Acute lymphoblastic leukemia Flashcards Preview

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Flashcards in Acute lymphoblastic leukemia Deck (19)
1

Which chemotherapy agent has shown activity against relapsed or refractory T-ALL as a single agent?

Nelarabine

2

What is the proper radiation regimen in CNS3 T ALL?

18Gy to whole brain, including posterior halves of eyes

3

What are the specific translocations in Burkitt (3)?

C-myc
t(2;8)
t(8;14)
t(8;22)

4

Define CNS3 status?

Presence of 5 of more WBC and cytospin positive for blasts

5

Name prognostic factors in infant ALL (5)

1. Age
2. WBC at diagnosis
3. MLL rearrangement
4. Response to therapy
5. MRD

6

Name 5 predisposition syndrome for ALL

1. Li-Fraumeni
2. PAX5
3. NF1
4. Bloom syndrome
5. Ataxia-telangiectasia

7

What cytogenetic anomaly is associated with hypereosinophilia at diagnosis of ALL?

t(5;14)(q31;q32

8

Who is more at risk of developing osteonecrosis?

Teenagers, females, patients on treatment

9

What is the most important prognostic factor in ALL?

MRD

10

Name 3 good cytogenetic features

1. Hyperdiploidy
2. ETV6-RUNX1
3. Trisomies 4, 10, 17

11

What is the mechanism of allopurinol and rasburicase?

Allopurinol: competitive inhibition of xanthine oxidase, leading to decreased formation of uric acide
Rasburicase: recombinant urate oxidase, which promotes catabolism of uric acid into allantoin (water soluble, easily excreted in urine)

12

Which patients required CNS radiation?

CNS3
T-cell ALL
Patients presenting with very high WBC count at Dx (?)

13

What is the prognosis of infant ALL?

EFS: 20-40%

14

How is defined hematologic remission following induction for ALL?

Normocellular bone marrow with blasts < 5% and absence of blasts in peripheral blood;
Should be done in context of almost normal counts, i.e. ANC > 500 and platelets > 100 000

15

Primary induction failure in ALL
- Incidence
- RF
- Prognosis

<5% of cases
RF: T-cell ALL, high WBC at presentation
Poor prognosis (OS: 30%); might be improved by HSCT in first remission

16

In maintenance therapy for ALL, why do we use 6MP rather than 6TG?

Higher rates of hepatotoxicity (VOD, cirrhosis) are seen with 6-TG
6-TG has theoretical advantage of not relying on TPMT for metabolism and is potent in vitro, but no clinical benefit proven (efficacy seems equivalent between both)

17

Discuss pros and cons of prednisone and dexamethasone in ALL treatment

Dexamethasone is more potent than prednisone, has more CNS penetration and is associated with better EFS.
However, associated with more toxicities, especially in older children and adolescents, including osteonecrosis, fractures, infections.

18

Recommended supportive therapies in infant ALL (8 measures)

IV broad spectrum Atbx for F&N
Empiric antifungal therapy for persistent fever * 3-5 days
Consideration of antifungal prophylaxis
PJP prophylaxis
RSV Prophylaxis
Influenza vaccination
IVIg replacement
Prolonged hospitalisation until marrow recovery

19

Prognostic factors in infant ALL

- Age
- WBC at presentation
- MLL rearrangement
- Response to prednisone (number of blasts at D8)
- MRD