AML, ALL, CML, CLL

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1.

Abnormal cells of leukemia are

called...

myeloid or lymphoid
"blasts"

2.

Dosage form of omacetaxine?

IV solution for SQ
administration, unlike TKI
which are all PO
formulations.

3.

Do you take Nilotinib with meals

or without meals?

Without, on an empty
stomach.

4.

Give all ALL patients CNS

treatment? (T/F)

TRUE

5.

How do you manage

conjunctivitis due to high dose
cytarabine?

Steroid eye drops QID,

start before first dose of
Ara-C until 24-48 hours
after last dose of MTX.

6.

How is MTX excreted?

renally

7.

How is MTX metabolized?

hepatically

8.

If CLL patient relapses in <24-36

months, what do you do?

Repeat first line treatment

9.

If CLL patient relapses in >24-36

months, what do you do?

Change treatment regimen

10.

In what phase of CML is nilotinib

not used?

BP-CML

11.

List all refractory/relapse AML

regimens.

More aggressive:
- standard 7+3
- modified 5+2
- FLAG-ida
- FLAG
- MEC
- G-CLAC
-HDAC
Less aggressive
-Low dose cytarabine
-Decitabine
-5-Azacytidine

12.

Stem cell transplantations (SCT)

have better outcomes in which
phase of CML (chronic,
accelerated, or blast) ?

Chronic phase

13.

Tyrosine kinase inhibitors are

CI with what meds?

PPI and H2RA's, but if

must give H2RA then give
it 2 hours after TKI

What are Intrathecal treatment

options for CNS
treatment/prophylaxis?

-MTX
-Cytarabine
-Hydrocortisone
*must all be preservative
free

15.

What are major SE of

omacetaxine?

Myelosuppression
Hyperglycemia

16.

What are risk factors for ALL?

Age > 70
Radiation
Genetic disorders,
ex:Down syndrome

14.

17.

What are risk factors for

AML?

Environmental exposure
Chemicals (benzene)
Prior chemotherapy exposure
(alkylating agents,
antimetabolites,
topoisomerase inhibitors)

18.

What are risk factors for

CLL?

race (caucasian)
advanced age
eastern european or russian
jewish decent
family history

19.

What are the 2 main and

most aggressive treatments
for CLL?

FCR: Fludarabine,
cyclophosphamide, and
rituximab
CVP: Cyclophosphamide,
mitoxantrone, and prednisone

20.

What are the doses for

imatinib for the different
phases of CML?

CP-CML: 400 mg po once

daily
AP-CML: 600 mg po once
daily
BP-CML: 600 mg po once
daily

21.

What are the drugs for low

intensity therapy for AML
patients?

-Hydroxyurea
-5-Azacytidine
-Decitabine
-SQ cytarabine

22.

What are the major ADR of

cytarabine?

-Rash
-Neurotoxicity (cerebellar)
-Conjunctivitis

23.

What are the major ADR of

MTX?

-AKI
-Hepatotoxicity
-Pneumonitis
-Neurotoxicity (cerebellar)

24.

What are the RAI Stages?

0: lymphocytosis only
1: lymphocytosis with
lympadenopathy
2: lymphocytosis with
hepatomegaly or
splenomegaly
3: lymphocytosis with anemia
4: lymphocytosis with
thrombocytopenia

25.

What do you give as

prophylaxis for bacteria,
including pseudomonas in
CLL patient?

Levofloxacin or Ciprofloxacin

26.

What do you give as

prophylaxis for
Cytomegalovirus in CLL
patient?

Valgancyclovir

27.

What do you give as

prophylaxis for fungus
aspergillus in CLL patient?

Posaconazole or Voriconazole

28.

What do you give as prophylaxis for

fungus candida in CLL patient?

Fluconazole

29.

What do you give as prophylaxis for

Herpes Simplex Virus in CLL
patient?

Acyclovir

30.

What do you give as prophylaxis for

Pneumocystitis in CLL patient?

Bactrim, dapsone,
atovaquone

31.

What do you give as rescue for MTX

toxicity?

Leucovorin 10-25 mg IV
Q6h
Start 24-36 hours after
start of MTX infusion

32.

What do you give as rescue for MTX

toxicity in renally impaired patient?

Glucarpidase, 50
units/kg IV bolus over
5 minutes

33.

What is backbone therapy for

consolidation of ALL?

-High dose MTX

-Cytarabine
-Peg-asparaginase
-6MP (pediatrics)
+/- TKI

34.

What is backbone therapy for

induction of ALL?

-Vincristine
-Anthracycline
-Corticosteroid
(Dex>Pred)

35.

What is backbone therapy for

maintenance of ALL?

-6MP
-MTX
-Vincristine
-Corticosteroids
+/-TKI

36.

What is backbone therapy for

relapse of ALL?

-Blinatumomab
-Vincristine Sulfate
Liposome Injection
-Augmented
HyperCVAD +/Rituximab+/-TKI
-Corticosteroids + TKI

37.

What is MOA of MTX?

Inhibits dihydrofolate
reductase

38.

What is MOA of omacetaxine?

Reversible protein
synthesis inhibitor

39.

What is the BBW for nilotinib?

QT prolongation

40.

What is the clinical presentation of

CLL?

B symptoms (fever,
night sweats, wt.loss,
fatigue)
CBC abnormalities
hepatomegaly,
splenomegaly,
lympadenopathy
infection

41.

What is the goal of consolidation

therapy for AML?

Eliminate residual
leukemia cells

42.

What is the goal of standard

induction therapy for AML?

Achieve complete
remission

43.

What is the standard

induction therapy for
AML?

7+3: Cytarabine 100mg CIVI over 24

h for 7 days
AC (idarubicin 12 mg IV or
daunorubicin 45-90mg days 1-3)

44.

What meds have DDI

with MTX, causing
reduced clearance of
MTX?

-NSAIDS
-BACTRIM
-PPI

45.

When do you treat for

CLL?

Rai staging 0-II if

active/symptomatic.
Rai staging 3-4

46.

When do you use

omacetaxine?

if patient is resistant to 2+ TKI with

chronic phase (CP) CML or
accelerated phase (AP) CML, or with
T3151 mutation.

47.

When do you watch

and wait, rather than
treat for CLL

Rai staging 0-II, asymptomatic

48.

Which drug is active

against most BCR-ABL
kinase mutations in
CML?

Ponatinib.