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Chapter 18: Leukemia

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JL is a 47-year-old Caucasian man who reports to his primary care physician complaining of a 2-week history of fatigue and fever. A CBC with differential reveals an elevated WBC (35,000 U/L) and profound thrombocytopenia (platelets 30,000 U/L). The patient is diagnosed with acute myeloid leukemia (AML-M4). Initial induction therapy should consist which of the following:

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a. Mitoxantrone

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b. Cytarabine + idarubicin

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c. Cytarabine + imatinib

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d. Asparaginase

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Answer b is correct. The most active agents in AML are anthracyclines and the antimetabolite cytarabine. Cytarabine in combination with idarubicin is often referred to as "7+3" regimen (cytarabine 100 mg/m2 days 1-7, idarubicin 12 mg/m2 days 1-3). Accounting for age, other comorbidities, and patient's ejection fraction, this combination should be recommended for initial induction therapy.

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Answer a is incorrect. Mitoxantrone is recommended in adult AML; however, it is usually not given as monotherapy for induction. For patients younger than 60 years, they should receive standard dose cytarabine + (daunorubicin or idarubicin) per National Comprehensive Cancer Network (NCCN) guidelines.

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Answer c is incorrect. Imatinib is not recommended in AML induction. Imatinib is recommended in CML, GIST tumors, and Ph+ ALL.

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Answer d is incorrect. Asparaginase in not recommended in the treatment of adult AML. Asparaginase is recommended in pediatric and adult ALL regimens.

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JL is a 47-year-old Caucasian man who reports to his primary care physician complaining of a 2-week history of fatigue and fever. A CBC with differential reveals an elevated WBC (35,000 U/L) and profound thrombocytopenia (platelets 30,000 U/L). The patient is diagnosed with acute myeloid leukemia (AML-M4).

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TLS is characterized by the following:

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a. Hypocalcemia, hypouricemia, hyperkalemia

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b. Hyperphosphatemia, hyperkalemia, hyperuricemia

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c. Hypercalcemia, hyperkalemia, hypomagnesium

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d. Hypokalemia, hyperphosphatemia, hypouricemia

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Answer b is correct. Electrolyte disturbances commonly seen in TLS include hyperuricemia, hyperkalemia, hyperphosphatemia, and hypocalcemia.

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Answer a is incorrect. Hyperuricemia is commonly seen in TLS. Uric acid levels are often greater than 7.5 mg/dL which may require drug therapy such as rasburicase.

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Answer c is incorrect. Alterations in serum magnesium levels are not associated with TLS.

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Answer d is incorrect. Serum potassium and uric acid levels are often increased in TLS.

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JL is a 47-year-old Caucasian man who reports to his primary care physician complaining of a 2-week history of fatigue and fever. A CBC with differential reveals ...

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