leukemia Flashcards
Pediatric ALL risk-based treatment
Yes (standard/high risk)
risk groups based on leukemia lineage, age, cytogenetics, induction response
Adult ALL risk-based treatment
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)
AML risk-based treatment
Yes (favorable, intermediate, poor)
based on cytogenetics/molecular abnormalities of AML (FLT3-ITD, IDH1/2), CD33 expression, age/performance status)
glucocorticoids MOA/indication
GR agonist
ALL
asparaginase MOA/indication
inhibition of protein synthesis via ASN depletion
ALL
imatinib, dasatinib, nilotinib, ponatinib MOA/indication
Bcr-Abl TKI
Ph+ B-ALL
ruxolitinib MOA/indication
JAK inhibitor
Ph-like B-ALL (JAK/Stat mutation)
rituximab MOA/indication
Anti-CD20 mAb
CD20+ Adult B-ALL
midostaurin MOA/indication
FLT3 TKI
FLT3-mutated AML
enasidenib MOA/indication
IDH2 inhibitor
IDH2-mutated AML (low intensity)
ivosidenib MOA/indication
IDH1 inhibitor
IDH1-mutated AML (low intensity)
venetoclax MOA/indication
BCL-2 inhibitor
low intensity AML
decitabine and azacitidine MOA/indication
DNMT inhibitors
low intensity AML
gemtuzumab ozogamicin MOA/indication
anti-CD33 mAb-drug conjugate
CD33+ AML
tretinoin MOA/indication
RARa agonist
APL
arsenic trioxide MOA/indication
degradation of the RARa fusion protein
APL
induction therapy for pediatric ALL
backbone is glucocorticoids, ASNase, vincristine
w/o Bcr-Abl TKI (Ph+)
consolidation therapy for pediatric ALL
methotrexate & 6MP common
w/o: Bcr-Abl TKI (Ph+), ruxolitinib (Ph-like)
maintenance therapy for pediatric ALL
6MP and methotrexate x 2-3 years, periodic vincristine and corticosteroids
induction therapy for adult ALL
Hyper-CVAD
w/o Bcr-Abl TKI (Ph+), rituximab (CD20+)
consolidation therapy for adult ALL
similiar to induction therapy
w/o Bcr-Abl TKI (Ph+)
maintenance therapy for adult ALL
similar to pediatric maintenance therapy (6MP and methotrexate x 2-3 years, with periodic vincristine and corticosteroids)
induction therapy for AML
7+3 regimen
w/o midostaurin (FLT3-ITD mutation), gemtuzumab (CD33+)
consolidation therapy for AML
allogenic HCT or HiDAC regimen
w/o midostaurin (FLT3-ITD mutation), gemtuzumab (CD33+)
maintenance therapy for AML
for patients with unfavorable cytogenetics: azacitidine monotherapy
what does cycle A of the Hyper-CVAD regimen consist of
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)
what does maintenance therapy consist of for Hyper-CVAD
POMP:
6-mercaptopurine, vincristine, methotrexate, prednisone
what does cycle B of the Hyper-CVAD regimen consist of
High-dose methotrexate (day 1)
HiDAC (Day 2 and 3)
2 intrathecal chemotherapy (MTX or Ara-C)
adult AML standard induction therapy varies and depends on _____
age and performance status:
age <60 with good performance status (high intensity)
vs
age >60 with poor performance status (low intensity)
preferred regimen for adult AML age <60 with good performance status
7+3 regimen: standard dose cytarabine (100-200 mg/m3) for 7 days) + anthracycline (idarubicin or daunorubicin for 3 days)
preferred regimen for adult AML age >60 with poor performance status
venetoclax (100-400 mg qd) and a hypomethylating agent (decitabine or azacitidine) for up to 7 days/cycle (no actionable mutations)
