AML

AML

AML

What was the main efficacy of gemtuzumab when added to 7+3 induction for de novo AML in the ALFA-0701 trial ?

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Improved EFS but not OS

AML
AML

What dose of daunorubicin is required for induction in AML?

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60-90 mg/m2
Phase 3 clinical trial showed that 60-90 mg/m2 is superior to 45 mg/m2

AML
AML

Which lymphoid cell surface markers can be seen in AML but are not diagnostic of AML?

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CD 2,7,19

AML
AML

Which cytogenetic abnormalities are pathognomonic of AML?

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inversion 16, t(16;16) and t(8;21)

AML
AML

What are the exceptions to a blast count percentage in a bone marrow to diagnose AML?

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Myeloid sarcoma, presence of chromosome abnormalities including inversion 16, t(16;16) and t(8;21)

AML
AML

What blast count is required in the bone marrow for AML diagnosis?

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20% at least

AML
AML

Which 4 immunohistochemistry stains will only be seen with AML and not ALL?

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Sudan Black, myeloperoxidase, chloroacetate esterase, nonspecific esterase

AML
AML

Which 5 cell surface markers are commonly seen in AML?

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CD13,33,34,117,HLA-DR

AML
AML

What does underlying hepatosplenomegaly suggest in newly diagnosed AML?

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Underlying myeloproliferative disorder

AML
AML

Which AML subtypes have central nervous system propensity?

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Monocytic
Myelomonocytic

AML
AML

Which AML subtypes have the most cutaneous involvement?

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Monocytic
Myelomonocytic

AML
AML Part 2

What can be added to ATRA for high risk APL?

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Anthracycline +/- cytarabine or AsO3 + anthracycline

AML Part 2
AML

What defines a higher risk APL patient?

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White blood cell count greater than 10,000

AML
AML

What alternative therapy is there for consolidation in AML with cytarabine related central nervous
system toxicity?

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Autologous stem cell transplantation

AML
AML

Which AML subtype has a propensity for alveolar hemorrhage besides M3?

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M5 (monocytic)

AML
AML

Which chemotherapy agent can be added to 7+3 induction to improve response rates and overall
survival?

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Cladribine

AML
AML

How is APL differentiation syndrome treated?

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Dexamethasone 10 mg twice daily preferred

AML
AML

What are the symptoms of differentiation syndrome with APL?

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Increasing white blood cell count, fever, dyspnea, hypoxia, pleural effusions, weight gain, edema

AML
AML

Which cell surface markers are associated with M7 AML?

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CD41 and CD61 – related to glycoprotein IIb/IIIa and trisomy 21

AML
AML

Which other translocation is similar to t(15;17) and what is its relation to ATRA?

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t(11;17) , low response, seen in 1% of APL cases , poor prognosis

AML
AML

How do you treat early relapse M3 AML?

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ATRA + AsO3, anthracycline, + IT chemo + consolidate with Auto-HSCT

AML
AML

Does cKIT abrogate NPM1 and/or other good risk features in AML?

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Yes, cKIT trumps other coexistent features

AML
AML

What features should prompt a higher dose of anthracycline for AML induction?

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Age less than 50, NPM1 mutation, FLT3-ITD, DNMT3A mutation

AML
AML

How can you treat relapsed early (<6mo) M3 APML?

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Autologous stem cell transplantation

AML
AML

What is the relationship between IDH1/2 AML outcomes?

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IDH2= favorable
IDH1= unfavorable

AML
AML

What time course defines early and late relapsed M3 AML?

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6 months

AML
AML

How can you treat late relapse (>6mo) M3 AML?

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Rechallenge with ATRA+AsO3

AML
AML

What category of risk are normal cytogenetics in AML?

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Intermediate risk

AML
AML

Which genes do anthracyclines and Topo II inhibitors target?

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MLL (11q23)

AML
AML

Which 3 laboratory and diagnostic parameters need to be maintained while treating somebody with APL
with arsenic?

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Potassium, magnesium, QTc

AML
AML

What are some consolidative options for someone with AML that has severe neurotoxicity from Ara-C?

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Autologous stem cell transplantation

AML
AML

How can you induce extramedullary AML?

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7+3 and radiotherapy, 2000 – 3000 cGy

AML
AML

What induction chemotherapy options are there for patients with heart failure with AML?

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FLAG, HIDAC, HIDAC + etoposide

AML
AML

What cardiac ejection fraction minimum is needed in order to use anthracyclines for induction in AML?

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40%

AML
AML

How can you manage AML in pregnant women?

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7+3 induction – no dose change needed

AML
AML

What is the prognostic value of cKIT in AML?

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Poor prognosis

AML
AML

What defines monosomy in AML?

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2 monosomies or single monosomy + 1 other cytogenetic change

AML
AML

How does FLT3-ITD allelic ratio play into NPM1 mutations and risk profile ?

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NPM1 mutation + FLT3-ITD low ration (<0.5) = good riskNPM1 mutation + FLT3-ITD low ratio (>0.5) = poor risk

AML
AML

What are 2 chromosomal and 2 molecular markers in favorable risk AML?

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t(8;21) inv (16) t(16;16)
CEBPA (biallelic) NPM1 with FLT3-ITD

AML
AML

What is the difference between secondary and treatment-related AML?

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Secondary AML arising from an underlying clonal hematologic malignancy including MPN, MDS, AA
Treatment related is from exposure to cytotoxic agents

AML
AML

Which genetic mutations suggests secondary AML rather than de novo AML?

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SRSF2, SF3B1, U2AF1, ZRSR2, ASXL1, EZH2, BCOR, STAG2

AML
AML

With gene is encoded in chromosome region 11q23?

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MLL

AML
AML

What is unique about inversion 16 AML with respect to relapse?

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High percent remission with second course of induction therapy

AML
AML

What is another name for inversion 16 AML?

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Core binding factor AML

AML
AML

What is the prognostic value of 11q23/MLL gene rearrangement in AML?

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poor prognosis in combination with or without other chromosomal aberrations

AML
AML

Which trisomy by itself was a poor prognostic marker for AML?

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Trisomy 8 unless coupled with good prognostic marker including t(8;21), inv(16), t(9;11), t(16;16)

AML
AML

What makes NPM1 and CEBPA good prognosis in AML?

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NPM1 in normal cytogenetics and CEBPA (biallelic) and normal cytogenetics

AML
AML

Which cytogenetic changes are good risk in AML?

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Inversion 16, deletion 9q, t(16;16), t(8;21)

AML
AML

What is the prognosis of FLT3-TKD mutated AML?

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Unknown

AML
AML

Which mutation is most common in AML and when is it a good prognostic marker?

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NPM1 and good prognosis if seen with normal cytogenetics

AML
AML

When would you consider a repeat induction regimen for AML versus a salvage regimen?

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Older patients, young patient with low burden refractory disease, hypocellular marrow, 10- 20% blasts,
High tumor burden primary refractory disease likely requires salvage therapy

AML
AML Phase 3

Has any phase 3 trial shown superiority of any IT regimen for CNS prophylaxis ?

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No

AML Phase 3
AML

How can you treat IDH2-differntiation syndrome ?

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Withhold IDH2 inhibitor and start steroids

AML
AML

What is the clinical presentation of IDH2-differntiation syndrome ?

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Pulmonary edema, hypoxia, dyspnea

AML
AML

What is a feared complication of enasidenib ?

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IDH2-differntiation syndrome

AML
AML

What is the target of ivesidenib ?

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IDH1

AML
AML

What is the target of enasidenib ?

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IDH2

AML
AML

What metabolite does IDH2 synthesize in AML cells ?

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2-hydroxy-ketoglutarate

AML
AML

Has an OS been demonstrated with the RATIFY trial in FLT3 AML ?

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Yes

AML
AML

What did the RATIFY trial assess in FLT3 AML ?

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Midostaurin as both maintenance and concurrent therapy with induction

AML
AML

What did the SORMAIN trial assess in FLT3 AML ?

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Sorafenib maintenance following allo-HSCT in FLT3-ITD AML

AML
AML

Was there an OS demonstrated in the ADMIRAL trial for AML ?

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Yes

AML
AML

What did the ADMIRAL trial assess ?

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Gilderitinib in r/r FLT3 AML

AML
AML

Was an OS demonstrated in the QuANTUM-R trial ?

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yes

AML
AML

What was quizartinib compared against in the QuANTUM-R trial ?

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MEC, LoDAC, FLAG-Ida

AML
AML

What did the QuANTUM-R trial assess ?

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Quizartinib in r/r FLT3 AML

AML
AML

Does gilteritinib target ITD or TKD in FLT3 mutated AML ?

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Both

AML
AML

Does an IDH mutation in AML confer a better or worse survival in AML patients with normal cytogenetics and no other aberrations ?

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Worse

AML
AML

Is IDH1 or IDH2 more prevalent in AML ?

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IDH2

AML
AML

Is there a survival advantage when venetoclex is added to low dose Ara-C for AML patients who are not candidates for intensive induction chemo ?

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Yes

AML
AML

Does the risk of neutropenia increase when venetoclex is added to low dose Ara-C for AML patients who are not candidates for intensive induction chemo ?

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Yes

AML
AML

Which agents are ideal for intrathecal treatment of AML when there is confirmed CNS involvement ?

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Methotrexate, hydrocortisone and Cytarabine

AML
AML

What is another name for IL3 Receptor A ?

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CD123

AML
AML

What is the intracellular target of the diphtheria toxin ?

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EF2

AML
AML

What is the payload of Tagraxofusp ?

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Catalytic and transmembrane domain of the Diphtheria toxin

AML
AML

Which cytokine is the tagraxofusp a clone of ?

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IL-3

AML
AML

Which antibody has been approved for use in BPDCN ?

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Tagraxofusp

AML
AML

Which IHC markers are required to diagnose BPDCN ?

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4 out 6 of the following CD 4, 56, 123, TCL-1, CD2AP, CD303

AML
AML

What comprises FLAG-IDA ?

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Fludarabine, cytarabine, G-CSF and idaurubicin

AML
AML

What ophthalmic prophylaxis is required of patients receiving high dose cytarabine ?

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Steroid eye drops

AML
AML

What factors can predispose patients to cytarabine-related neuro toxicity ?

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Older age and renal dysfunction

AML
AML

What risk stratification does a RUNX1 mutation confer in AML ?

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Poor risk

AML
AML

What are some induction options for poor performance status elderly AML patients without actionable mutations ?

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Single agent gemtuzumab, glasdegib + cytarabine, Venetoclax plus low dose cytarabine or hypomethylating agent

AML
AML

What is a non-cytotoxic induction option for patients older than 60 with poor risk AML ?

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Venetoclax plus hypomethylating agent or Venetoclax plus low dose cytarabine

AML
AML

Can favorable risk AML patients that are older than 60 still qualify for gemtuzumab in addition to an intensive induction regimen ?

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Yes

AML
AML

Which patients are better candidates for liposomal encapsulated daunorubicin and cytarabine for induction ?

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Older patients and those with t-MDS, AML-MRC, and antecedent MDS/CMML

AML
AML

Which AML patients should get a screening lumbar puncture after first remission ?

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WBC >40K, FLT3 mutated, Monocytic Differentiation, Mixed Phenotype, Extramedullary Disease

AML
AML

What defines bone marrow hypoplasia after induction chemo in AML ?

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Cellularity less than 20% with less than 5% blasts

AML
AML

When should a post-induction bone marrow biopsy be performed in AML ?

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Days 14-21

AML
AML

Does cladribine prolong survival in AML when added to induction for poor risk patients ?

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No

AML
AML

Which risk groups of AML can receive fludarabine in addition to 7+3 for induction ?

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Intermediate and poor risk AML

AML
AML

Which patients could qualify for high dose Ara-C (cytarabine 1-3,000mg/m2) for AML induction ?

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Younger than 45 (category 1), otherwise category 2B

AML
AML

Should midostaurin be added to TKD or ITD FLT3 mutated AML after induction ?

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Both

AML
AML

When is midostaurin added to induction for intermediate risk FLT3 mutated AML ?

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Days 8-21 after 7+3 is complete

AML
AML

What category NCCN recommendation is there for idarubicin + cytarabine for favorable risk AML induction ?

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Category 1

AML
AML

What can be added to standard induction to CD33 positive AML patients that have good risk cytogenetics ?

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Gemtuzumab

AML
AML

What is an the flow cytometry signature for APL?

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HLA-DR -, CD34-, MPO+, CD33+

AML
AML

How can you consolidate a late relapse AML who achieves a second remission?

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Allogeneic stem cell transplant

AML
AML

What makes t(8;21) in AML good versus poor risk?

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T(8;21) alone = good risk
T(8;21) + cKIT mutation = intermediate risk.

AML
AML

What are the good risk features for AML?

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Inversion 16,t(16;16), t(8;21), t(15;17), normal cytogenetics with NPM1 mutation and FLT3-ITD
negativity, normal cytogenetics with isolated biallelic CEBPA

AML
AML

Which AML patients benefits from higher dose daunorubicin?

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FLT3-ITD, high risk in intermediate risk AML, those younger than 50 years old

AML
AML

Which mutations should prompt use of higher dose daunorubicin in AML?

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DNTM3A, NPM1, MLL translocation

AML
AML

Is IDH2 mutation good risk or poor risk in AML?

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Good risk

AML
AML

What are 4 poor prognosis mutation seen in AML?

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TET2, MLL-PTD, ASXL1, PHF6

AML
AML

How do you treat early and late relapsed AML (M3)?

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Early, less than 6 months, ATRA, AsO3+ anthracycline.
Late, greater than 6 months, ATRA+AsO3

AML
AML

How can you treat extra medullary sarcoma?

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7+3, no surgery, no radiotherapy

AML
AML

What are the 2 known extra medullary types of AML?

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Myeloid sarcoma and Leukemic Cutis

AML
AML

What are the nuclear cytoplasmic features of APL?

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Azurophilic granules
Auer rods
Bilobed nucleus

AML
AML

What is a risk factor for central nervous system disease in AML?

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White blood cell count greater than 100,000
M4/M5 subtype

AML
AML

Which AML subtype is at increased risk for central nervous system disease?

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M4/M5

AML
AML

How would you consolidate normal cytogenetic AML patients with NPM1 mutations?

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High dose Ara-C

AML
AML

Should midostaurin be considered for FLT-TKD AML patients?

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Yes

AML
AML

How can you consolidate a FLT3-ITD AML after successful induction?

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Allogeneic stem cell transplantation

AML
AML

What are the two FLT3 mutation subtypes and which is more relevant?

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FLT3-ITD is a stronger driver while FLT3-TKD mutations drive disease to a lesser extent

AML
AML

Which mutations in CEBPA leads to good outcomes in AML?

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Biallelic CEBPA with increased CR and OS

AML
AML

What does a cKIT mutation confer in AML?

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Poor prognosis

AML
AML

What other NPM1 mutations co-occur with in AML that confer good prognosis?

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Normal cytogenetics

AML
AML

What GVHD effect can lead to increased infection with encapsulated bacteria?

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Splenic atrophy

AML
AML

What are the 6 adverse cytogenetic features of AML?

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Deletion 7, deletion 5, inversion 3, trisomy 8, t(6;9), t(11;19), greater than or equal to 3 cytogenetic
changes

AML
AML

Which gene is affected with therapy related MDS and t(4;11)?

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MLL – 11q23

AML
AML Part 4

What did the HOVON97 trial assess in elderly adults with de novo AML ?

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Azacitidine maintenance following 2 cycles of intensive chemo – improved DFS

AML Part 4
AML

Is there randomized phase 3 data supporting the use of clofarabine with LoDAC in elderly unfit patients with de novo AML ?

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Yes, but failed to show OS, only EFS and CR

AML
AML

Is there phase 3 data to support the use of gemtuzumab in elderly unfit patients for de novo AML treatment ?

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Yes, EORTC-GIMEMA AML-19 Trial

AML
AML

Did the BRIGHT AML 1003 demonstrate an OS improvement ?

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Yes

AML
AML

What did the BRIGHT AML 1003 study assess ?

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Glasdegib + LoDAC versus LoDAC in de novo AML unfit for induction chemo

AML
AML

Has an OS been demonstrated for de novo AML treated with front-line decitabine in elderly/ unfit patients ?

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Yes, DACO-016 trial

AML
AML

What combinations of venetoclex in elderly / unfit de novo AML patients are available ?

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LoDAC, azacitidine and decitabine

AML
AML

Is there phase 3 data supporting the use of azacitidine in elderly / unfit patients with de novo AML ?

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Yes, AZH PH GL 2003 trial

AML
AML

What are the major AE associated with gemtuzumab ?

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Grade 3/4 thrombocytopenia/neutropenia as well as VOD

AML
AML

What was the main efficacy of gemtuzumab when added to 7+3 induction for de novo AML in the ALFA-0701 trial ?

View Answer
View Question

Improved EFS but not OS

AML
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