Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Hematology, oncology > CLL > Flashcards

CLL Flashcards

1
Q

Typical clinical course with CLL

A

While most patients will have an initial CR or PR, ALL will relapse eventually.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Preferred first line options for CLL

A

1) venetoclax + obinutuzumab
2) acalabrutinib + obinutuzumab

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

CLL drug classes

A
  • Bruton’s tyrosine kinase [BTK] inhibitors
  • PI3-kinase inhibitors
  • BCL2 inhibitors
  • novel antibodies and other investigational therapies (eg, chimeric antigen receptor T cells)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

clinical significance of IgVH mutational status

A

= mutated immunoglobulin heavy chain variable
- UNmutated = shorter survival overall and a higher risk of relapse following conventional treatment, including chemoimmunotherapy and hematopoietic cell transplantation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

13q deletion clinical significance

A

very good prognosis because the median time for survival (that is, 50 percent survival) is almost

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

17q deletion clinical significance

A

1) poor prognosis (median survival historically only 3 years from the time of diagnosis)
2) predicts lack of benefit from standard chemoimmunotherapy
3) Favorable response to ibrutinib

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

11q deletion clinical significance

A

poor prognosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

most common adult leukemia

A

CLL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

median age at diagnosis

A

72

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

CLL RF’s

A

Male, older age, caucasian

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Variables involved in CLL staging

A
  • lymphocytosis
  • presence of hepatomegaly and splenomegaly
  • presence of cytopenias
  • **no imaging
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What typically leads to CLL diagnosis?

A
  • incidental lymphocytosis

- asymptomatic lymphadenopathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

presentation

A
  • fatigue and malaise, early satiety, abdominal discomfort (splenomegaly), B symptoms (fevers, night sweats, weight loss), recurrent infections
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Diagnostic criteria + what is required for diagnosis

A

1) Peripheral blood B-lymphocyte count >5K
2) Flow cytometry confirmation of circulating B lymphocyte clonality (CD5+ + CD23+)
3) Percentage of prolymphocytes <55% of lymphocytes
* BMB not needed. Just flow cytometry.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

typical cell surface markers

A

CD5, CD19, CD23

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

average time to initiation of therapy

A

4-5 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

CLL workup

A

FISH
Flow cytometry
Immunohistochemistry
NO BMB needed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Poor prognosticator on FISH testing

A 
Deletion 17p (OS 2-3 years)
Deletion 11q (OS 6-7 years)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Favorable prognosticator on FISH testing

A

Deletion 13q

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Factors that influence treatment strategy

A

Age
Functional status and comorbidities
Cytogenetics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

management of AIHA in CLL

A

IF indication for CLL exists independent of anemia –> treat CLL
IF no indication for CLL treatment: steroids + folic acid, followed by SLOW taper

22
Q

common side effects of ibrutinib

A

Diarrhea + peripheral lymphocytosis (may look like CLL progression but is not) + rash + Afib + antiplatelet effect (increased bleeding risk)

23
Q

Contraindication to ibrutinib

A

patient on anticoagulation

24
Q

purine analogs

A

pentostatin and cladribine

25
Q

prophylaxis when using alemtuzumab

A
  • acyclovir for HSV ppx

- PCP prophylaxis with bactrim

26
Q

prophylaxis when using purine analogs

A
  • acyclovir for HSV ppx

- PCP prophylaxis with bactrim

27
Q

what is richter’s transformation + clinical importance

A

Extraordinarily rare transformation of CLL or hairy cell leukemia into a fast-growing DLBCL. Very bad prognosis.

28
Q

treatment of richter’s transformation

A

Same treatment as for DLBCL

29
Q

treatment regimen depends on…

A

presence of 17p deletion (but preferred first line regimens are the same with and without)

30
Q

Labs

A

absolute lymphocytosis (threshold = 5K but can be up to 100K) + hemolytic anemia + hypogammaglobulinemia (25%) + mild cytopenias (neutropenia, anemia, thrombocytopenia) + elevated LDH

31
Q

Major branch point in management

A

Presence of 17p mutation

32
Q

Indications for starting treatment

A

1) Evidence of progressive marrow failure (worsening anemia and/or thrombocytopenia)
2) Massive (ie, ≥6 cm below the left costal margin) or progressive or symptomatic splenomegaly
3) Massive (ie, ≥10 cm in longest diameter) or progressive or symptomatic lymphadenopathy
4) Progressive lymphocytosis with an increase of >50 percent over a two-month period or lymphocyte doubling time (LDT) of <6 months.
constitutional symptoms (Significant fatigue (ie, Eastern Cooperative Oncology Group performance status [ECOG PS] ≤2, inability to perform usual activities), Night sweats for ≥1 month without evidence of infection, Unintentional weight loss ≥10 percent within the previous six months, Fevers for ≥2 weeks without other evidence of infection

33
Q

Clinical staging system for CLL

A

Rai

34
Q

CLL labs

A

absolute lymphocytosis (threshold = 5K but can be up to 100K) + hemolytic anemia + hypogammaglobulinemia (25%) + mild cytopenias (neutropenia, anemia, thrombocytopenia) + elevated LDH

35
Q

CLL diagnosis

A

Peripheral blood B-lymphocyte count >5K
+ Characteristic immunophenotype = Flow cytometry with CD5+ + CD23+
Also – Percentage of prolymphocytes <55% of lymphocytes
*BMB not needed.

36
Q

Important cytogenetic markers in CLL

A

11,13,17

37
Q

CLL vs. B cell SLL

A

The term CLL is used when the disease manifests primarily in the blood, whereas the term SLL is used when involvement is primarily nodal.

38
Q

Disease warranting treatment in CLL is referred to as

A

“active disease”

39
Q

CLL clinical course

A

extremely heterogeneous disease with certain subsets of patients having survival rates without treatment that are similar to the normal population

40
Q

Criteria for defining massive splenomegaly

A

Greater than 6 cm below the left costal margin

41
Q

Adverse prognostic features

A
  • low ZAP-70
  • CD38
  • P53 mutant
  • unmutated IGHV
42
Q

Major branch point in selection of initial systemic therapy

A

Presence of 17p deletion, TP53 mutational status

43
Q

Term for premalignant phase

A

MBL (monoclonal b lymphocytosis)

44
Q

Cutoff levels for cytopenias that are typically used to initiate treatment and caveat

A
  • Hgb <10
  • plt count <100k
  • assuming declining, some people have stable platelet counts below 100k and don’t need treatment
45
Q

clinical significance of ZAP-70 + interpretation

A
  • Surrogate for IGHV mutation status but it will change overtime, unlike IGHV
  • Low is good (correlates to mutated IGHv)
46
Q

predictive vs. prognostic

A 
prognostic = independent of treatment
predictive = response with treatment
47
Q

prognosis of patients who transform to DLBCL (Richter’s)

A

Absolutely dismal (worse than FL transformation)

48
Q

Clinical significance of TP53 mutation

A

TP53 mutations are both predictive of worse clinical outcomes with chemoimmunotherapy as compared to targeted therapies (eg, BTK or BCL2 inhibitors)

49
Q

Preferred BTK inhibitor and why

A
  • acalabrutinib
  • less cardiotoxicity
50
Q

highest risk cytogenetic finding

A

17p deletion (tp53)

51
Q

11q significance in CLL

A

intermediate, can be overcome by newer therapies

52
Q
A

Hematology, oncology (218 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions