CLL and ITP Quiz

Question 1

Match the following treatments with their most relevant MOA:

1. Fludarabine
2. Rituximab
3. Ibrutinib
4. Cyclophosphamide
5. Alemtuzumab

A. Antibody targeting cells that express CD52
B. Antibody targeting cells that express CD20
C. Inhibitor of Bruton’s tyrosine kinase which is involved in the B-cell signaling process
D. Mimics the purine base adenosine incorporating itself into DNA strands
E. Causes alkylation of DNA leading to strand breaks

Answer 1

1) D
2) B
3) C
4) E
5) A

Question 2

When used in combination with traditional chemotherapy rituximab has been proven to improve what outcomes for CLL patients?

Progression free survival
Overall survival
Response rates
None of the above
All of the above

Answer 2

All of the above

Question 3

Fludarabine is commonly used in the treatment of CLL due to its potent activity against lymphocytes. Because of this ability to deplete lymphocyte counts, which of the following is recommended?

A) Monitoring of CD4 lymphocyte counts
B) Herpes and PCP prophylaxis
C) No additional monitoring
D) Cytomegalovirus prophylaxis

Answer 3

B

Question 4

Idiopathic thrombocytopenia purpura (ITP) is a result of:

A) Failure of the bone marrow to produce platelets
B) Antibodies causing destruction of one’s own lymphocytes
C) Antibodies causing destruction of one’s own platelets
D) Failure of megakaryocytes to develop appropriately

Answer 4

C

Question 5

An ESA may be used for anemia in patients with non-myeloid malignancies where the anemia is due to the effect of concomitantly administered chemotherapy and at least 2 additional months of chemotherapy is planned. An ESA should only be considered when the hemoglobin is < 10 g/dL and only until the chemotherapy course is completed.

Per the NCCN Guidelines, erythropoietin-stimulating agents used for chemotherapy-induced anemia should be HELD until a patient’s hemoglobin reaches:

A) A target at least 14 g/dL
B) A target greater than 12 g/dL
C) To maintain a target Hb not to exceed 10-12 g/dL

Answer 5

To maintain a target Hb not to exceed 10-12 g/dL

Question 6

A 60 year old man with past medical history of hypertension (controlled on 1 medication) and no other comorbidities has recently been diagnosed with CLL. It is Rai stage III and he has been having symptoms of night sweats and weight loss. The genetic workup does not reveal a del17p/TP53 mutation. What would be the most appropriate first line treatment?

A) Rituximab
B) Obinutuzumab + chlorambucil
C) Ibrutinib
D) Fludabarine + cyclophosphamide + rituximab (FCR)

Answer 6

C

Question 7

Which of the following is not true regarding venetoclax?

A) Requires a ramp up dosing schedule
B) Monitoring must be done for tumor lysis syndrome
C) Screening for drug interactions must be done
D) Should only be utilized in those <65 years old

Answer 7

D