CML Flashcards
Aside from blast percentage, what are concerning signs for accelerated phase CML? (5)
Basophils >19%
Plt <100k
Plt >1 million while on treatment
Progressive splenomegaly
What is the goal BCR/ABL IS after 3 months on therapy?
<10%
What is the goal BCR/ABL IS after 6 months on therapy
<1%
What is the goal BCR/ABL IS after 12 months on therapy?
<0.1%
What is the BCR/ABL IS level of failure after 6 months on therapy?
> 10%
What is the BCR/ABL IS level of failure after 12 months of therapy?
> 1%
Options for low risk 1L CP-CML (4)
Imatinib
Dasatinib
Nilotinib
Bosutinib
Toxicity of Dasatinib
Pleural effusion
HAs
pHTN
Toxicity of Nilotinib (4)
Rash
HA
Elevated lipase
Prolonged QT
Toxicity of bosutinib (4)
Diarrhea
Lipase
Rash
HA
Toxicity of imatinib (3)
Diarrhea
Muscle spasms
Swelling
What is the general treatment difference in 1L CP-CML between imatinib and 2nd gen TKIs
2nd gen has higher likelihood of TFR, but more toxic and mor expensive.
2L options for CML after failure of imatinib? (4)
Dasatinib
Ponatinib
Bosutinib
Nilotinib
3L options for CP-CML (4)
Dasatinib
Nilotinib
Ponatinib
Asciminib
What is the criteria for Treatment free remission?
MR4 (<0.01%) for 2 years, on a TKI for 3 years, able to be screened very frequently when off
T315 mutation is only susceptible to what two TKIs?
Ponatinib
Asciminib
V299L mutation is resistant to which two TKIs?
Dasatinib and bosutinib
F317L mutation is resistant to which two TKIs?
dasatinib
Bosutinib
G250E mutation is resistant to which TKI?
Bosutinib
E255V mutation is resistant to which TKI?
Nilotinib
Y253H mutation is resistant to which TKI?
Nilotinib
F359 mutation is resistant to which TKI?
Nilotinib
Options for intermediate or high risk CP-CML in 1L
Dasatinib
Nilotinib
Bosutintib
Treatment options for AP-CML (4)
Dasatinib 140 mg daily
Nilotinib 400 mg BID
Bosutinib 500 mg daily
Ponatinib 45 mg daily
For patients on a treatment free remission, at what BCR/ABL IS do you restart TKI?
> 0.1%
What is standard of care 1L treatment for CMML-1?
HMA or HU
What is SOC for 1L CMML-2?
HMA +/- Venetoclax then allo
What is the difference between CMML-1 and CMML-2?
Blast count.
CMML-1: <10% blasts
CMML-2: 10-20%
CMML with a t(5;12) is responsive to what teratment?
Imatinib
CMML with PDGFR-rearrangement often presents with what laboratory abnormality?
Eosinophilia
CMML with PDGFR rearrangement is sensitive to what treatment?
Imatinib
Toxicities of ponatinib (5)
Arterial Thrombosis
VTE
CHF
LFTs
Pancreatitis
arrhythmia