CML/CLL Flashcards
Average age of diagnosis in CML
64
Average age of diagnosis of CLL
70
T/F there are more NEW cases of CML than CLL
False
CLL > CML
T/F there are more deaths from CML than CLL
False
CLL > CML
What is the most common leukemia in the US?
CLL
T/F CLL is idiopathic?
True
T/F you usually know the cause of CML
False
Usually do not know
- likely increased by environmental exposure which damage chromosomes
Pathophysiology of CML
- reciprocal translocation b/t chromo 9 & 22
- shorted arm of chromo 22 = Ph chromo
- creates fusion gene bcr-abl
- creates TK
- constitutively active
What blast % is found in chronic phase of CML?
<10% in peripheral blood or bone marrow
What blast % is found in accelerated phase of CML?
10-29% in peripheral blood and bone marrow
What blast % is found in blast crisis in CML?
>30% in peripheral blood and bone marrow
How long does chronic phase of CML last?
What is it associated with?
can last for years
Associated with funcitonal myeloblasts
How long does the accelerated phase of CML last?
What is it associated with?
Lasts weeks
Associated with therapy resistance and disease progression
How long can you live in blast crisis in CML?
Die in days to weeks
Without treatment, CML disease progresses within how many years?
~5 years
What can be used to quickly lower WBC in CML?
Hydroxyurea
What can be used if WBCs are dangerously high in CML?
leukophoresis
What drug can decrease WBC the slwoest in CML?
TKIs
T/F hydroxyurea can help slow disease progression in CML
False
TKIs help slow disease progression
Which TKI is the ONLY one that works for T3151 mutation in CML?
Ponatinib
Imatinib binds the inactive/active confimation of bcr-abl?
inactive
Nilotinib binds the inactive/active confimation of bcr-abl?
inactive
Dasatinib binds the inactive/active confimation of bcr-abl?
active
Bosutinib binds the inactive/active confimation of bcr-abl?
both!
What is a complete hematologic response (CHR)?
normalization of peripheral blood counts
What is a major cytogenetic response (MCR)?
= 35% Ph+ cells on metaphase in bone marrow
What is major molecular remission (MMR)?
PCR shows 3 log decline in bcr-abl from baseline
What is complete molecular remission (CMR)?
PCR shows 4-5 log decline in BCR-abl from baseline
MMR =
109 cells
T/F IFN-a is used in CML
False
used to be, but not anymore!
- dose related and required life-long tx
Imatinib is 1st gen/2nd gen
Dasatinib is 1st gen/2nd gen
Ima: 1st
Das: 2nd
What is IFNa usually combined with for CML treatment?
ARA-C
T/F IFNa + ARA C is better than imatinib in CML
False!
Ima > IFNa + ARA C
Toxicities of Imatinib
- hepatoxic
- hematologic tox
- fluid retention
- muscle pain/cramps
GI symptoms
What to tell patient on imatinib
Take with food and large glass of water
DDI with warfarin: increase INR; consider therapy modification
T/F imatinib is more potent than dasatinib
false
das 300x > ima
T/F dasatinib has no difference in overall or progression free survival compared to imatinib
true
- increased response rates though