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Flashcards in Acute Leukemia Deck (50):
1

Which of these Leukemias is considered a Chronic leukemia (Select All)

A. ALL

B. AML

C. CLL

D. CML

C. CLL

D. CML

2

Which of these leukemias is considered an Acute leukemia? (Select All)

A. ALL

B. AML

C. CLL

D. CML

A. ALL

B. AML

3

Lymphomas are defined as: (Select All)

A. A mass lesion in the Mediastinum or other bones of the body

B. Reading of >25% blasts in the bone marrow

C. Reading of < 25% blasts in the bone marrow

D. May or may not present with a mass or lesion 

A. A mass lesion in the Mediastinum or other bones of the body

C. Reading of < 25% blasts in the bone marrow

4

Leukemias are defined as (Select all)

A. Reading of >25% blasts in the bone marrow

B. May or may not present with a mass lesion

C. Mass lesion is always present in at least one large bone in the body

D. Reading of <25% blasts in the bone marrow

A. Reading of >25% blasts in the bone marrow

B. May or may not present with a mass lesion

5

Which of the following statements is true regarding Acute leukemia? (Select All)

A. Onset is usually rapid

B. Cancer cell types are usually mature

C. Patients usually exhibit bad survival and are fatal

D. Treatment usually includes chemotherapy with or without HSCT

E. Treatment of acute leukemia is usually difficult due to resistance

A. Onset is usually rapid

C. Patients usually exhibit bad survival and are fatal

D. Treatment usually includes chemotherapy with or without HSCT

E. Treatment of acute leukemia is usually difficult due to resistance

6

Which of the following statements is true regarding Chronic leukemia? (Select All)

A. Onset is usually gradual

B. Cancer cell types are usually mature

C. Patients usually exhibit better survival

D. Treatment usually includes chemotherapy with or without HSCT

E. Treatment of chronic leukemia is difficult due to possibly being resistant

A. Onset is usually gradual

B. Cancer cell types are usually mature

C. Patients usually exhibit better survival

E. Treatment of chronic leukemia is difficult due to possibly being resistant

7

  • T/F Acute leukemia can present as an emergency and require immediate treatment but has a higher cure rate in comparison to chronic leukemias 

True

8

  • T/F Lymphomas are more common than Leukemia 

True

9

Acute Lymphocytic Leukemia (ALL) is primarily considered a ___ disease.

A. Adult

B. Pediatric

C. Geriatric

D. Neonatal

B. Pediatric

10

T/F Acute Lymphocytic Leukemia ((ALL) has been shown to have higher cure rates in Adult patients over the years but Pediatric cure rates have not shown much improvement 

False

11

All of the following are Risk Factors of Acute Lymphocytic Leukemia (ALL) EXCEP: 

A. Chemical Exposure 

B. Previous chemotherapy 

C. Genetic disorders

D. Increased Age

E. B-Cell ALL

E. B-Cell ALL

12

Which chromosome mutation is associated with poorer outcomes in patients with Acute Lymphocitic Leukemia? 

A. t(1,22)

B. t(5,23)

C. t(9,22)

D. t(8,28)

C. t(9,22)

13

Leukemia can be associated with abrupt onset of sypmtoms due to bone marrow suppression. Which of these abrupt symptoms is correctly matched with it's cause? (Select All)

A. Fatigue --> Anemia

B. Bleeding, bruising--> Leukopenia

C. Fever or infection --> Leukopenia

D. Fatigue --> Thrombocytopenia

E. Bleeding, bruising --> Thrombocytopenia

A. Fatigue--> Anemia

C. Fever or infection --> Leukopenia

E. Bleeding, bruising --> Thrombocytopenia

14

What is the purpose of Immunophenotyping when it comes to Diagnosing and working up a patient with cancer? (Select All)

A. Determines the prescence of cell markers (CD20)

B. Determines whether or not patient will tolerate medication therapy

C. Assists in determining lineage of cancer (B-Cell Vs. T-Cell)

D. Assists in determining prognosis

A. Determines the prescence of cell markers (CD20)

C. Assists in determing lineage of cancer (B-Cell Vs. T-Cell)

D. Assists in determining prognosis

15

T/F

B-Cell Leukemia is known to be more common than T-Cell Leukemia

True

16

Which of these forms of Leukemia is the MOST common type?

A. Early pre-B ALL

B. Common ALL

C. Mature B-Cell ALL (Burkitt's leukemia)

D. Pre-T ALL

E. Mature T-Cell ALL

B. Common ALL

17

Which of these important abnormalities can be detected by Immunophenotyping? 

A. BCR-ABL t(9,22)

B. Patient side effect profile 

C. Potential allergies to chemotherapeutic agents

D. None of the above

A. BCR-ABL t(9,22)

18

What is the most common cause of death in ALL?

A. Anemia

B. Total Body Irradiation

C. Infections

D. Disseminated Intravascular Coagulation (DIC)

C. Infections

19

How did St. Judes influence the concept of treatment in Leukemic patients? (Select All)

A. Intoduced the concept of "treatment phases"

B. Introduced Remission induction- usually 3 drugs

C. Intensification/ Consolidation- Different agent combo

D. CNS prophylaxis and Continuation therapy 

E. Introduced the concept of IV chemotherapeutic agent administration

A. Intoduced the concept of "treatment phases"

B. Introduced Remission induction- usually 3 drugs

C. Intensification/ Consolidation- Different agent combo

D. CNS prophylaxis and Continuation therapy 

20

What is the goal of Remission in the treatment of cancer?

A. Prevent the regrowth of cancer cells

B. Rapidly kill most tumor cells

C. Completely eradicate remaining cancer cells

D. CNS prophylaxis 

 

B. Rapidly kill most cancer cells

 

21

All of the following are definitions of Remission EXCEPT:

A. Less than 5% leukemic blasts in bone marrow remain

B. Normal blood cells

C. Abscence of tumor cells in the blood

D. Complete removal of tumor cells from bone marrow

E. Abscence of other signs and symptoms of cancer

D. Complete removal of tumor cells from bone marrow

22

When does CNS prophylaxis begin?

A. Begins and continues during the Consolidation/Intensification phase of treatment

B. Begins at the beginning of the Remission phase

C. Begins at the beginning of the continuation phase

D. Begins after the entire cancer therapy regimen is complete

A. Begins and continues during the Consolidation/Intensification phase of treatment

23

What is the goal of Consolidation therapy?

A. Completely eradicates the remaining tumor cells

B. Reduces the tumor cell percentage to less than 5% in the bone marrow

C. Uses high dose mutidrug chemotherapy to further reduce tumor burden

D. CNS prophylaxis 

C. Uses high dose mutidrug chemotherapy to further reduce tumor burden

24

What is the goal in the Maintenance phase of cancer treatment?

A. Kill any residual cancer cells that were not killed in the Remission Induction and Intensification/ Consolidation phases

B. Begin CNS prophylaxis

C. Utilize high-dose multidrug chemotherapy to reduce tumor burden 

D. Reduce the residual cancer cells that were notkilled in the Remission Induction and Intensification/Consolidation phases to a manageable level. 

A. Kill any residual cancer cells that were not killed in the Remission Induction and Intensification/ Consolidation phases

25

(Short Answer) Why is it important to eliminate all remaining cancer cells in the Maintenance phase of cancer treatment? 

Any remaining cancer cells no matter the number will eventually grow and proliferate again so they need to be completel eradicated. 

26

Which of the following medicatinos is in the Hyper-CVAD treatment regimen? (Select All)

A. Cyclophosphamide

B. Vincristine 

C. Prednisone 

D. Dexamethasone

E. Ara-C (Cytarabine)

A. Cyclophosphamide

B. Vincristine

D. Dexamethasone

E. Ara-C (Cytarabine)

27

Course A of HyperCVAD consits of which medications? (Select All)

A. Cyclophosphamide

B. High-dose Ara-C (Cytarabine)

C. High dose MTX IT

D. Vincristine

E. Dexamethasone 

A. Cyclophosphamide

D. Vincristine

E. Dexamethasone

28

Course B of HyperCVAD consists of which medications (Select All)

A. Cyclophosphamide

B. High dose MTX IT

C. Vincristine

D. High dose Ara-C (Cytarabine)

E. Dexamethasone

B. High dose MTX IT

D. High dose Ara-C (Cytarabine)

29

Which of these medications is given for CNS prophylaxis?

A. Cytarabine

B. Cyclophosphamide

C. High-Dose MTX IT

D. Vincristine

C. High Dose MTX IT

30

Which of these medications is given as Supportive Care in the treatment of cancer? (Select All)

A. Ciprofloxacin 

B. Cyanocobalamin

C. Fluconazole

D. Acyclovir

E. G-CSF

A. Ciprofloxacin

C. Fluconazole

D. Acyclovir

E. G-CSF

31

What does the term "Hyper" mean in HyperCVAD?

A. Rapid, high dose medication therapy

B. Hyper-fractioned meaning smaller doses given more frequently 

C. High dose medication, given less frequently 

D. None of the above

B. Hyper-fractioned meaning smaller doses given more frequently 

32

CL is a 12 yo patient who has just undergone HyperCVAD regimen in order to treat his B-Cell ALL. Which maintinence regimen is this patient a candidate for?

A. HSCT and Imatinib

B. Interfereon-a and Ara C for 2 years

C. No maintinence therapy required

C. No maintinence therapy required

patients that present with B-Cell ALL do not require maintinence therapy after treatment.

33

Patient CV is an 8 yo female who has just finished HyperCVAD therapy for his cancer treatment. The cancer that was treated in this particular patient contained the t(9,22) mutation known as the Philadelphia Chromosome. What maintinence therapy should this patient receive?

A. HSCT and Imatinib

B. Interferon-a and ARA C for 2 years

C. no maintenance therapy required

A. HSCT and Imatinib

this is because of the BCR-ABL t(9,22) mutation

34

IT is a 17 yo female who has just finished her HyperCVAD regimen in order to treat her T-Cell ALL. What maintinence therapy should she receive?

A. HSCT and Imatinib

B. Interferon-a and Ara C for 2 years

C. No maintenance therapy 

B. Interferon-a and Ara C for 2 years

All other patients who do not have either B-Cell ALL or the Ph+ (t(9,22)) chromosome are given interfereon-a and Ara-C for 2 years. 

35

How do we assess response to therapy? (Select All)

A. Bone marrow evaluation

B. Assess cytologic complete remission 

C. Measurement of Minimal Residual Disease (MRD)

D. Measurement of Peak Flow Symmetry 

A. Bone marrow evaluation

B. Assess cytologic complete remission 

C. Measurement of Minimal Residual Disease (MRD)

36

Which of the following is NOT an assay for Minimal Residual Disease? 

A. Flow Cytometry

B. Flow Symmetry

C. Polymerase Chain Reaction (PCR)

D. In Fluorescence in situ Hybridization (FISH)

B. Flow Symmetry

37

Which of the following criteria must be met for a Complete Response? (Select All)

A. <5% blasts in the bone marrow

B. No abnormal peripheral blasts in blood

C. Complete eradication of blasts from the bone marrow

D. Normal hematological response

E. Resolution of signs and symptoms

A. <5% blasts in the bone marrow

B. No abnormal peripheral blasts in blood

D. Normal hematological response

E. Resolution of signs and symptoms

38

Of the Myeloid Malignancies the most common is ___. 

A. Acute Myeloid Leukemia (AML)

B. Chronic Myeloid Leukemia (CML)

A. Acute Myeloid Leukemia (AML)

39

(Short Answer)

Acute Myeloid Leukemia (AML) is considered to have a higher cure rate in adults under the age of 60 in comparison to those above the age of 60. What is the reason for this?

Intense Chemotherapy: Many people above the age of 60 are unable to receive intense chemotherapy that is required to cure AML

Intolerance: Many people above the age of 60 do not want this type of therapy because of the large amounts of side effects associated with the high intensity.

Bodily function: As people age their bodily function such as metabolism of the medication and liver/renal function declines and may not be candidates for the intense medication therapy

Transplant Issues: Older patients above the age of 60 are sometimes not able to receive a transplant due to complications that could arise afterwards

40

Which of the following is a part of AML therapy?

A. Induction

B. Consolidation

C. Allo Transplant

D. All of the above

D. 

41

Acute Myeloid Leukemia Induction therapy is typically done using:

A. HyperCVAD in small frequent doses. 

B. High dose MTX given intrathecally weekly x 4 cycles

C. HiDAC therapy 

D. Cytarabine+Daunarubicin 

D. Cytarabine+Daunarubicin

42

Which of the following statements is true regarding the Induction phase when treating AML? (Select All)

A. Goal is to kill all leukemic cells in the blood and bone marrow

B. Cytarabine will be given on days 1-3 days and daunarubicin will be given on days 1-7

C. If there are no detectable leukemia in the blood or bone marrow by day 14, continue to the post remission phase

D. If there is still leukemia present in the bone or blood by day 14, search for alternative chemotherapy regimen

E. If there is still leukemia present in the bone or blood by day 14, re-induction therapy should occur using same regimen

A. Goal is to kill all leukemic cells in the blood and bone marrow

C. If there are no detectable leukemia in the blood or bone marrow by day 14, continue to the post remission phase

E. If there is still leukemia present in the bone or blood by day 14, re-induction therapy should occur using same regimen

43

Which of the following statements are true regarding AML Consolidation (Post-Remission)? (Select All)

A. Goal is to kill any residual leukemic disease

B. Typically uses the same medications in the induction phase at identical dosages

C. Consolidation phase uses the HiDAC chemotherapy regimen

D. Usually utilizes different drugs/dosage than what was used in the induction phase

A. Goal is to kill any residual leukemic disease

C. Consolidation uses the same medications in the induction phase at identical dosages

D. Usually utilizes different drugs/dosages than what was used in the induction phase

44

Which of these describes the HiDAC regimen when treating AML?

A. High Dose Doxarubicin x 4 cycles

B. High Dose Cyclophosphamide x 4 cycles 

C. High Dose Cytarabine x 4 cycles

D. High Dose Cyanocobalamin x 4 cycles

C. High dose Cytarabine

45

After Induction and Consolidation therapy are successful what typically occurs afterwards?

A. Maintenance therapy using Intrathecal MTX in order to prevent CNS involvement

B. Maintenance therapy using Interferon-a and Ara-C for 2 years after treatment

C. Allo-Transplant after control of leukemic cells has been established

D. Maintenance therapy using HyperCVAD

C. Allo-Transplant after control of leukemic cells has been established

46

Which of the following statements is NOT true regarding AML Allo-Transplant?

A. Occurs after control of leukemic cells 

B. Decision to transplant will depend on Age and Cytogenetics of AML

C. Allo-transplant is preferred with a matched sibling 

D. Transplant may occur in the prescence of residual cancer

 

D. Transplant may occur in the prescence of residual cancer

47

When is Maintenance therapy initiated in patients who present with AML?

A. Always given after transplant in order to prevent possible regrowth of leukemic cells

B. Given as a complement to consolidation therapy in order to further eradicate remaining leukemic cells

C. Given when goal of therapy is to cure

D. Given when consolidation therapy is not possible

D. Given when consolidation therapy is not possible

48

Which of the following is a toxicity that must be noted when administering Cytarabine? (Select All)

A. Full body hairloss

B. Severe CNS toxicity with doses > 1g/m

C. Conjunctivitis

D. Hand and Foot syndrome

B. Severe CNS toxicity with doses > 1g/m

C. Conjunctivitis

49

What general class of medication is used in order to prevent or treat conjunctivitis that is associated with Cytarabine?

A. IV Fluoroquinolone

B. IV NSAID

C. Oral NSAID

D. Opthalamic Steroid

E. Oral Steroid

D. Opthalamic steroid

50

Which of the following are toxicities associated with using anthracycline antibiotics (Daunarubicin) in treatment of AML? (select all)

A. Dose-limiting cardiotoxicity at cumulative doxorubicin dose equivalent of 450 mg/m2

B. Full body hairloss

C. Moderate Nausea/Vomitting

D. Extravasation Risk 

A. Dose-limiting cardiotoxicity at cumulative doxorubicin dose equivalent of 450 mg/m2

C. Moderate Nausea/Vomitting

D. Extravasation Risk