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Heme malignancies > Leukemia > Flashcards

Leukemia Flashcards

1
Q

t(15;17)

A

PML:RARa; M3; APL

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2
Q

t(8;21) or inv(16)

A

CBF:RUNX1T1; M2; abnl eosinophilia; good prog

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3
Q

favorable prognosis markers: no need for trx

A

inv(16); t(8;21); t(15;17)

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4
Q

poor prognosis markers, need transplant

A

del(5q), -5, del(7q), -7, complex, 11q23

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5
Q

11q23

A

MLL gene: translocation with 11q23 bad

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6
Q

del5q del7q

A

associated with alkylators, poor prognosis group AML

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7
Q

FLT3 mutation

A

FLT-internal tandem repeat; poor prognosis ,

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8
Q

CEBPA mutation

A

favorable prognosis

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9
Q

induction

A

7+3: 90 dauno + 200 cytarabine x 7 days;

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10
Q

idarubicin

A

12mg/m2 for 3 days equivalent to 90 dauno

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11
Q

daunorubicin

A

90x3d = 50x5d

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12
Q

del5q MDS

A

lenalidomide if low/int-I risk

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13
Q

MDS cytopenia treatment

A

can use EPO

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14
Q

allotSCT for MDS

A

recommended for INT-2: cases include: poor karyotype and 5-10 blasts; poor karyotype and 2/3 cytopenias; good karyotype, 2/3 cytopenias and 11-20 blasts; 11-20 blasts;

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15
Q

IPSS

A

% blasts: 5-10- 0.5; 11-20: 1.5, 21+ 2. karyotype: intermediate 0.5; poor 1; cytopenia: 2/3 gets another 0.5 points.

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16
Q

MDS karyotypes

A

poor: complex or chromosome 7; good: 5q-, y-, 20q-

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17
Q

CLL karyotyping

A

13q- good

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18
Q

11- CLL

A

massive LAD out of proportion

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19
Q

17- CLL

A

higher richter transformation, resistance; consider up-front transplant

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20
Q

imatinib dosing

A

400mg/day; higher doses lead to increased cytogenetic CR but no difference in OS, PFS at 24mo

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21
Q

T315I

A

CML resistance mutation–> dasatinib/nilotinib doesn’t work

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22
Q

nilotinib dosing

A

400mg BID, higher CR compared to imatinib

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23
Q

dasatinib dosing

A

100mg day, higher CR compared to imatinib

24
Q

gleevec failure

A

no heme response at 3 mo, no cytogenetic response at 6month, no partial at 12 month, no complete by 18 months

25
Q

alkylating agent heme malignancies

A

del5q, del7q–> poor prognosis, 5-7yr latencies, also MDS

26
Q

topoII associated maligngnices

A

11q23, 21q22, poor prognosis

27
Q

ALL cells

A

+CD19 +CD200; 1/2 CD10+,

28
Q

p190

A

ALL Ph translocation

29
Q

ALL high risk types

A

t(4;11), t(8;14), t(1;19). Ph-positive(922)

30
Q

gleevec response

A

major response: <35% metaphase in marrow

31
Q

CML resistance

A

if no T315 or P-looop mutation, can consider increasing dose or using another TKI

32
Q

Primary resistance in AML

A

if resistance following 7+3–>HIDAC, you can still proceed to transplant with 10-20% success rate

33
Q

HTLV-1

A

T-cell leukemia causative- endemic in Caribbean, Japan (sexual contact, blood, mat/fet). 2-4% of infected will get leukemia

34
Q

benzene

A

can cause AML or myelodysplasia

35
Q

alkylator-associated MDS/AML cytogenetics

A

-5, -7, +8; develop 4-6 years after exposure, low response rates

36
Q

topoisomerase inhibitor AML

A

no MDS phase, 1-2 year latency, 11q23 abel, or 21q22 translocation.

37
Q

NPM1 mutation without FLT3 mut

A

good risk

38
Q

Preparative regimens for AML for AlloSCT

A

1) CY 60mg/kg x 2 + TBI 10-14Gy/3-6D. or 120mg/kg with oral busulifan 16mg/kg

39
Q

reduced intensity conditioning AlloSCT for >60

A

cannot use if active relapsed disease. otherwise encouraging with less toxicity

40
Q

APL treatment by risk factor

A

WBC give ATRA–>consolidate with ATRA/ArO3 (consider omitting chemo); if WBC>10–> high risk need all three

41
Q

anthracycline-associated AML

A

APL type, t(15;17)

42
Q

topoisomerase associated AML

A

no MDS, 11q23/21q22, short latency (6mo-3yr)

43
Q

myeloperox or nonspecific esterase

A

AML stains. Negative in ALL

44
Q

p190bcr-abl

A

associated with ALL

45
Q

p210bcr-abl

A

associated with CML (and some ALL)

46
Q

ALL standard therapy

A

vincristine, prednisone, anthracycline, asparaginase

47
Q

Ph-positive ALL

A

add a TKI.

48
Q

mature B-cell ALL

A

add rituximab

49
Q

ALL CNS prophylaxis

A

necessary. high risk: high WBC count or high LDH. trophy reduces risk to

50
Q

ALL consolidation therapy

A

high dose MTX, cytarabine, CY and anthracycline

51
Q

ALL maintenance therapy

A

low dose MTX, 6-MP, vincristine, predinsone

52
Q

good risk ALL

A

hyperdiploidy, or del(9p)

53
Q

ALL risk factors

A

Poor risk: age>35, >30WBC, pro B-cell, bad cytogenetics, >wks to CR

54
Q

transplant for ALL

A

all patients should get if

55
Q

elderly with Ph-positive ALL

A

can consider dasatinib+prednisone

56
Q

recurrent T-cell ALL therapy

A

nelarabine–>40% CR

57
Q

mature B-cell ALL (Burkitt’s)

A

improved prognosis with high dose MTX, cytarabine, rituximab

Heme malignancies (5 decks)

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