CML facts Flashcards

1
Q

Nilotinib SE

A

CV
Metabolic syndrome
Pancreatic enzymes/Pnacreatitis
Hyperbilirubinemia
QT prolongation

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2
Q

Nilotinib 1st line in CML

A

ENESTnd

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3
Q

Dasatinib 1st line in CML

A

DASISON

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4
Q

Bosutinib 1st line in CML

A

BEFORE

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5
Q

Dasatinib dose

A

100 mg qd

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6
Q

Nilotinib dose

A

300 mg bid
without food

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7
Q

Bosutinib dose

A

400 mg qd
start gradually
ramp up of 200 for 1-2 weeks
300 for 1-2 weeks

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8
Q

Imatinib trial in CML

A

IRIS

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9
Q

Imatinib dose

A

400 mg qd

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10
Q

Imatinib SE

A

Neutropenia
Fatigue
GI
Rash
Edema
Muscle cramps

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11
Q

Goals of Tx in CML

A

OS
Minimal damage to QOL
Decrease risk of long term toxicity
DMR to allow TFR

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12
Q

Dasatinib SE

A

Neutropenia
Thrombocytopenia and platelet dysfunction
PHTN
Pleural effusion

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13
Q

Dasatinib 2nd line in CML

A

START-R
Phase II
Imatinib resistant
Compared to high dose imatinib
Deeper and longer responses

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14
Q

Ponatinib 2nd/3rd line in CML

A

PACE
phase II
Long term OS 70%
30% ATE

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15
Q

Ponatinib 1st line in CML

A

EPIC- negative trial due to toxicity

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16
Q

Ponatinib SE

A

CV- 26%
Thrombocytopenia
Rash
Dry skin
Abdominal pain

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17
Q

Ponatinib dose

A

45 mg/30mg
reduce to 15 mg when in CCyR
based on OPTIC trial

18
Q

Tx of AP CML

A

Entity does not exist anymore
Historically
2nd gen are preferred with higher doses

19
Q

BP phenotype in CML

A

50% myeloid, 33% lymphoblastic, undifferentiated and MPAL -rest

20
Q

Poor risk predictors in BP CML

A

ACA and >50% blasts
LDH
Thrombocytopenia
Prior TKI
Age > 58
Chromosome 15 aberrations

21
Q

Tx of BP CML

A

2nd gen TKI followed by allo transplant

22
Q

TFR requirements in CML

A

CP CML
1st line or 2nd line if intolerance
5 years of TKI (4 years for 2nd gen)
DMR> 2 years (preferred 3 years for MR4)

23
Q

% of ACAs in CML

A

10-15%

24
Q

Most common ACAs in CML

A

trisomy 8
additional loss on 22q

Poor prognosis-
isochromosome 17
del 7
3q26

25
Q

Chromosome location of BCR:ABL1

A

BCR chro 22
ABL1 chro 9

26
Q

% of pts with BCR:ABL1 variants in CML

A

5%

27
Q

% of pts negative to Ph chromsome on cytogentics in CML

A

2-5%
still PCR and FISH positive

28
Q

Most common transcripts in CML

A

e13a2
e14a2
both p210

29
Q

Non p210 BCR:ABL1 transcripts in CML

A

e1a2/e1a3
resulting in p190

poor prognosis

30
Q

Dasatinib 50 vs 100mg in CML

A

Similar effectiveness with better toxicity profile

31
Q

Asciminib 2nd line in CML

A

ASCEMBL trial
compered to bosutinib
assessed MMR at 6 mon which is not an acceptable endpoint
no PFS or OS advantage

32
Q

Asciminib dosage

A

40 mg bid
200 mg bid if T315I

33
Q

High risk mutations in CML

A

ASXL1
IKZF1
RUNX1

AIR

33
Q

CML-BP response to Tx

A

TKI+ Chemo
40% for myeloid
70% for lymphoid

34
Q

Variant translocations in CML %

A

10-15%
22 and other chromosomes

35
Q

ELTS

A

Age (less significant than in SOKAL)
Blasts
Splenomegaly
PLT

36
Q

Need for testing NGS and TK mutations in CML at diagnosis

A

Only in BP
No need in CP

37
Q

2nd gen vs. Imatinib TKIs in CML

A

Faster and deeper responses
No OS benefit
Different SE

38
Q

Bosutinib SE

A

GI
Fluid retention
Hepatic
Renal

39
Q

% of mutation of TKI in CML that is significant

A

> 15%