Leukemia Therapeutics Flashcards
Describe Chronic Myeloid Leukemia (CML)
excess mature neutrophil production
95% will present w/ BCR-Abl
how does CML present
most are asymptomatic
leukocytosis (counts greater than 1,000,000)
how is CML diagnosed and tested
bone marrow biopsy
FISH testing will determine presence of BCR-Abl
what are the phases of CML
chronic phase (no blasts)
accelerated phase (more blasts)
Blast crisis (lots of blasts- terminal)
what is the treatment goal for CML
eradicate leukemia with minimal toxicity
TKIs are main treatment
Assessing treatment response in CML
Hematologic response
Cytogenetic response
Molecular repsponse
what are the 3 levels of molecular response in CML
early: BCR-Abl <=10 %
Major: BCR-Abl < 0.1%
Deep: BCR-Abl <0.01
what TKIs are used in chronic phase CML
Imatinib
Dasatinib
Nilotinib
Bosutinib
what is a side effect of imatinib
nausea
what is side effect of dasatinib
fluid retention (pleural effusion)
what is a side effect of Nilotinib
QTc prolongation
metabolic syndrome
worse compliance due to BID
what is a side effect of bosutinib
diarrhea
what TKIs are used in refractory/T315I mutant chronic CML
ponatinib
asciminib
what is TKI discontinuation criteria for CML
No history of AP or BP
TKI therapy for at least 3 years
deep molecular response
stable deep molecular response for at least 2 years
what is the monitoring after TKI discontinuation
PCR
patient remaining at least major molecular response
Loss of major molecular response = restart TKI within 4 weeks
