Leukemias

Question 1

People who get Acute Lymphocytic Leukemia

Answer 1

Youth (boys)

Question 2

People who get Acute Myelogenous Leukemia

Answer 2

Elderly (men)

Question 3

Chemo that can cause AML

Answer 3

alkylating agents and topoisomerase II inhibitors

Question 4

CNS involvement

Answer 4

ALL

not really AML

Question 5

Components of ALL therapy

Answer 5

Multi-agent chemopre-symptomatic CNS therapy
post-induction intensification
Maintence

Question 6

Induction of ALL

Answer 6

Vincristine and prednisone+daunorubicin and L-asparaginase

+TKI if bcrabl+

Question 7

CNS treatment in ALL

Answer 7

to prevent relapse
Can be intrathecal, lumbar puncture with methotrexate and cytarabine. Or high dose because cross BBB.
Can be radiation

Question 8

Consolidation treatment

Answer 8

after getting a 2 log drop

Last 7-12 months

Question 9

Maintenance treatment

Answer 9

1.5-2 years. Lower doses

Can be mercaptopurine, methotrexate, vincristine, and prednisone

Question 10

TKIs in ALL

Answer 10

for Philadelphia chromosome positive t(9:22)
Imatinib
Dasatinib***
Nilotinib
Ponatinib

Question 11

Salvage therapy in ALL

Answer 11

Clofarabine, Nelarabine (T-cell chemo)
HSCT
Blinatumomab (CD19)
Inotuzumab
Tisagenlevleucel

Question 12

Treatment induction for AML

3+7

Answer 12

Antracycycline for 3 days (daunorubicin, idarubicin, mitoxantron) + Cytarabine for 7 days

Question 13

Consolidation treatment for consolidation

Answer 13

High dose cytarabine for 1-4 cycles

Question 14

Acute Promyelocytic Leukemia

APL

Answer 14

Tretinoin and arsenic

add anthracycline +/- cytarabine if high risk
Dexamethasone for retinoic acid syndrome

Question 15

Gingival hyperplasia

Answer 15

seen in AML

Question 16

CLL state 0 treatment

Answer 16

never treat this, slow growing

Question 17

CLL stage 1/2 treatment

Answer 17

Treat depending on location and size

Question 18

CLL chemoimmunotherapy

Answer 18

FCR (fludarbine, cyclophos, rituximab)
PCR (pentostatin, cyclophos, rituximab)
BR (bendamustine, rituximab)

Question 19

Idelalidib

Answer 19

for relapsed CLL, po
PI3K delta inhibitor
give with rituximab
causes: colitis, infections

Question 20

Ibrutinib

Answer 20

Bruton’s Tyrosine Kinase inhibitor
for relapsed high risk CLL patients
Several 3A4 interactions

Question 21

Venetoclax

Answer 21

BCL2 inhibitor
causes thrombocytopenia, neutropenia, infections, tumor lysis syndrome because of apoptosis happening
for relapsed high risk CLL patients

Question 22

Ofatumumab and Obinutuzumab

Answer 22

for untreated or relapsed CLL
antiCD20 used in older patients that can’t tolerate others
used with chlorambucil

Question 23

Alemtuzumab

Answer 23

for CLL, antiCD52

causes infections

Question 24

IVIG

Answer 24

give monthly if hypogGGemia.

Higher rates after CD20 antibody therapy

Question 25

Treatment for AIHA, ITP, RS

Answer 25

Steroids

Rituximab, cyclospotin

Question 26

Chronic Myeloid Leukemia

Answer 26

Philidelphia chromosome+
Use molecular response from blod to diagnose based on how many bcrabl in PCR
Track progress by reduction in cells

Question 27

Front line therapy for CML

Answer 27

TKI (bcrabl targeted)
Imatinib, Dasatinib, Nilotinub
Maybe need hydroxyurea for leuko/thrombocytosis, allopurinol for TLS

Question 28

Imatinib

Answer 28

Lots of drug intxns 3A4 and pgp
OK with acid suppressants
may cause mild QTc prolongation
used more in CML
Don't use as 2nd line because not as potent

Question 29

Dasatinib and Nilotinib

Answer 29

used in high risk CML over imatinib
More potent at bcrabl ATP binding site
Interact with 3A4 and acid suppressants
Dasatininb: pleural effusion, tx with diuretic or steroids
Nilotinib: QT prolongation

Question 30

T315I mutation in CML

Answer 30

Use Ponatinib

high risk of thromboembolic disease

Question 31

Omacetaxine

Answer 31

CML with multiple TKI failures
protein translation inhibitors
infections