Lecture 10 Flashcards
Leukemia
Chronic Myeloid Leukemia has a mutation in ? (* based on the lineage)
Hemapoietic progenitor cells
Early in the lineage
Where exactly is the mutation for CML from ?
Inversion between chromosome 9 and 22
resulting in BCR-ABL and phildelphia chromosome
What is the Philadelphia chromosome ?
chnaged chromosome 22+
What is the consequences of mutations causing CML ?
abnormal tyrosine Kinase
proliferate and avoid apoptosis
What are the signs and symptoms for CML ?
most people are asymptomatic
Splenomegaly ( spleen stores WBCs) –> weight loss, anorexia, early satiety
Leukocytosis ( WBC>25)
Leukostatis ( WBC >100) infiltrates the organs and compromising their function
Compromises hematopoiesis ( anemia, bone pain)
Fever, nigh sweats
What are the different phases of CML ?
Chronic, accelerated and blast
What is the characterisitcs for chronic CML ?
COMMON
<10% of immature cells ( blast) are in the peripheral or bone marrow
What is the characteristics of accelerated CML ?
10-19% blasts in the periphery and bone marrow
What do we treat leukostasis with ?
Hydroxyurea ( cell breakdown + allopurinol
What is the indicaton and MOA of hydroxyurea and allopurinol ?
ONLY for symptoms management of leukostasis
urea –> stops RNA reductase and cause major cell apoptosis
Allopurinol –> prevent tumour lysis breakdown from urea
What are the TX for CML ?
TKinhibitors –> small molecules
1st : imaticinb
2nd: Dasatinib and nilotinib
I Don’t kNow
What is the goal of care for chronic phase ?
maintain and induce remission
prevent worsening
minimize txicity
What are the SE of BCR-ABL TKi ?
myelosuppression
N/V ( mild)
Fluid retention ( manage with diuretics)
Rash
Hepatotoxicity ( limit tylenol) - Imatinib)
QTc ( higher with nilotinib)
Vascular
Diarrhea ( loperamide)
Which of the BCR- ABL TKI needs to be with food ?
Ima and Dasa
Which of the BCR- ABL TKI increase tylenol exposure ? Hepatoxicity
Imatinib
