Hematologic Malignancies Flashcards

A 60-year-old with newly diagnosed AML has FLT3-ITD mutation. Which agent should be added to standard induction chemotherapy based on current NCCG guidelines?

Answer: Midostaurin

Midostaurin, a FLT3 inhibitor, significantly improves OS when added to standard 7+3 induction in FLT3-mutated AML (RATIFY trial).

A patient with Hodgkin lymphoma relapses after ABVD chemotherapy. PET-CT confirms relapsed disease. What is the standard treatment approach for transplant-eligible patients?

Answer: Salvage chemotherapy followed by autologous stem cell transplant

Relapsed/refractory Hodgkin lymphoma in transplant-eligible patients is treated with platinum-based salvage chemotherapy followed by high-dose chemotherapy and autologous SCT.

Which clinical feature distinguishes essential thrombocythemia (ET) from a reactive thrombocytosis?

Answer: Presence of JAK2, CALR, or MPL mutation

Driver mutations (JAK2 V617F, CALR, MPL) confirm clonal thrombocytosis in ET; reactive thrombocytosis has no clonal mutation.

A patient with Waldenström macroglobulinemia presents with episodic Raynaud phenomenon, urticaria, and hyperviscosity. Which immunoglobulin class is responsible?

Answer: IgM

Waldenström macroglobulinemia is characterized by a monoclonal IgM paraprotein; its large pentameric structure causes hyperviscosity and cold agglutinin/cryoglobulin phenomena.

A patient with T-cell acute lymphoblastic leukemia (T-ALL) has a mediastinal mass causing superior vena cava syndrome. Which chemotherapy backbone is most appropriate for induction?

Answer: Hyper-CVAD or BFM-based multi-agent protocol

T-ALL is treated with intensive multi-agent protocols such as Hyper-CVAD or BFM, which incorporate L-asparaginase and CNS prophylaxis.

In myelodysplastic syndrome (MDS), which cytogenetic finding is associated with the best prognosis and typically responds to lenalidomide?

Answer: Del(5q)

Isolated del(5q) MDS has an excellent prognosis and is uniquely sensitive to lenalidomide, which targets the haploinsufficient CSNK1A1 gene on 5q.

A 35-year-old with Burkitt lymphoma receives CODOX-M/IVAC chemotherapy. Which prophylactic medication is most critical to prevent a life-threatening metabolic complication?

Answer: Rasburicase

Burkitt lymphoma has an extremely high proliferative rate; rasburicase rapidly degrades uric acid to prevent severe tumor lysis syndrome during induction.