CML

Question 1

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

Answer 1

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

Question 2

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

Answer 2

<10%

Question 3

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

Answer 3

<1%

Question 4

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

Answer 4

<0.1%

Question 5

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

Answer 5

> 10%

Question 6

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

Answer 6

> 1%

Question 7

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

Answer 7

Imatinib
Dasatinib
Nilotinib
Bosutinib

Question 8

Toxicity of Dasatinib

Answer 8

Pleural effusion
HAs
pHTN

Question 9

Toxicity of Nilotinib (4)

Answer 9

Rash
HA
Elevated lipase
Prolonged QT

Question 10

Toxicity of bosutinib (4)

Answer 10

Diarrhea
Lipase
Rash
HA

Question 11

Toxicity of imatinib (3)

Answer 11

Diarrhea
Muscle spasms
Swelling

Question 12

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

Answer 12

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

Question 13

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

Answer 13

Dasatinib
Ponatinib
Bosutinib
Nilotinib

Question 14

3L options for CP-CML (4)

Answer 14

Dasatinib
Nilotinib
Ponatinib
Asciminib

Question 15

What is the criteria for Treatment free remission?

Answer 15

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

Question 16

T315 mutation is only susceptible to what two TKIs?

Answer 16

Ponatinib
Asciminib

Question 17

V299L mutation is resistant to which two TKIs?

Answer 17

Dasatinib and bosutinib

Question 18

F317L mutation is resistant to which two TKIs?

Answer 18

dasatinib
Bosutinib

Question 19

G250E mutation is resistant to which TKI?

Answer 19

Bosutinib

Question 20

E255V mutation is resistant to which TKI?

Answer 20

Nilotinib

Question 21

Y253H mutation is resistant to which TKI?

Answer 21

Nilotinib

Question 22

F359 mutation is resistant to which TKI?

Answer 22

Nilotinib

Question 23

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

Answer 23

Dasatinib
Nilotinib
Bosutintib

Question 24

Treatment options for AP-CML (4)

Answer 24

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

Question 25

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

Answer 25

>0.1%

Question 26

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

Answer 26

HMA or HU

Question 27

What is SOC for 1L CMML-2?

Answer 27

HMA +/- Venetoclax then allo

Question 28

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

Answer 28

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

Question 29

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

Answer 29

Imatinib

Question 30

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

Answer 30

Eosinophilia

Question 31

CMML with PDGFR rearrangement is sensitive to what treatment?

Answer 31

Imatinib

Question 32

Toxicities of ponatinib (5)

Answer 32

Arterial Thrombosis VTE CHF LFTs Pancreatitis arrhythmia