Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Therapeutics IV > Leukemia - Block 4 > Flashcards

Leukemia - Block 4 Flashcards

1
Q

Describe the mechanism of AML and ALL?

A
  1. Cell expands and mutates
  2. Causes an imbalance between differentiation and proliferation
  3. Lekemic cells have growht/survival advantges to normal cells (crowding out)
  4. “Lymphocytic” means it develops from early (immature) forms oflymphocytes
  5. Immature cells are considered “Blasts”
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the goals of acute leukemia tx?

A

Achieve a fast clinical and hematological remission

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the presentations of acute lymphocytic leukemia?

A
  1. Tired, weak, malaise
  2. Bruising, pale skin
  3. DZ
  4. Infections

Classic B sx:
* Fever, night sweats, weight loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Lab findings of ALL? Organ involvement?

A

Anemia - weakness, fatigue
Thrombocytopenia- GI bleeding, skin, gums, urine
Leukopenia - infection, fever

Spleen or liver enlargement
Bone pain
Mediastinal mass
Seizures/headaches

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How do you diagnose ALL?

A
  1. Bone marrow aspirate and biopsy
  2. Lumbar puncture
  3. Marrow or blood > 19% blasts (normal <5%)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are childhood ALL prognostic RF?

A

Standard risk:
* 1-10 YO
* WBC <50
* Karyotype: No t(9;22) or (4;11)

High risk:
* <1 and ≥10 YO
* WBC ≥50
* t(9;22) or (4;11)
* Dx in CNS or testes
* Male
* Response to induction therapy >4wks
* Down’s syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the tx schedule for ALL?

A
  1. Induction/remission (4wks)
  2. Cosolidation/intentification (4wk)
  3. Maintenance/Post consolidation (2-3yr)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is considered cure?

A

5-10 yrs of complete remission

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is considered ALL complete remission?

A
  1. No evidence of leukemia in body
  2. Absence of leukemic blasts in peripheral blood
  3. <5% blasts in bone marrow

Complete remission DOES NOT mean cure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is considered partial remission for ALL?

A

Significant response to tx, 5-25% blasts remaiun

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is considered relapse for ALL?

A

Recurrance of leukemic blasts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How long does it normally take children ALL to acheve complete remission?

A

day 28 of tx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How do we manage induction?

A
  1. TLS tx
  2. IV ABX
  3. Blood products
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the goal of CNS prophylaxis?

A

Eradicat undetectatable leukemia in CNS and prevent leukemia from spreading to the CNS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the rationale of CNS prophylaxis?

A

<5% present with blasts in CNS
Sanctuary sites: CNS and testes
* Drugs don’t easily penetrate BBB
* Pt with no CNS involvement at diagnosis relapse in CNS/testes (50-85%)

CNS prophylaxis decreased relapses to <2% in children

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What are the drugs for CNS prophylaxis?

A
  1. Intrathecal cytarabine, hydrocortisone, methotrexate
  2. Cranial irradiation (long-term ADR)
  3. High dose IV methotrexate or cytarabine
17
Q

What are the drugs used for consolidation/intensification?

A

Vincristine, mercaptopurine and IT methotrexate

May add cyclophosphamide, cytarabine or peg-asparaginase to high risk

May do allogeneic stem cell transplant for patients with high risk factors (needing a donor match)

18
Q

What is the goal of consolidation/intensification?

A

After CR achieved to further eradicate residual or undetectable dx and maintain remission

19
Q

What is the goal for maintenance tx?

A

Further eradicate residual leukemic cells and prolong remission duration

20
Q

Tx for relapse

A

Treatment is dependent on how long after chemotherapy they relapse
* Stem cell transplant is option

21
Q

Tx for Ph+?

A

More aggressive add BCR-ABL inhibitor

22
Q

Tx for Ph-? ADR?

A

Blinatumomab (Blincyto®)
Bispecific CD 19-directed CD3 T-cell Engager

ADR: Cytokine release syndrome (fever, HA, diarrhea, rash, myalagias)
* Nerological tox (confusion, loss of consciousness, behavior changes, sz, cerebral edema, elevated intracranial pressure)

23
Q

Presentaion fo AML?

A

Classic B sx

24
Q

RF of AML?

A
  1. Increasing age
  2. Smoking
  3. Chemical exposure
  4. Previous chemo/radiation tx
  5. Male
25
Q

Prognositc factors of AML?

A

Secondary leukemia (poorer prognosis)

Older age: duration of remission is less compared to younger patients

26
Q

Tx schedule for AML?

A
  1. Remission induction
  2. Post induction/consolidation (2-4 months)
  3. DC therapy or bone marrow transplant
27
Q

Indications for AML tx?

A

Performance Status (PS) of Patient: elderly not CI but PS may predict tolerance

Immediate tx required:
* Hospital stay
* Intensive high dose therapy (Infection, neutropenia, bleeding)

28
Q

What is the tx regimen for standard induction? ADR?

A
  1. 7 days of continuous infusion cytarabine
  2. 3 days of idarubicin or daunorubicin

CR within 1-2 cycles
7+3 controversial in pt under 60-maybe higher doses should be used

ADR: prolonged neutropenia

29
Q

What is the goal of AML remission induction? Duration?

A

To rapidly induce a complete remission (CR)

Duration 1-2 yrs

30
Q

Rationale of Post induction/Consolidation for AML?

A

Most patients will relapse within 4-8 months without further treatment

Goal: Additional therapy is warranted to eradicate residual leukemic cells and to prevent drug-resistant disease

31
Q

What would you use in AML if poor prognostic factors and younger age?

A

Allogenic stem cell transplant

Therapeutics IV (39 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions