What is the characteristic translocation and oncoprotein associated with CML?
Translocation t(9;22) creates BCR-ABL fusion protein (p210)
What features make up the Sokal risk assessment score in CML?
Age, spleen size, platelet size, and blast percentage
What are the first line treatment options for CML?
Imagining (low-risk only), dasatinib, nilotinib, bosutinib
**Technically asciminib is now approved in the frontline setting as well
What are some of the side effects of nilotinib?
QT prolongation, GI upset, pancreatitis, hyperglycemia, hypercholesterolemia, liver toxicity, and risk of arterial adverse events/peripheral artery occlusion
What is unique about the way that nilotinib is has to be taken?
No food for two hours before or 1 hour after taking nilotinib
What are some of the common toxicities of dasatinib?
QT prolongation, thrombocytopenia and platelet dysfunction (potential for bleeding), GERD, pleural effusion, pericardial effusion, pulmonary hypertension
What are some of the common side effects of imatinib?
Skin rash, muscle cramps, diarrhea, periorbital swelling/edema, liver function abnormalities, and QT prolongation
What are some of the characteristic toxicities of bosutinib?
Diarrhea, nausea/vomiting, hepatotoxicity, rash, fluid retention, cardiovascular events (heart failure, MI), and renal insufficiency
How soon should BCR-ABL transcript be checked after starting someone on treatment for their CML?
3 months
What is the goal BCR-ABL IS 3 months after starting TKI for CML?
< 10%
What is the goal BCR-ABL IS at 6 months for someone on therapy for CML?
< 1%
What is the goal BCR-ABL IS at 12 months for someone on treatment for CML?
< 1%
Asciminib and ponatinib can be used to overcome what resistance mutation?
T315I
What ribosomal inhibitor is approved in the third line or later for CML patients who have failed at least two other TKI’s?
Omacetaxine
What are some of the characteristic toxicities of ponatinib?
Arterial and venous thrombotic events, pancreatitis, rash, and hypertension
What are indications for allogeneic transplant in CML?
- Chronic phase disease resistant to at least 1 second generation and 1 third generation TKI
- Blast phase disease after achieving best response to TKI
What criteria must a patient with CML meet in order to be deemed eligible for a trial of treatment discontinuation?
- Be on treatment for at least 3 years consecutively
- Achieve a 10^-4 log reduction (aka MR4 or < 0.01%) and maintain this for a continuous 2-year period
What is the surveillance schedule in a patient who discontinues their TKI for CML?
Check BCR-ABL monthly for months 1-6, then every other month for months 7-12, then every 3 months after
