Potpourri?
Diagnostic Criteria
Blast count >20 %
If >10 but less <20 --> need genetic abnormalities
Favorable prognostic features
NPM1 without FLT3-ITD
t (8;21)
t (16;16) or inv 16
bZIP in frame mutation
RUNX1
t(15;17)
Young healthy individuals with AML do not need a transplant when they have this
Favorable Cytogenetics
Chronic GvHD
Skin thickening/scleroderma
Transaminitis
GI -- ulcerations + diarrhea
Fasciitis/myositis
Standard AML treatment
7+3 + gemtuzumab
(cytarabine + anthracycline)
CNS risk
WBC >30k (>40k?)
Myelomonocytic leukemia
Mixed phenotype leukemia
FLT3+
Extramedullary dx
High Risk APML
WBC >10k
When to administer live vaccines following transplant
2 years
Cytarabine toxicity
Cerebellar dysfunction
Targeted FLT3-ITD therapies
Sorafenib (ITD only)
Quizartenib (ITD only)
Midostaurin ( ITD and TKD), 2nd line
Gilteritinib (ITD and TKD), 2nd line
Leukostasis
>50k in AML, >100k in ALL
treat with hydrea, chemo or leukopharesis
5 year survival rate
30%
GvHD ppx:
CI (tacrolimus/sirolimus)
Anti-metabolite
PtCy
Use of this CD33+ targeted drug conjugate increases the risk of this often lethal complication
What is gemtuzumab ozogamicin
What is VOD
For patients not eligible for transplant
IDH1+ --> Azacitidine + Venetoclax or Azacitidine + Ivosedinib
IDH - --> Azacitide + Venetoclax or Decitabine + Venetoclax
Rare Pulmonary AML presentation
What is diffuse alveolar hemorrhage
Intermediate risk
FLT3-ITD
GvHD treatment
Steroids
Ruxolitinib
Belumosidil
Ibrutinib
Allopurinol and Rasburicase MOA
Exanthine oxidase
Uric acid metabolizer to allotoin
Treatment related AML
topoisomerase II inhibitors (11q23) (1-3 years)
Alkylating Agents + radiation (-5, -7) (5-7 years)
Liposomal version of donouribicin and cytarabine or 7+3
Extramedullary acute leukemias (name 2)
Myeloid Sarcoma
Leukemia Cutis
Adverse Risk (name 5)
ASXL1
Tp53
t (6;9)
inv 13
monosomy 5 or 7
t (v;11q23.3) -- KMT2A --
Also having MRD on BmBx
MDS associated
Germline
*** More than 3 cytogenetic changes***
Passenger Lymphocyte Syndrome
Immune mediated hemolysis after minor mismatch
Donor B lymphocytes produce antibodies against the recipient's red blood cells
VOD Criteria
t bili >2
Hepatomegaly/RUQ pain
Sudden weight gain >2% from baseline
Within 21 days
Consolidation
Transplant eligible --> High dose Ara-C (2-4 cycles)
Transplant ineligible --> c/w therapy indefinitely