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Malignant Hematology > CML > Flashcards

CML Flashcards

1
Q

Aside from blast percentage, what are concerning signs for accelerated phase CML? (5)

A

Basophils >19%
Plt <100k
Plt >1 million while on treatment
Progressive splenomegaly

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2
Q

What is the goal BCR/ABL IS after 3 months on therapy?

A

<10%

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3
Q

What is the goal BCR/ABL IS after 6 months on therapy

A

<1%

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4
Q

What is the goal BCR/ABL IS after 12 months on therapy?

A

<0.1%

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5
Q

What is the BCR/ABL IS level of failure after 6 months on therapy?

A

> 10%

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6
Q

What is the BCR/ABL IS level of failure after 12 months of therapy?

A

> 1%

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7
Q

Options for low risk 1L CP-CML (4)

A

Imatinib
Dasatinib
Nilotinib
Bosutinib

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8
Q

Toxicity of Dasatinib

A

Pleural effusion
HAs
pHTN

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9
Q

Toxicity of Nilotinib (4)

A

Rash
HA
Elevated lipase
Prolonged QT

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10
Q

Toxicity of bosutinib (4)

A

Diarrhea
Lipase
Rash
HA

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11
Q

Toxicity of imatinib (3)

A

Diarrhea
Muscle spasms
Swelling

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12
Q

What is the general treatment difference in 1L CP-CML between imatinib and 2nd gen TKIs

A

2nd gen has higher likelihood of TFR, but more toxic and mor expensive.

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13
Q

2L options for CML after failure of imatinib? (4)

A

Dasatinib
Ponatinib
Bosutinib
Nilotinib

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14
Q

3L options for CP-CML (4)

A

Dasatinib
Nilotinib
Ponatinib
Asciminib

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15
Q

What is the criteria for Treatment free remission?

A

MR4 (<0.01%) for 2 years, on a TKI for 3 years, able to be screened very frequently when off

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16
Q

T315 mutation is only susceptible to what two TKIs?

A

Ponatinib
Asciminib

17
Q

V299L mutation is resistant to which two TKIs?

A

Dasatinib and bosutinib

18
Q

F317L mutation is resistant to which two TKIs?

A

dasatinib
Bosutinib

19
Q

G250E mutation is resistant to which TKI?

A

Bosutinib

20
Q

E255V mutation is resistant to which TKI?

A

Nilotinib

21
Q

Y253H mutation is resistant to which TKI?

A

Nilotinib

22
Q

F359 mutation is resistant to which TKI?

A

Nilotinib

23
Q

Options for intermediate or high risk CP-CML in 1L

A

Dasatinib
Nilotinib
Bosutintib

24
Q

Treatment options for AP-CML (4)

A

Dasatinib 140 mg daily
Nilotinib 400 mg BID
Bosutinib 500 mg daily
Ponatinib 45 mg daily

25
Q

For patients on a treatment free remission, at what BCR/ABL IS do you restart TKI?

A

> 0.1%

26
Q

What is standard of care 1L treatment for CMML-1?

A

HMA or HU

27
Q

What is SOC for 1L CMML-2?

A

HMA +/- Venetoclax then allo

28
Q

What is the difference between CMML-1 and CMML-2?

A

Blast count.
CMML-1: <10% blasts
CMML-2: 10-20%

29
Q

CMML with a t(5;12) is responsive to what teratment?

A

Imatinib

30
Q

CMML with PDGFR-rearrangement often presents with what laboratory abnormality?

A

Eosinophilia

31
Q

CMML with PDGFR rearrangement is sensitive to what treatment?

A

Imatinib

32
Q

Toxicities of ponatinib (5)

A

Arterial Thrombosis
VTE
CHF
LFTs
Pancreatitis
arrhythmia

Malignant Hematology (13 decks)

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