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Chapter 15. Leukemias

DC is a 59-year-old Caucasian man who reports to his primary care physician complaining of 2-week history of fatigue and fever. A CBC with differential reveals an elevated WBC (25,000 U/L) and profound thrombocytopenia (platelets 30,000 U/L). His peripheral blood has 20% blasts. A bone marrow biopsy was performed and DC was diagnosed with acute myeloid leukemia (AML-M4). Molecular testing revealed—FLT3 negative, NPML1 negative, C-KIT negative. Initial induction therapy should consist of the following:

a. Mitoxantrone

b. Cytarabine + idarubicin

c. Cytarabine + imatinib

d. Asparaginase

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.

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

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

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

DC is a 59-year-old Caucasian man who reports to his primary care physician complaining of 2-week history of fatigue and fever. A CBC with differential reveals an elevated WBC (25,000 U/L) and profound thrombocytopenia (platelets 30,000 U/L). His peripheral blood has 20% blasts. A bone marrow biopsy was performed and DC was diagnosed with acute myeloid leukemia (AML-M4). Molecular testing revealed—FLT3 negative, NPML1 negative, C-KIT negative.

TLS is characterized by the following:

a. Hypocalcemia, hypouricemia, hyperkalemia

b. Hyperphosphatemia, hyperkalemia, hyperuricemia

c. Hypercalcemia, hyperkalemia, hypomagnesium

d. Hypokalemia, hyperphosphatemia, hypouricemia

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

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

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

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

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