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Blood & Lymph > Leukemia Clinical Care 2 > Flashcards

Leukemia Clinical Care 2 Flashcards

1
Q

Study that was crucial in making Imatinib the standard treatment for CML, instead of IFN + Ara-C?

A

IRIS Study: showed significant improvement in treatment outcome

(progression-free survival at 18 mo.)

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2
Q

What are the 2 other tyrosine kinase inhibitors (2nd generation)?

A
  1. Nilotinib
  2. Dasatinib
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3
Q
A

wet purpura (blood blister)

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4
Q
A

Acute Myeloid leukemia

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5
Q
A

Acute Myeloid Leukemia

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6
Q
A

AML

(CD13 & CD33 positive distinguish myeloid cells from T cell or B cell)

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7
Q

Acute Myeloid Leukemia median age of onset

A

67 yo

(M:F = 1:1)

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8
Q

Predisposing factors to AML (5)

A
  1. radiation
  2. benzene
  3. myeloproliferative or myelodysplastic syndromes
  4. congenital DNA repair disorder
  5. smoking (2 fold increase)
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9
Q

How do you determine a good or poor prognosis in AML?

A

Cytogenetic analysis

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10
Q

How does the WHO classify AML?

A
  1. Recurrent genetic abnormalities
  2. Multilineage dysplasia
  3. Therapy-related
  4. ambiguous lineage (lymphoid + myeloid lineage)
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11
Q

Recurrent genetic abnormalities (AML) with a good prognosis (3)

A
  1. t(15;17) → PML/RARa
  2. inv 16 → CBFb/MYH11
  3. t(8:21) → AML/ETO

(11q23 → MLL is less common)

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12
Q

AML tx phases (2)

A
  1. remission induction phast : lower leukemia burden from 1012 → 109
  2. post-remission therapy: cure
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13
Q

AML tx

A

combo chemo: cytarabine + anthracycline (aka “7 + 3”)

(Complete remission (CR) depending on age - 80% if < 60 yo; ~45% if > 60 yo)

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14
Q

Acute Promyelocytic Leukemia (APL) -M3 translocation

(used to be called AML-M3)

A

t (15;17)

PML-RAR fusion

(blocks neutrophils from differentiation)

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15
Q
A

Auer rods (aka “faggot cells”)

APL - M3

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16
Q

Why do elderly patients have a poor AML prognosis (4)?

A
  1. emerge from antecedent hematologic disorder
  2. karyotype abnormalities
  3. express MDR genes
  4. co-morbidities
17
Q

Evaluation of AML in the elderly

A
  1. ECOG PS
  2. ADLs
  3. Charleston comorbidity scores (to decide if chemo is approps)
18
Q

Elderly patients may receive chemo tx for AML if they meet which criteria (3)?

A
  1. up to age 70 w/good PS
  2. independent ADLS
  3. low morbidity
19
Q

Geriatric patient AML Tx

A

hypomethylating agents (low dose chemo)

20
Q

Acute Lymphoblastic Leukemia prognosis: children vs. adults

A
  • children ~ 80% cure
  • adults ~ 30% cure
21
Q

Acute lymphoblastic leukemia sx (5)

A
  1. cytopenia (bone marrow failure)
  2. CNS involvement
  3. bleeding
  4. organomegaly
  5. lymphadenopathy

(B symptoms: fever, sweats, weight loss)

22
Q

Poor prognostic factors for ALL

A
  1. over 60 yo 10-15% survival
  2. B cell: > 30 x 109; T cell: >100 x 109
  3. Ph - ALL

AYA (adolescent & young adults - 15-39 y/o) do better

23
Q

Favorable cytogenetic abnormalities with ALL

A

hyperdiploid; del9p

24
Q

Cytogenetic abnormalities w/poor prognosis w/ALL

A
  1. Ph +ALL t(9;22)
  2. Ph - ALL:
  • t(4;11) KMTZA translocation
  • t(8;14) complex karyotype
  • hypodiploid (30-39 chromosomes); near triploidy (60-78 chromosomes)
25
Q

1st line therapy for B cell ALLs are based on ____ (2).

A
  1. phase (initiation, consolidation, maintenance, CNS prophylaxis)
  2. population-based (peds, AYA, Ph+ ALL)
26
Q

T-cell ALL relapse tx

A

Nelarabine (purine nucleoside analogue)

(prodrug; not curative)

27
Q

BiTE

A

Bispecific T-cell Engager: tethers T cell to cancer cell → engages & kills

28
Q

Leukostasis

A

symptomatic hyperleukocytosis (>100,000/uL can be asymptomatic, if not → leukostasis)

(seen in AML & CLL)

29
Q

CLL typically have a WBC count of

A

>400,000/uL

(low plts, low Igs)

30
Q

Why is leukostasis bad?

A

increases viscosity → local hypoxemia → release of cytokines → coagulation cascade or bleeding

(HA, SOB)

31
Q
A

Pulmonary leukostasis

(infiltration)

32
Q
A

neurologic infarct

(result of leukostasis)

33
Q

Why is this increased “buffy coat” bad?

A

it can cause an error in the reading of other blood components

34
Q

Spurious Lab Tests

A

marked leukocytosis: hyperkalemia, hypoxemia , hypoglycemia

Blood & Lymph (29 decks)

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