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PHM 703- Oncology, Hematology > CML > Flashcards

CML Flashcards

1
Q

CML risk factor

A

Ionizing radiation

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2
Q

CML symptoms

A

Splenomegaly: >50% present → abdominal pain, early satiety
Anorexia, bone pain, purpura, unexplained weight loss, fatigue

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3
Q

CML lab findings

A

Leukocytosis: WBX >25 x 10^9/L
Thrombocytosis on CBC with diff
Ph+ positive

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4
Q

Ultimate goal of CML therapy

A

Get patient to chronic phase and stay there, prevent progression to AP or BP

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5
Q

CP goal of CML

A

delay progression to AP/BP, eradicate Philadelphia chromosome

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6
Q

AP goal of CML

A

control WBC count, bring back to CP and avoid progression to BP

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7
Q

BP goal of CML

A

Survive induction, bridge to allogeneic stem cell transplant

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8
Q

CML treatment

A

TKIs!

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9
Q

Initial selection of TKIs in CML

A

Low-risk score: imatinib or any second generation TKI
Intermediate-high risk score: any second generation TKI

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10
Q

AP/CP goal

A

Return patient to chronic phase

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11
Q

Accelerated phase treatment

A

Second generation TKI preferred
Omacetaxine can be considered in some cases d/t resistance or intolerance to ≥2 TKIs
Consider allogeneic transplant

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12
Q

Blast crisis treatment

A

TKI +/- chemo followed by allogeneic HSCT
Chemo chosen is based on subtype of disease
AML or ALL-based induction regimens

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13
Q

Side effects common in ALL TKIs

A

Myelosuppression
Transaminitis
Electrolyte changes

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14
Q

1st generation TKI

A

imatinib

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15
Q

AEs of imatinib (besides the ones common in all TKIs)

A

edema/fluid retention
Myalgias
Hypophosphatemia
N/V/D

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16
Q

Imatinib dose adjustments

A

Need to adjust in renal and hepatic impairment

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17
Q

Imatinib DDIs

A

3A4 substrate and inhibitor

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18
Q

Imatinib MoA

A

Selective inhibitor of BCR-ABL TKI

Inhibits c-KIT and platelet-derived growth factor receptor (PDGFR)

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19
Q

2nd generation TKIs

A

Dasatinib, nilotinib

20
Q

Dasatinib MoA

A

Dual inhibitor of BCR-ABL and Src family of kinases; also inhibits c-KIT and PDGFR

21
Q

Dasatinib AEs (besides the common class effects)

A

Pleural/pericardial effusions
Bleeding risk
Pulmonary arterial HTN

22
Q

Dasatinib is the _____ of treatment

A

Mainstay!

23
Q

Dasatinib DDIs

A

3A4 substrate

24
Q

Dasatinib absorption requirements

A

Needs an acidic environment, so no PPIs or H2RAs

25
Q

Nilotinib AEs (besides the class effects)

A

Elevated pancreatic enzymes
Indirect hyperbilirubinemia
QTc prolongation- BBW
CV events

26
Q

Nilotinib metabolism

A

3A4 substrate and inhibitor; also 2C8, 2C9, 2D6

27
Q

Nilotinib dose adjustment

A

Adjust in hepatic impairment

28
Q

Nilotinib monitoring

A

Lipid panel

29
Q

Nilotinib administration

A

Empty stomach 2 hours before or 1 hour after eating

30
Q

3rd generation TKIs

A

Bosutinib, ponatinib

31
Q

Bosutinib MoA

A

Dual activity against BCR-ABL, Src, Lyn, and Hck kinases

Has activity against many BCR-ABL mutations that are resistant to imatinib, dasatinib, and nilotinib (except T315I and V299L)

32
Q

Bosutinib AEs (besides class effects)

A

N/V/D, rash, HA

33
Q

Bosutinib indication

A

Approved for newly diagnosed CML upfront, advanced disease including resistance/intolerance to prior therapy

34
Q

Bosutinib metabolism

A

3A4 substrate

35
Q

Bosutinib dose adjustment

A

Adjust in hepatic impairment

36
Q

Ponatinib MoA

A

Targets VEGFR, PDGFR, Src, FGFR, FLT3, RTK, TIE2

Active against ALL BCR-ABL point mutations, including T315I

37
Q

Ponatinib AEs

A

BBW for vascular occlusion, HF, hepatoxicity

Elevated pancreatic enzymes
HTN
Skin toxicity
Thrombotic events

38
Q

Ponatinib indication

A

Approved for patients with T315I mutation and for those whom no other TKI therapy is indicated

39
Q

Ponatinib metabolism

A

3A4 substrate

40
Q

Ponatinib dose adjustment

A

Adjust in hepatic impairment

41
Q

Asciminib drug class

A

STAMP inhibitor

42
Q

Asciminib MoA

A

Targets ABL1 Myristoyl pocket
Allosteric inhibitor

43
Q

Asciminib indication

A

Patients who have previously received 2+ TKIs or those with T315I mutation

44
Q

Asciminib administration

A

Empty stomach 2 hours before or 1 hour after eating

45
Q

Omacetaxine mepesuccinate MoA

A

Reversible inhibitor of protein synthesis

46
Q

Omacetaxine mepesuccinate indication

A

Patients with resistance and/or intolerance to 2 or more TKIs

47
Q

Omacetaxine mepesuccinate AEs

A

Myelosuppression
Nausea
Diarrhea
Fever

PHM 703- Oncology, Hematology (15 decks)

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