CML Flashcards
What is the hallmark translocation in CML?
t(9;22) BCR/ABL gene
What are side effects of Imatinib?
Myelosuppression, Fluid retention, edema, skin rash, renal abnormalities, weight gain, muscle aches, diarrhea
What are the side effects seen with Nilotinib?
Rash, headaches, increased T. Bili, increased blood sugar, renal issues, pancreatitis, VOC (CVA, MI), QT prolongation
What are the side effects seen with Dasatinib?
Myelosuppression, pleural effusion, Pulm HTN, platelet dysfunction
What are the side effects of Bosutinib?
Myelosuppression (more thrombocytopenia), D/N/V, pancreatitis, renal, and transaminitis.
What is the indication for Ponatinib?
Resistance or intolerance to at least two prior kinase inhibitors OR with a T3151 mutation! Please don’t forget that.
What are the side effects seen with Ponatinib?
Thrombocytopenia, rash, dry skin, HTN, abdominal pain. Arterial occlusive events-CVA, MI, PAD.
In the first 3 months of TKI therapy what is the goal of BCR/ABL transcript? At what time point is it a tx failure?
It should be less than 10%. You can proceed with caution if they aren’t, but by 6 months if they aren’t this is a treatment failure
What is the BCR/ABL transcript goal at 12 months?
Less than 0.1%
If a patient is at 1-10% BCR/ABL transcript at 1 year what is the best next step in management?
Evaluate for drug to drug interaction, patient compliance, and send for mutational analysis. You can either switch to a new TKI, keep the same (if not imatinib)-check for BCR/ABL at 3 and 12 months, or increase if on Imatinib to 800mg.
If a patient has a BCR/ABL transcript greater than 10% at 6 months or 1 year what is the best next step in management?
Switch to alternate TKI and evaluate for allogeneic SCT. Also want to check for patient compliance and send for mutational analysis. They have to switch therapy!
If a patient has a BCR ABL of 0.1-1% at one year what is the best next step in management?
If long term survival is the goal-continue same TKI
If treatment free remission is the goal, should consider switching to get it to less than 0.1%.
Is imatinib contraindicated in pregnancy?
Yes due to fetal malformations
What is the tx for accelerated phase CML?
Second gen TKI
What is the definition of accelerated phase?
10-19% blasts in the bone marrow or periphery. Peripheral blood basophils of 20% or more. Thrombocytopenia unresponsive to therapy less than 100K. Cytogenetic evidence of clonal evolution.
