformation: may occur _______ in approximately _____% of patients with CLL.

A

terminally

10

80
Q

CLL – Late complications

Solid Tumour: CLL patients have a higher incidence of developing __________ (ie: GI, lung or any other organ) and also have a high risk of development of ____ cancers.

A

a second malignancy

skin

81
Q

Bacterial, viral and fungal infections are the 3rd most important cause of morbidity and mortality in CLL.

T/F

A

F

Thee most!

82
Q

CHRONIC MYELOID LEUKAEMIA

CML is a clonal disorder of _________________ cell.

A

a pluripotent stem

83
Q

CHRONIC MYELOID LEUKAEMIA
It is characterized by:

______
Extreme blood ______ and granulocytic _____

_____philia
Thrombo_____

_____megaly

A

Anaemia

granulocytosis; immaturity

Baso

cytosis; Spleno

84
Q

CML

Malignancy of the ________ cells with excessive proliferation of the _____ lineage (especially _______)

A

hematopoietic stem

myeloid

granulocytes

85
Q

CML

The diagnosis of CML is usually based on detection of the _______ chromosome, or ______ t(__;__), which is present in ___% of patients.

A

Philadelphia(Ph)

translocation ; 9;22

95

86
Q

CML

Another 5% of patients with CML have complex or variant translocations involving ______ that have (different or the same?) end result, which is ___________________________________

A

additional chromosomes

The same

fusion of the BCR gene on chromosome 22 to the ABL gene on chromosome 9.

87
Q

BCR -___________ gene on chromosome __

ABL- ________________ gene on chromosome __

A

breakpoint cluster region; 22

Abelson leukaemia virus; 9

88
Q

CML

The Philadelphia chromosome is found in cells from the _____,______,______,________ lineages, indicating that CML is a disease of the ______________________ -cell.

A

myeloid, erythroid, megakaryocytic, and B lymphoid

pluripotent hematopoietic stem

89
Q

Role of Ph. chromosome in pathogenesis of CML

Genetic sequence on Chromsome _______ (__) are fused with sequences translocated from Chromosome __(__)

A

22 (bcr)

9 (abl)

90
Q

Role of Ph. chromosome in pathogenesis of CML

This fusion gene (___-___) codes for an abnormal protein with _____ activity ( ____ ).

Which is involved in signal transduction and activates pathways within the affected cells leading to ________

A

BCR-ABL

Tyrosine Kinase ; p210

malignant transformation.

91
Q

Tyrosine kinases work by transferring a ___ group from ____ to intracellular proteins that regulate _______

A

phosphate

ATP

cell division.

92
Q

The incidence of CML appears to be constant worldwide.

T/F
.

A

T

93
Q

CML Epidemiology

CML is rare below the age of _____ years

But occurs at ____ decades of life, with a median age of onset of ___-___ years.

A

20

all

50–60

94
Q

CML Epidemiology

The incidence is slightly higher in (males or females?) than in (males or females?) .

A

Males

Females

95
Q

CML Epidemiology

The risk of developing CML is slightly but significantly increased by exposure to ___________, as occurred in survivors of the _______ exploded in Japan in 1945, and in patients irradiated for ________ but, in general, almost all cases must be regarded as ‘ ______ ’ and no predisposing factors are identifiable.

A

high doses of irradiation

atomic bombs

ankylosing spondylitis

sporadic

96
Q

CML Epidemiology

there is familial predisposition and definite association with HLA genotypes

T/F

A

F
In particular, there is no familial predisposition and no definite association with HLA genotypes has been recognized.

97
Q

CML -clinical features

The typical symptoms at presentation are: fatigue, anorexia, bleeding and weight loss.

Signs are _______,_______(2%), _____ (16%), ______ (1% of males)

About 20 - 40% of patients are ____ptomatic, and in these patients, the diagnosis is based solely on _________

A

splenomegaly, hepatomegaly

purpura; priapism

asym; an abnormal blood count.

98
Q

CML -clinical features

The most common abnormality on physical examination is _______, which is present in up to _____ of patients.

A

splenomegaly

half

99
Q

CML – Clinical features Natural Evolution of CML – CML Phases

 _______ phase
_______ phase
______ phase

A

Chronic

Accelerated

Blastic

100
Q

CML – Clinical features Natural Evolution of CML – CML Phases

 Chronic phase: usually presents in this phase, with progressive ______ and ________. The disease is (responsive or resistant ?) to cytotoxic therapy.

A

leukocytosis and splenomegaly

responsive

101
Q

CML – Clinical features Natural Evolution of CML – CML Phases

 Accelerated phase: Symptoms are (better or worse?) , with night ____, ____ pain, splenomegaly is (more or less?) responsive to therapy.

Peripheral blood shows increasing numbers of _____,_____, and _______.

Disease is (easy or difficult?) to control. ____-___% blasts

A

Worse

Night sweats, bone pain

Less

basophils, blasts and promyelocytes

Difficult; 10-19

102
Q

CML – Clinical features Natural Evolution of CML – CML Phases

 Blastic phase:

symptoms progress, _______ deposits (_______) appear

> ____% blasts in blood or bone marrow.

Blast transformation may be lymphoid (___%) or myeloid (___%)

A

extramedullary; chloromas

20

15;85

103
Q

CML – Laboratory findings Hematologic findings and Morphology:

The white cell count is (elevated or depressed?) and the differential shows ______ neutrophils, bands, metamyelocytes, promyelocytes and myelocytes (precursors of the neutrophils).

WBC >____ × 109/L

The platelets are usually (elevated or depressed?)

A

Elevated ;mature

50

elevated

104
Q

CML – Laboratory findings Hematologic findings and Morphology:

Haemoglobin is often slightly (above or below?) normal.

There is also ___ease in the number of basophils and sometimes of _____ in the peripheral blood.

The bone marrow shows marked (myeloid or lymphoid?) hyperplasia.

A

Below

incr; eosinophils

myeloid

105
Q

The biochemical changes seen in CML are specific

T/F

A

F

non-specific.

106
Q

CML – Laboratory findings : Biochemical changes

chronic phase serum uric acid is _____ but frequently ____.

serum alkaline phosphatase is _____ or ____

LDH) is usually _____.

Serum K+ may be spuriously _____

The serum vitamin B12 and B12 binding capacity are greatly ____eased

A

slightly raised ; normal

normal or slightly raised.

raised

raised; incr

107
Q

CML-biochemical changes

Serum K+ may be spuriously raised due to ____________ from _______ or, less commonly, from ______ after the blood is drawn.

The serum vitamin B12 and B12 binding capacity are greatly increased due to ______________.

A

leakage of intracellular potassium from platelets

leucocytes

raised levels of transcobalamin I

108
Q

CML – Laboratory findings

Immunophenotyping Is needed to make the diagnosis of CML.

T/F

A

F

Immunophenotyping Is not needed to make the diagnosis
of CML.

109
Q

CML

Cytogenetics: The presence of the _______ is the sine qua non of this disease.

A

Philadelphia chromosome

110
Q

CML - Treatment Supportive treatment

•______ and ______ prior to starting cytotoxic therapy for prevention of ___ nephropathy (nucleic acid breakdown)

•_____for bone pain or splenic pain

•______________ may be used for palliation of massive splenomegaly

A

Hydration and allopurinol ; urate

Analgesics

Splenic irradiation

111
Q

bone pain or splenic pain – these are more commonly seen in the _____________ phases of CML

A

accelerated and blast

112
Q

CML - Treatment

Specific treatment

Choice of therapy depends on the ________,___________ and the availability of a matched bone marrow donor.

A

age of the patient, phase of disease

113
Q

CML - Specific treatment

Chronic phase

•______(____)
•_____therapy
•_____ transplantation

A

Glivec (imatinib)

chemo

Stem cell

114
Q

CML - Specific treatment

Chronic phase
Glivec (imatinib) inhibits the _______ of the ______. Produces clinical, haematological and cytogenetic remissions in a (low or high?) percentage of patients in the chronic phase.

A

tyrosine kinase activity

BCR-ABL fusion protein

High

115
Q

First line drug in the management of chronic phase disease is ???

A

Imatinib

116
Q

CML - specific Treatment

Chemotherapy:

Mention 5

A

Cytarabine
Hydroxyurea
Alpha- interferon
Busulfan -
α Homoharringtonine

117
Q

Hydroxyurea :

May be used in pregnancy

carcinogenic

T/F

A

T

F( it’s not)

118
Q

Alpha interferon will effectively ______

α Homoharringtonine Enhances ______ of CML cells.

A

lower the cell count.

apoptosis

119
Q

Interferon can used if BMT is planned.

T/F
With reason

A

F

Interferon is not used if BMT is planned – worsens outcome.

120
Q

CML- specific treatment

Stem cell transplantation: Allogeneic SCT is a proven treatment for CML but due to its risks is usually reserved for ________.

Although Better results are obtained in ____ than _______ or ____ phases.

A

imatinib failures

chronic

accelerated or acute

121
Q

CML - Specific Treatment

Blast phase
Lymphoid: ____ and _____ will induce remissions in some patients ( back to ___ phase) ; remissions are of ___ duration

Myeloid:______ and _____ , remissions are (easier or harder?) to induce than in de-novo AML.

A

vincristine and prednisone ; chronic; short

cytosar and adriamycin; harder

122
Q

CML - specific Treatment

Accelerated phase
Cytotoxic therapy used in _______, or ————

Combination of agents – add ——- to oral agent

A

higher doses; switch agents.

cytosar

123
Q

Imatinib is valuable in management of blastic transformation

T/F

A

T

Imatinib is valuable in management of blastic transformation but resistance usually occurs within a few weeks

House Hemat (29 decks)

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