Hematologic Malignancies Flashcards

Which type of leukemia is the most common leukemia in adults in the United States?

Answer: Chronic lymphocytic leukemia (CLL)

Chronic lymphocytic leukemia (CLL) is the most common adult leukemia in Western countries, accounting for approximately 25–30% of all leukemias.

The Philadelphia chromosome, resulting from a t(9;22) translocation that produces the BCR-ABL fusion gene, is the hallmark of which leukemia?

Answer: Chronic myeloid leukemia (CML)

The Philadelphia chromosome [t(9;22)] producing BCR-ABL is the defining molecular abnormality of CML and the target of tyrosine kinase inhibitors like imatinib.

A patient is diagnosed with acute promyelocytic leukemia (APL, AML-M3). Which agent is a cornerstone of induction therapy that induces differentiation of malignant promyelocytes?

Answer: All-trans retinoic acid (ATRA)

ATRA targets the PML-RARA fusion protein in APL, promoting differentiation of malignant promyelocytes and is combined with arsenic trioxide or anthracyclines for induction.

A patient with newly diagnosed AML has a FLT3-ITD mutation. What is the clinical significance of this finding?

Answer: It is associated with poor prognosis and warrants addition of a FLT3 inhibitor such as midostaurin

FLT3-ITD mutations in AML are associated with high relapse rates and poor overall survival; adding midostaurin (a FLT3 inhibitor) to standard induction chemotherapy improves outcomes.

Which of the following is the most accurate description of a complete cytogenetic response (CCyR) to imatinib therapy in CML?

Answer: No Philadelphia chromosome-positive cells detected in cytogenetic analysis (0% Ph+ metaphases)

Complete cytogenetic response (CCyR) is defined as 0% Philadelphia chromosome-positive metaphases on conventional cytogenetic analysis of bone marrow.

The Rai and Binet staging systems are used to classify the prognosis of which hematologic malignancy?

Answer: Chronic lymphocytic leukemia (CLL)

The Rai (US) and Binet (European) staging systems stratify CLL patients into risk groups based on lymphocytosis, lymphadenopathy, organomegaly, and cytopenias.

Tumor lysis syndrome (TLS) is most likely to occur following the initiation of treatment in which clinical scenario?

Answer: A patient with high-grade Burkitt lymphoma beginning chemotherapy

Burkitt lymphoma has an extremely high proliferative rate; rapid cell lysis upon chemotherapy releases intracellular contents, causing the classic TLS electrolyte abnormalities (hyperkalemia, hyperphosphatemia, hypocalcemia, hyperuricemia).