Cytogenetics & Mutations
This cytogenetic abnormality defines APL.
What is t(15;17) PML-RARA?
What regimen is considered “7+3”?
Cytarabine for 7 days + Anthracycline for 3 days
What percentage of blasts is required for an AML diagnosis (excluding defining translocations)?
What is ≥20% blasts?
What is the first-line management for APL differentiation syndrome?
Hold ATRA and give Dexamethasone 10 mg IV BID
Happens 7-10 days after therapy
30% of patients will acquire new mutations they didn’t have before (FLT3) and can also lose FLT3 mutations.
What is True?
Prognostic implication of NPM1 mutation without FLT3-ITD.
What is favorable risk?
The VIALE-A trial established this regimen as standard for unfit AML?
What is AZA/VEN?
(VIALE C also approved LDAC/VEN)
LDAC/Glasdegib also approved
What type of granule and rod-like inclusion is seen in Auer rods?
What are Myeloperoxidase-positive primary granules?
What infection prophylaxis is recommended during prolonged neutropenia?
What is Antibacterial (FQ), antifungal (azoles), antiviral (acyclovir)?
Need to dose reduce venetoclax if on CYP450 inhibitor (i.e. vori/posaconazole, ciprofloxacin
T/F One should pursue transplant in relapsed setting if CR2 has been achieved regardless of orginal risk status
What is T?
Therapy related AML Mutations as well as how long they occur after each therapy
Anthracyclines - topo II (11q23) - MLL/KM2TA rearrangement; aggressive; chemorefractory; happens 1-3 years after
Radiation/alkylating like cytoxan - 5 and -7; 5-7 years after radiation/chemotherapy
This is the standard treatment for therapy related AML?
What is VYXEOS (CPX-351)? COMBO/LIPOSOMAL daunorubicin/cytarabine
What will flow cytometry show for APML?
What are MPO+, CD33+, CD34-, HLA-DR-?
What is the WBC count needed to start venetoclax?
What is < 25K?
Can use hydrea to bring counts down
FLAG IDA is a regimen used in the relapsed setting. It stands for...
What is fludarabine, cytarabine, GCSF, idarubicin?
Which mutation confers poor prognosis and resistance to venetoclax?
What is TP53?
Which FLT3 inhibitor is used in combination with 7+3 induction in newly diagnosed AML with both ITD/TKD mutations?
What is Midostaurin? (RATIFY trial)
Quizartinib only for ITD
What constitutes high risk APML?
Low risk - white count is less than 10K and platelet > 40K
Intermediate - WBC < 10K platelet < 40K
High risk - WBC > 10K
Add gemtuzumab or idarubicin to ATRA/ARSENIC for high risk
These leukemic patients need an LP.
Over 30K (maybe 50K?)
Monocytic Leuekmia (M4/M5)
FLT3 - typically bc of high white count
WAIT until blasts from peripheral blood come down - start chemo, wait for it to come down, then do LP (if platelet too low, then do LP after)
This FLT3 inhibitor can be used in relapsed AML (both ITD/TKD)
What is gilterinib?
These are the two Core Binding Factor Mutations
What are t(8;21)(q22;q22) → RUNX1::RUNX1T1 (AML1::ETO)
inv(16)(p13q22) or t(16;16)(p13;q22) → CBFB::MYH11?
Which IDH1 and IDH2 inhibitors are FDA approved for AML?
What are Ivosidenib (IDH1) and Enasidenib (IDH2)
This is considered unfit for transplant?
What is the Ferrara Criteria?
Age > 75 years old
CHF requiring treatment or EF < 50%
DLCO < 65% or FEV1 < 65%
ECOG 2-3 (most subjective), can be disease dependent
What are two specific things to monitor for patients on while on HIDAC?
This novel menin inhibitor targets KMT2A-r and NPM1-mutated R/R AML
What is revumenib (or ziftomenib)?