Chronic Leukemia Flashcards
Which of these has the HIGHEST incidence of all leukemias?
A. Acute Lymphocytic Leukemia (ALL)
B. Acute Myeloid Leukemia (AML)
C. Chronic Lymphocytic Leukemia (CLL)
D. Chronic Myelogenous Leukemia (CML)
C. Chronic Lymphocitic Leukemia
Remember that AML is the most common MYELOID malignancy
Chronic Lymphocytic is the most common in out of all the leukemias
__ Chronic Lymphocytic Leukemia is more common than __.
A. B-Cell, T-Cell
B. T-Cell, B-Cell
A. B-Cell, T-Cell
B-Cell type is still more common in chronic leukemia just like it is in acute leukemia
In comparison to acute leukemia, chronic leukemia tends to progress ___.
A. Slower
B. Faster
B. Faster
T/F
Chronic B-Cell Leukemia progresses faster and has a worst prognosis in comparison to T-Cell leukemia
F
T-Cell chronic leukemia progresses faster and has a worst prognosis
Which of the following are criteria for the initiation of treatment in Chronic Lymphocytic Leukemia? (Select all)
A. Fever with evidence of infection, extreme fatigue, night sweats and weight loss (B-symptoms)
B. Increasing anemia or thrombocytopenia due to bone marrow failure
C. Bulky or progressive lymphandenopathy or splenomegaly
D. Autoimmune cytopenias not responsive to corticosteroids
E. Rapidly rising lymphocyte count
B. Increasing anemia or thrombocytopenia due to bone marrow failure
C. Bulky or progressive lymphandenopathy or splenomegaly
D. Autoimmune cytopenias not responsive to corticosteroids
E. Rapidly rising lymphocyte count
Treatment can begin if patients present with fever without evidence of “B-Symptoms”. Which of the following is considered a “B-symptom”? (Select All)
A. Extreme fatigue
B. Fever
C. Night sweats
D. Weight loss
A. Extreme fatigue
C. Night sweats
D. Weight Loss
Which of these Chronic Leukocytic Leukemia (CLL) patients is a candidate for Watch and Wait treatment?
A. Patients who are Low risk
B. Patients who are Moderate risk
C. Patients who are High risk
A. Patients who are low risk
PA, a 43 yo female patient has been recently diagnosed with Chronic Leukocytic Leukemia (CLL) and has been considered a moderate-risk patient. Patient appears in generally good health and is able to perform daily tasks. Which treatment is she a candiate for?
A. Bendamustine + Rituximab
B. Obinutuzumab + Chlorambucil
C. Ibrutinib
D. Fudarabine/Cyclophosphamide/Rituximab(CD20)(FCR)
D. Fudarabine/Cyclophosphamide/Rituximab(CD20)(FCR)
TA is a 66 yo male who was recently diagnosed with Chronic Lymphocytic Leukemia (CLL) and is considered high-risk. The patient appears to be alert and oriented but requires assistance in daily activitys such as showering and walking. Which of the following treatments is he a candidate for? (Select All)
A. Obintuzumab (CD20) + Chlorambucil
B. Fudarabine/Cyclophosphamide/Rituximab(CD20) (FCR)
C. Bendamustine + Rituximab
D. Ibrutinib
A. Obintuzumab (CD20) + Chlorambucil
D. Ibrutinib
Which of these is the only curative method for Chronic Leukocytic Leukemia (CLL)?
A. Flutarabine, Cyclophosphamide, Rituximab, 1st line
B. Obintuzumab (CD20) + Chlorambucil
C. Allo Transplant
D. Ibrutinib
C. Allo Transplant
Which of the following are Goals of treatment in Chronic Leukocytic Leukemia (CLL)? (Select All)
A. Relief of Symptoms
B. Cure
C. Correct Cytopenias
D. Response
A. Relief of Symptoms
C. Correct Cytopenias
D. Response
We tend to not strive for cure in chronic leukemia unless the patient is healthy
Which of the following is a phase of progression for Chronic Myelgenous Leukemia (CML)? (Select All)
A. Chronic Phase
B. Accelerated Phase
C. Proliferative Phase
D. Blastic Phase
A. Chronic Phase
B. Accelerated Phase
D. Blastic Phase
Rank the following Responses in CML therapy in order from Easisest to achieve to Hardest to achieve.
I: Molecular
II: Hematologic
III: Cytogenic
A. I, II, III
B. II, III, I
C. III, II, I
D. II, I III
B. II, III, I
Hematologic–> Cytogenic–> Molecular
What was the purpose of the IRIS trial?
A. Established Bosutinib as first-line therapy for CML
B. Established Nilotinib as first-line therapy for CML
C. Established Imatinib as first-line therapy for CLL
D. Established imatinib as first-line therapy for CML
D. Established imatinib as first-line therapy for CML
The BCR-ABL mutation that can be found in Chronic Myelogenous Leukemia (CML) known as T315I is resistant to which of the following medicatinos (Select All)
A. Ponatinib
B. Imatinib
C. Dasatinib
D. Nilotinib
E. Bosutinib
B. Imatinib
C. Dasatinib
D. Nilotinib
E. Bosutinib
Which of the following Tyrosine Kinase Inhibitors (TKIs) is a second generation TKI? (Select All)
A. Imatinib
B. Bosutinib
C. Dasatinib
D. Ponatinib
E. Nilotinib
C. Dasatinib
E. Nilotinib
Which of these medications is recommended as 1st-line therapy for Chronic Myelogenous Leukemia? (Select All)
A. Bosutinib
B. Dasatinib
C. Ponatinib
D. Nilotinib
E. Imatinib
B. Dasatinib
D. Nilotinib
E. Imatinib
Which of the following statments is true regarding the trials that compared Nilotinib and Dasatinib to Imatinib?
A. The second generation TKIs Nilotinib and Dasatinib both proved to be far more efficacious and improved survival than imatinib
B. The second gernation TKIs Nilotinib and Dasatinib both showed improved response rates than Imatinib but similar survival.
C. The second gernation TKIs Nilotinib and Dasatinib were both shown to be ineffective in comparison to Imatinib
D. There were virtually no differences in therapy between the second generation TKIs and Imatinib
B. The second gernation TKIs Nilotinib and Dasatinib both showed improved response rates than Imatinib but similar survival.
Which of the following Tyrosine Kinase Inhibitors (TKIs) is a 3rd generation TKI? (Select All)
A. Bosutinib
B. Imatinib
C. Dasatinib
D. Nilotinib
E. Ponatinib
A. Bosutinib
E. Ponatinib
When are the 3rd Generation TKIs (Bosutinib and Ponatinib) considered in therapy for Chronic Myelogenous Leukemia (CML)?
A. Considered as 1st line therapy and drugs of choice in all conditions
B. Can be used as therapy if the CML has progressed while on Imatinib, Nilotinib and Dasatinib
C. Can be used in refracotry CML
D. 3rd generation TKIs are only considered if patient cannot tolerate Imatinib or the second generation TKIs
B. Can be used as therapy if the CML has progressed while on Imatinib, Nilotinib and Dasatinib
In what condition does Bosutinib (Bosulif) require dose-adjustment?
A. Renal Dysfunction
B. Hepatic Impairment
C. CNS impairment
D. Cardiotoxicity
B. Hepatic impairment
In the prescence of hepatic impairment the dose must be reduced to 200 mg PO daily
Which of these medications is known to cause a DDI with Bosutinib and lowers its absorption?
A. Omeprazole
B. Loratidine
C. Meloxicam
D. Fexofenidine
A. Omeprazole
PPIs decrease bosutinib drug levels in the blood because it decreases the TKI absorption. This applies to all TKI medications
Also know that Bosutinib has DDIs with CYP3A4 Inhibitors and Inducers
What is the FDA indication for the use of Ponatinib (Iclusig) in the treatment of CML? (Select All)
A. CML with T315I-positive cells
B. 1st-line treatment in all CML cases
C. When other TKIs cannot be used
D. When patient is also receiving SSRI therapy
A. CML with T3151-Positive cells
C. When other TKIs cannot be used
