hematologic malignancies

Question 1

what are the major hematologic malignancies (8)

Answer 1

acute myelogenous leukemia (AML)
acute promyelocytic leukemia (APL)
acute lymphocytic leukemia (ALL)
chronic myelogenous leukemia (CML)
chronic lymphocytic leukemia (CLL)
Hodgkin's lymphoma
non-hodgkins's lymphoma
multiple myeloma

Question 2

what cancer is an unregulated proliferation of myeloid line progenitor cells

Answer 2

acute myelogenous leukemia (AML)

Question 3

what are the signs and symptoms of acute myelogenous leukemia

Answer 3

1. malaise
2. bone pain
3. fever
4. gum hypertrophy
5. CNS effects (headache, seizure, visual; usually in ALL)

Question 4

what are some poor prognostic factors with AML?

Answer 4

older than 60
elevated WBC (100,000)
CNS involvement
Infection
Secondary from other cancer
myelodysplasia
Organ impairment
unfavorable cytogenetic karyotype (deletion of chromosomes 7 or 5)

Question 5

what are the treatment options for myelogenous leukemia (AML)

Answer 5

1. induction = cytarabine for 7 days and daunorubicin, or idarubicin for 3 days
2. consolidation = high dose cytarabine or allogeneic stem cell transplant

Question 6

what are some common complications with cytarabine and daunorubicin or idarubicin

Answer 6

pancytopenia
GI problems
Tumor lysis syndrome
Cardiotoxicity
hand-foot syndrome (rash) from cytarabine

Question 7

what is more harsh; 3000 mg/m2 cytarabine BID or continuous 100 mg/ m2 cytarabine for 7 days

Answer 7

continuous 100 mg/ m2 is much more toxic

Question 8

what is the dose limiting effect of cytarabine

Answer 8

cerebellar toxicity; must have neurological exams during high dose regimen

Question 9

what can be done to prevent conjunctivitis in patients on cytarabine

Answer 9

dexamethasone eyedrops QID

Question 10

what can be done to prevent conjunctivitis in patients on cytarabine

Answer 10

dexamethasone eyedrops QID

Question 11

what is the best option for high risk patients with myelogenous leukemia

Answer 11

allogeneic stem cell transplant

Question 12

what is the best option for treating elderly patients with myelogenous leukemia

Answer 12

supportice care with transfusions and antibiotics

Question 13

what can be given to elderly patients with myelogenous leukemia who have had prior hematologic disorders

Answer 13

decitabine or azacitidine

Question 14

what are the options for AML relapse

Answer 14

1. clinical trial
2. salvage chemotherapy
3. allogeneic transplant
4. autologous stem cell transplant

Question 15

what is a form of AML that is diagnosed by the presence of translocation 15;17

Answer 15

acute promyelocytic leukemia (APL)

Question 16

what is the APL mechanism

Answer 16

1. translocation of 15;17
2. RARA protein turns into PML-RARA
3. Promyelocytes build up and never mature into granulocytes

Question 17

what is the deadliest form of leukemia if untreated

Answer 17

APL (acute promyelocytic leukemia)

Question 18

the induction treatment of APL (acute promyelocytic leukemia) includes what

Answer 18

ATRA 45 (all-trans retinoic acid), or tretinoin

Question 19

ATRA 45 is a derivative of what?

Answer 19

vitamin A

Question 20

the induction treatment of APL (acute promyelocytic leukemia) includes what

Answer 20

ATRA 45 (all-trans retinoic acid), or tretinoin
with “7 + 3”
or ATRA plus arsenic for poor performance status (and low risk)

Question 21

ATRA 45 is a derivative of what?

Answer 21

vitamin A

Question 22

What is the MOA of ATRA

Answer 22

breaks down PML-RARA fusion protein allowing promyelocytes to differentiate

Question 23

What are the adverse effects of arsenic?

Answer 23

QT prolongation

Question 24

What is a common complication for treatment with ATRA

Answer 24

APL Differentiation Syndrome - huge cytokine release due to sudden differentiation of leukemic cells

Question 25

what is treatment for APL differentiation syndrome

Answer 25

stay on ATRA (even though may appear septic) and treat with steroids