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PHM703 Heme/Onc/Crit Care > Exam 2 - Leukemia > Flashcards

Exam 2 - Leukemia Flashcards

1
Q

List characteristics of acute leukemias?

A

rapid onset, symptomatic, rapid fatality, immature cells (“blasts”), usually leukopenia

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2
Q

List characteristics of chronic leukemias?

A

slowly progressive, mostly asymptomatic, higher survival, immature and mature cells

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3
Q

Myeloid cancers usually involve? (3) Lymphoid usually involve?

A

basophils, neutrophils, and eosinophils; B and T cells

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4
Q

How is AML diagnosed?

A

bone marrow aspirate and biopsy demonstrating 20% isolated blasts

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5
Q

List risk factors for AML?

A

increasing age, prior chemotherapy (therapy-related), cigarette smoke, radiation/benzene/pesticide/petrochemical exposures

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6
Q

List signs and symptoms of AML?

A

hyperleukocytosis, anemia (fatigue, SOB), thrombocytopenia (higher bleeding), neutropenia (infections), spontaneous tumor lysis syndrome, CNS involvement is rare

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7
Q

What is the treatment for hyperleukocytosis?

A

hydroxyurea

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8
Q

What is the MOA of hydroxyurea?

A

ribonucleotide reductase inhibitor

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9
Q

What are AEs of hydroxyurea?

A

GI, tumor lysis, toxicities (cutaneous vasculitic ulcerations, mucositis, alopecia, hyperpigmentation)

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10
Q

What are prognostic markers for AML?

A

cytogenetics, age, primary vs secondary AML, performance status, donor availability, WBC count at diagnosis, extramedullary disease

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11
Q

List the FMS-like-tyrosine kinase (FLT3) mutations? (2)

A

those involving internal tandem duplication, tyrosine kinase domain

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12
Q

List the other common AML mutations? (5)

A

those to isocitrate dehydrogenase, DNA methyltransferase 3A, RUNX1, TET2, spliceosomal

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13
Q

What is days 1-7 for induction chemotherapy? Adverse effects during this time?

A

chemotherapy administration; N/V, GI

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14
Q

What is days 8-24 for induction chemotherapy? Adverse effects and what occurs during this time?

A

cell count nadir and recovery; fatigue, fever/infection, high red blood cell and platelet transfusion requirement

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15
Q

What is days 25+ for induction chemotherapy? What occurs during this time?

A

complete cell count recovery; discharge from hospital once ANC >500 and no longer platelet transfusion dependent

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16
Q

What is treatment for induction chemotherapy in AML? (2)

A

cytarabine 100 mg/m^2 IV x7 days plus daunorubicin 60 mg/m^2/d x3 days OR idarubicin 12 mg/m^2/d x3 days

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17
Q

What is treatment for FLT3-ITD+ AML?

A

quizartinib (Vanflyta)

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18
Q

What is treatment for FLT3-ITD+/TKD+ AML?

A

midostaurin (Rydapt)

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19
Q

What is treatment for favorable/intermediate cytogenetics in AML?

A

gemtuzumab ozogamicin (Mylotarg)

20
Q

What is treatment for secondary or therapy-related AML?

A

liposomal daunorubicin with cytarabine (Vyxeos)

21
Q

List goal treatment response criteria in AML? (3)

A

“leukemia-free state” by day 14, complete remission/complete response by day 28, complete remission with incomplete count recovery

22
Q

What is treatment for AML post-remission therapy in those receiving intensive chemo? (2)

A

high dose cytarabine (HiDAC) or liposomal daunorubicin with cytarabine (Vyxeos)

23
Q

What is treatment for intermediate and poor risk diseased AML patients?

A

allogeneic stem cell transplant

24
Q

What is used in “low-intensity chemo” for AML? (4)

A

hypomethylating agents (decitabine (Dacogen) or azacitidine (Vidaza)) plus venetoclax, low-dose cytarabine (LDAC) plus venetoclax, ivosidenib plus venetoclax, LDAC plus glasdeglib

25
Q

What are AEs of quizartinib (Vanflyta)?

A

needs dose adjustments for DDIs

26
Q

List the IDH inhibitors? (2)

A

ivosidenib (Tibsovo), enasidenib (IDHIFA)

27
Q

What does supportive care entail in AML? (2)

A

transfusions (pRBCs, platelets), infection prophylaxis

28
Q

What are AEs of anthracyclines (daunorubicin, idarubicin, mitoxantrone)? (3)

A

reddish or blueish urine/sclerae, myelosuppression, cardiac toxicity

29
Q

What are AEs of cytarabine?

A

neurotoxicity (cerebellar syndrome), conjunctivitis

30
Q

What are AEs of gemtuzumab ozogamicin (Mylotarg)? (2)

A

infusion-related reactions (premedicate with APAP, diphenhydramine, and methylprednisone), hepatotoxicity (including veno-occlusive disease)

31
Q

What are AEs of low-intensity chemo?

A

constipation (give standing bowel medications), low-moderate emetogenicity (premedicate with ondansetron), myelosuppression (venetoclax)

32
Q

What is treatment for bone pain as an AE from myeloid growth factors? (2)

A

loratadine, hydroxyzine

33
Q

Explain the Philadelphia chromosome?

A

fusion chromosome of 9 and 22 via a translocation that involves the upregulation of bcr by abl which leads to a constitutively active expression

34
Q

List signs and symptoms for CML?

A

asymptomatic (up to 50%), leukocytosis (WBC > 25x10^9/L), Philadelphia chromosome, anorexia, bone pain, weight loss, fatigue

35
Q

What is the first generation tyrosine kinase inhibitor (TKI)? Second? Third?

A

1st = imatinib (Gleevec), 2nd = dasatinib (Sprycel) and nilotinib (Tasigna), 3rd = bosutinib (Bosulif) and ponatinib (Iclusig)

36
Q

What is the MOA of imatinib (Gleevec)?

A

inhibits BCR-ABL tyrosine kinase (1st gen), inhibits c-KIT and platelet-derived growth factor receptor (PDGFR)

37
Q

What are AEs of imatinib (Gleevec)? (4)

A

edema, myalgias, hypophosphatemia, GI

38
Q

List mechanisms of resistance to TKIs? (3)

A

organic cation transporter 1, P-gp, point mutations in ABL kinase domain

39
Q

What are AEs of dasatinib (Sprycel)? (3)

A

pleural/pericardial effusions, bleeding risk, pulmonary arterial hypertension

40
Q

What are AEs of nilotinib (Tasigna)?

A

elevated pancreatic enzymes, hyperbilirubinemia, QTc prolongation, CV events

41
Q

What are AEs of bosutinib (Bosulif)?

A

GI, HA, rash

42
Q

If there are no contraindicated mutations, which treatments are recommended? (5)

A

asciminib (Scemblix), ponatinib (Iclusig), omacetaxine mepesuccinate (Synribo), allogeneic stem cell transplant, clinical trial

43
Q

What are AEs of ponatinib (Iclusig)? (3)

A

vascular occlusion (hypertension, heart failure, ischemic reactions), skin toxicity, hepatotoxicity

44
Q

What is the MOA of asciminib (Scemblix)?

A

STAMP inhibitor, targets myristoyl pocket

45
Q

What is the MOA of omacetaxine mepesuccinate (Synribo)?

A

reversible inhibitor of protein synthesis

46
Q

What are AEs of omacetaxine mepesuccinate (Synribo)?

A

myelosuppression, nausea, diarrhea, fever

47
Q

What is the most important factor contributing to relapse and TKI failure?

A

poor medication adherence

PHM703 Heme/Onc/Crit Care (18 decks)

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