CML Flashcards
CNL mutation
CSF3R
immunophenotype of CML
CD10, CD19, CD20 (mature cell)
accelerated phase CML criteria
1)10-19% blasts
2) *peripheral basophils >20%
3) platelet count <100k unrelated to treatment
4) additional chromosomal abnormalities (second Ph chromosome, trisomy 8, isochromosome 17q, trisomy 19), complex karyotype, or abnormalities of 3q26.2)
Chromosomal abnormalities that meet criteria for accelerated phase CML
- second Ph chromosome
- trisomy 8
- isochromosome 17q
- trisomy 19
- complex karyotype
- abnormalities of 3q26.2
Blast phase CML criteria
- 20% blasts
*extramedullary disease (myeloid sarcoma)
Rate of transformation from chronic phase to accelerated or blast phase annually
1% per year
Class effects of BCR/ABL TKIs
- teratogenic
- myelosuppression
- periorbital edema
imatinib SE’s
- edema
- hepatotoxic
dasatinib SE’s
- pleural effusions
- pulmonary HTN
- QT prolongation
- cardiac dysfunction
nilotinib SE’s
- QT prolongation (black box warning)
- hepatotoxic
- pancreatitis
- headache
bosutinib SE’s
- diarrhea
- rash
- LFT elevation
ponatinib SE
- arterial and venous thrombosis
- CHF
- hepatotoxic
- pancreatitis
TReatment goals
- complete hematologic response at 3 months
- complete cytogenetic response at 6 months
- MMR at 12 months
Criteria for TKI discontinuation
IF MMR AND age>18 AND Reliably taking TKI for ≥3 years AND No prior resistance to a second-generation (2G) TKI AND prior BCR/ABL transcript AND no accelerated phase history AND Stable molecular response (ie, MR4; BCR::ABL1 ≤0.01 percent by the International Scale [IS]) (table 1) for ≥2 years, as documented by ≥4 separate tests performed ≥3 months apart
First line TKIs
Dasatinib
bosutinib
imatinib
NOT ponatinib (used second line for T3151 positive)
