Hematologic Malignancies Flashcards
acute myloid leukemia (AML)
What are the goals of AML treatment?
short term= achieve complete remission (CR), long term= cure
acute myloid leukemia (AML)
What drugs regimens are used in AML induction therapy?
- 7+3 (“intensive therapy”) = Cytarabine + Daunorunicin OR Idarubicin
- Daunorubicin + Cytarabine
- Azacitidine OR Decitabine + Venetoclax
acute myloid leukemia (AML)
When would it be appropiate to use 7+3 induction regimen for patients with AML?
age < 60 or patients age > 60 but are a canidate for intensive therapy
acute myloid leukemia (AML)
How do bone marrow biopsies effect therapy for AML patients?
bone marrow biopsy 14-21 days after the start of therapy, hypoplasia= await recovery, low risidual blast= reinduction or add some intermediate-high dose cytarabine, presistent disease= re-induction, then bone marrow biopsy following recovery, CR= move to consolidation phase, presistent diseas= reinduction
acute myloid leukemia (AML)
What drug regimens are used in AML consolidation therapy?
- HiDAC= high dose Cytarabine
- Daunorubicin + Cytarabine
- Intermediate dose Cytarabine +/- Anthacycline
- allogenic bone marrow transplant
acute myloid leukemia (AML)
What drugs target FLT3 ITD or FLD3 TKD in AML?
- Midostaurin
- Quizartinib
- Gilteritinib
acute myloid leukemia (AML)
What drugs target CD33+ AML?
Gemtuzumab ozogamicin
acute myloid leukemia (AML)
What drugs target IDH mutations in AML?
- IDH2 mutation= Enasidenib
- IDH1 mutation= Ivosidenib, Olutasidenib
acute myloid leukemia (AML)
What are the “aggressive chemotherapy” regimens that may be employed in AML relapsed/refractory disease?
- CLAG (Cladribine + Cytarabine + Filgrastim) +/- Mitoxantrone OR Idarubicin
- HiDAC +/- Idarubicin, Daunorubicin, or Mitoxantrone
- FLAG (Fludarabine + Cytarabine + Filgrastim) +/- Idarubicin
- MEC (Etoposide + Cytarabine + Mitoxantrone)
acute myloid leukemia (AML)
What is acute promyelocytic leukemia (APL)?
cytogenetic abnormality: t(15;17)
10% of all AML
acute myloid leukemia (AML)
What is the treatment for low risk acute promyelocytic leukemia (APL)?
low risk= WBC < 10,000
pro-differation agents: all-trans retinoic acid (ATRA, tretinoin) + arsenic trioxide
acute myloid leukemia (AML)
What is the treatment for high risk acute promyelocytic leukemia (APL)?
high risk= WBC > 10,000
all-trans retinoic acid (ATRA) + arsenic trioxide +/- Idarubicin or Gemtuzumab ozogamicin
myelodysplastic syndrom (MDS)
What is myelodysplastic syndrome (MDS)?
myeloid stem cell disorder, 1/3 progress to AML
myelodysplastic syndrom (MDS)
What are the goals of therapy for myelodysplastic syndrom (MDS)?
palliative (delay disease progression, reduced transfusion requirements, improve QOL), although some patients that are young or with high risk disease may recieve allogenic transplant with goal to cure
myelodysplastic syndrom (MDS)
What are the therapy options for MDS?
- Azacitidine/Decitabine
- Decitabine + Cedazuridine
- Lenalidomide
- Erythropoiten stimulating agent
- Luspatercept
- Imetelstat
- Induction chemotherapy
- allogenic HSCT
myelodysplastic syndrom (MDS)
What MDS therapies may be used for del(5q)?
Lenalidomide
myelodysplastic syndrom (MDS)
What MDS therapys increased RBC production?
erythropoietin stimulating agent (ESA), Luspatercept OR Imetelstat may be used an alternative agent if patient is not responding to ESA
acute lymphoblastic leukemia (ALL)
What are the goals of therapy for acute lymphoblastic leukemia (ALL)?
cure
acute lymphoblastic leukemia (ALL)
What are the poor prognostic indicators of acute lymphoblastic leukemia (ALL)?
- WBC > 30 x 10^9 (B cell phenotype)
- WBC > 100 x 10 ^9 (T cell phenotype)
- increasing age
- t(9;22)- Philadelphia chromosome (Ph+)
- CNS or testicular involvement
- not attaining complete remission with induction therapy
- minimal residual disease (MRD) after induction therapy
acute lymphoblastic leukemia (ALL)
What drugs can be added to ALL therapy is patient has Philadelphia chromosome?
Imatinib, Dasatinib, Ponatinib
acute lymphoblastic leukemia (ALL)
What is the treatment scheme for a pediatric patient with ALL?
- induction
- consolidation
- interim maintenance
- delayed intensification
- interim maintenance II
- maintenance
acute lymphoblastic leukemia (ALL)
What drug is used in the pediatric treatment scheme for ALL that is NOT used in adults?
pegaspargase
acute lymphoblastic leukemia (ALL)
What drugs are used as CNS prophylaxis in ALL?
intrathecal methotrexate and cytarabine
acute lymphoblastic leukemia (ALL)
What supportive care consideration must be made for ALL treatment?
- tumor lysis syndrome
- infection risk
- high dose methotrexate used= urinary alkalinzation, leucovorin rescue
- high dose cytarabine used= steroid eye drops, cerebellar toxicity
chronic myeloid leukemia (CML)
What is the cytogenic abnormality identified in CML?
t(9;22), Philadelphia chromosome= BCR-Alb fusion gene that codes for BCR-Alb tyrosine kinase, increases proliferation and reduction in apoptosis
chronic myeloid leukemia (CML)
What are the goals of CML therapy?
maintenance of chronic phase with minimal toxicity, cure only possible with bone marrow transplant
chronic myeloid leukemia (CML)
What tyrosine kinase inhibitors can be used to treat CML?
- imatinib
- dasatinib, nilotinib
- bosutinib, ponatinib
- asciminib
chronic myeloid leukemia (CML)
What BCR-Alb tyrosine kinase inhibitors are used first line for CML?
- Imatinib
- Dasatinib
- Nilotinib
- Bosutinib
chronic myeloid leukemia (CML)
What can be used for subsequent treatment of CML?
- discontinuation may be possible, then reinitiation
- ponatinib
- asciminib
chronic lymphocytic leukemia (CLL)
What are the causes of CLL?
- cytogenetic abnormalities
- loss of apoptosis (BCL-1/2 mutation)
- increased cell survival (BTK, PI3K mutation)
- immunophenotype
chronic lymphocytic leukemia (CLL)
What are the goals of CLL therapy?
palliation
chronic lymphocytic leukemia (CLL)
When should stage 0/I/II CLL treatment be initiated?
may observe unless:
- symptoms
- bulky lymphadenopathy or hepatosplenomegaly
- progressive anemia
- progressive thrombocytopenia
- autoimmune cytopenia
chronic lymphocytic leukemia (CLL)
What is the 1st line CLL treatment without del(17p) or TP53 mutation?
Acalabrutinib +/- Obinutuzumab
Venetoclax + Obinutuzumab
Zanubrutinib
chronic lymphocytic leukemia (CLL)
What is the first line treatment for CLL with del (17p) or TP53 mutation?
Acalabrutinib +/- Obinutuzumab
Venetoclax + Obinutuzumab
Zanubrutinib
chronic lymphocytic leukemia (CLL)
What CLL therapeutic agent requires PJP and antiviral prophylaxis?
Fludarabine and PI3K inhibitor (duvelisib and idelalisib)
chronic lymphocytic leukemia (CLL)
What CLL therapeutic agents are associated with AFib?
BTK inhibitors (Ibrutinib, Acalabrutinib, Zanubrutinib) and pirtobrutinib
chronic lymphocytic leukemia (CLL)
What CLL drug requires tumor lysis syndrome prophylaxis?
venetoclax
hodgkin lymphoma
What is the goal of hodgkin lymphoma treatment?
cure
hodgkin lymphoma
What are the adverse risk factors that may effect treatment for Stage I/II hodgkins lymphoma?
B symptoms (fever, night sweats, wt loss > 10% of body weight in past 6 months), extranodal sites, bulky disease, 3 or more lymph node sites, ESR > 50 mm/hr
hodgkin lymphoma
What is ABVD regimen for hodgkins lymphoma?
- doxorubicin
- bleomycin
- vinblastine
- dacarbazine
hodgkin lymphoma
What is the BEACOPP regimen for hodgkins lymphoma?
- doxorubicin
- cyclophosphamide
- mensa
- etoposide
- prednisone
- procarbazine
- bleomycin
- vincristine
