leukemia

Question 1

Pediatric ALL risk-based treatment

Answer 1

Yes (standard/high risk)
risk groups based on leukemia lineage, age, cytogenetics, induction response

Question 2

Adult ALL risk-based treatment

Answer 2

based on patient age, Bcr-Abl status, CD20 expression of ALL, treatment response
(high risk being Bcr-Abl positive, age >65, poor initial response, high CD20 expression)

Question 3

AML risk-based treatment

Answer 3

Yes (favorable, intermediate, poor)
based on cytogenetics/molecular abnormalities of AML (FLT3-ITD, IDH1/2), CD33 expression, age/performance status)

Question 4

glucocorticoids MOA/indication

Answer 4

GR agonist
ALL

Question 5

asparaginase MOA/indication

Answer 5

inhibition of protein synthesis via ASN depletion
ALL

Question 6

imatinib, dasatinib, nilotinib, ponatinib MOA/indication

Answer 6

Bcr-Abl TKI
Ph+ B-ALL

Question 7

ruxolitinib MOA/indication

Answer 7

JAK inhibitor
Ph-like B-ALL (JAK/Stat mutation)

Question 8

rituximab MOA/indication

Answer 8

Anti-CD20 mAb
CD20+ Adult B-ALL

Question 9

midostaurin MOA/indication

Answer 9

FLT3 TKI
FLT3-mutated AML

Question 10

enasidenib MOA/indication

Answer 10

IDH2 inhibitor
IDH2-mutated AML (low intensity)

Question 11

ivosidenib MOA/indication

Answer 11

IDH1 inhibitor
IDH1-mutated AML (low intensity)

Question 12

venetoclax MOA/indication

Answer 12

BCL-2 inhibitor
low intensity AML

Question 13

decitabine and azacitidine MOA/indication

Answer 13

DNMT inhibitors
low intensity AML

Question 14

gemtuzumab ozogamicin MOA/indication

Answer 14

anti-CD33 mAb-drug conjugate
CD33+ AML

Question 15

tretinoin MOA/indication

Answer 15

RARa agonist
APL

Question 16

arsenic trioxide MOA/indication

Answer 16

degradation of the RARa fusion protein
APL

Question 17

induction therapy for pediatric ALL

Answer 17

backbone is glucocorticoids, ASNase, vincristine

w/o Bcr-Abl TKI (Ph+)

Question 18

consolidation therapy for pediatric ALL

Answer 18

methotrexate & 6MP common

w/o: Bcr-Abl TKI (Ph+), ruxolitinib (Ph-like)

Question 19

maintenance therapy for pediatric ALL

Answer 19

6MP and methotrexate x 2-3 years, periodic vincristine and corticosteroids

Question 20

induction therapy for adult ALL

Answer 20

Hyper-CVAD

w/o Bcr-Abl TKI (Ph+), rituximab (CD20+)

Question 21

consolidation therapy for adult ALL

Answer 21

similiar to induction therapy

w/o Bcr-Abl TKI (Ph+)

Question 22

maintenance therapy for adult ALL

Answer 22

similar to pediatric maintenance therapy (6MP and methotrexate x 2-3 years, with periodic vincristine and corticosteroids)

Question 23

induction therapy for AML

Answer 23

7+3 regimen

w/o midostaurin (FLT3-ITD mutation), gemtuzumab (CD33+)

Question 24

consolidation therapy for AML

Answer 24

allogenic HCT or HiDAC regimen

w/o midostaurin (FLT3-ITD mutation), gemtuzumab (CD33+)

Question 25

maintenance therapy for AML

Answer 25

for patients with unfavorable cytogenetics: azacitidine monotherapy

Question 26

what does cycle A of the Hyper-CVAD regimen consist of

Answer 26

Hyperfractionated cyclophosphamide (Day 1-3)
Doxorubicin (day 4)
Vincristine (Day 4 and 11)
Dexamethasone (Day 1-4 and 11-14)
2 Intrathecal chemotherapy (MTX or Ara-C)

Question 27

what does maintenance therapy consist of for Hyper-CVAD

Answer 27

POMP:
6-mercaptopurine, vincristine, methotrexate, prednisone

Question 27

what does cycle B of the Hyper-CVAD regimen consist of

Answer 27

High-dose methotrexate (day 1)
HiDAC (Day 2 and 3)
2 intrathecal chemotherapy (MTX or Ara-C)

Question 28

adult AML standard induction therapy varies and depends on _____

Answer 28

age and performance status:

age <60 with good performance status (high intensity)
vs
age >60 with poor performance status (low intensity)

Question 29

preferred regimen for adult AML age <60 with good performance status

Answer 29

7+3 regimen: standard dose cytarabine (100-200 mg/m3) for 7 days) + anthracycline (idarubicin or daunorubicin for 3 days)

Question 30

preferred regimen for adult AML age >60 with poor performance status

Answer 30

venetoclax (100-400 mg qd) and a hypomethylating agent (decitabine or azacitidine) for up to 7 days/cycle (no actionable mutations)