1. CASE STUDY: Use the following case to answer questions 1 through 4
A. A single cycle of multi-agent chemotherapy
B. Induction chemotherapy followed by allogeneic stem cell transplant
C. Induction chemotherapy followed by consolidation therapy and then maintenance therapy
D. Induction chemotherapy followed by maintenance therapy
E. Unsure
2. AH did not achieve a complete remission with first induction therapy but did following second induction therapy. A second relapse occurred following 1 year of maintenance therapy. AH will now receive induction therapy again. Which of the following novel regimens is only indicated for patients like AH who have had at least 2 relapses?
A. Blinatumomab
B. Inotuzumab ozogamicin
C. Tisagenlecleucel
D. Vincristine sulfate liposomal injection
E. Unsure
3. Liposomal vincristine is prescribed for AH. Which of the following best characterizes toxicities observed with liposomal vincristine sulfate injection?
A. Constipation, myelosuppression, and neuropathy
B. Constipation and neuropathy but no myelosuppression
C. Constipation and syndrome of inappropriate antidiuretic hormone secretion but minimal neuropathy
D. Only myelosuppression; no constipation or neuropathy
E. Unsure
4. As a pharmacist, you review the following order for AH: liposomal vincristine 2.25 mg/m2 over 60 minutes on days 1, 8, 15, and 22 every 28 days. This is the first time your hospital has used liposomal vincristine. What prophylactic regimen should accompany this order?
A. Premedication with dexamethasone 20 mg by mouth 1 hour before the first dose of each cycle
B. Premedication with dexamethasone 20 mg, diphenhydramine 25 mg, and acetaminophen 325 mg by mouth 30 to 60 minutes before treatment
C. Premedication with diphenhydramine 25 mg and acetaminophen 325 mg by mouth 30 to 60 minutes before treatment
D. Prophylactic bowel regimen with docusate 100 mg/sennasoids 17.2 mg by mouth daily
E. Unsure
5. CASE STUDY: Use the following case to answer questions 5 through 7
A. Binding and subsequent endocytosis of the anti-CD22 antibody-drug conjugate that releases calicheamicin resulting in DNA strand breaks
B. Blunting the activity of programmed cell death 1 (PD-1) receptors thereby restoring antitumor T-cell activity
C. Reprogramming of genetically modified autologous T-cells to recognize and attack CD19-positive ALL cells
D. Bi-specific CD19-directed CD3 T-cell engager that activates endogenous T-cells by connecting CD3 in the T-cell receptor complex with CD19 on malignant B-cells
E. Unsure
6. Which of the following pharmacist-driven interventions can reduce the risk of adverse effects or drug-drug interactions with inotuzumab ozogamicin for KB?
A. Coordinating care with home infusion centers for subsequent cycles and ensuring they are familiar with monitoring for cytokine release syndrome
B. Monitoring for neurologic symptoms and avoiding use of neurotoxic drugs
C. Monitoring international normalized ratio (INR) daily during therapy
D. Surveillance for changes in hepatic function and avoiding use of concomitant hepatotoxic drugs
E. Unsure
7. KB will start treatment immediately. She has yet to receive her influenza vaccine for the current influenza season. Which of the following is the most appropriate recommendation for KB?
A. She should wait until 3 months following treatment to receive the inactivated influenza vaccine
B. She should receive the vaccine now and then in 2 weeks before beginning treatment with inotuzumab ozogamicin
C. She can receive the inactivated vaccine but not on the same day as inotuzumab ozogamicin
D. She can receive the inactivated vaccine but not on the same day as inotuzumab ozogamicin and she should be revaccinated 1 month after completion of therapy
E. Unsure
8. Which of the following acute lymphoblastic leukemia (ALL) patients would benefit from chimeric antigen receptor (CAR)-T cell therapy with tisagenlecleucel according to the published clinical trials to date?
A. A 21-year-old female with B-cell ALL who is refractory to conventional induction therapy
B. A 46-year-old female with Philadelphia chromosome-negative precursor B-cell ALL who is not eligible for allogeneic hematopoietic stem cell transplantation
C. A 64-year-old male with Philadelphia chromosome-positive ALL who has relapsed following intensification therapy
D. A newly diagnosed 55-year-old male with Philadelphia chromosome-negative precursor B-cell ALL who has relapsed twice during the past 3 years
E. Unsure
9. MH is a 23-year-old female with relapsed Philadelphia chromosome-negative precursor B-cell acute lymphoblastic leukemia who will be receiving tisagenlecleucel infusion following lymphodepleting chemotherapy. Which of the following describes a life-threatening toxicity of tisangenlecleucel that requires careful monitoring by a pharmacist?
A. Cytokine release syndrome
B. Hepatic veno-occlusive disease
C. Infusion-related reaction
D. Secondary malignancy
E. Unsure
10. Your institution has recently hired a hematologist who specializes in acute lymphoblastic leukemia (ALL). Until now, most ALL patients were transferred to the local academic medical center for care. Now that you will be treating ALL at your institution, you are developing best practices for implementation. Which of the following practices is correctly matched with the treatment?
A. Blinatumomab: infuse over 2 hours as an outpatient
B. Inotuzumab ozogamicin: use a water bath device for preparation
C. Tisagenlecleucel: coordinate care with a home infusion service agency
D. Vincristine sulfate liposomal injection: allow for uninterrupted preparation time of 60 to 90 minutes
E. Unsure
Evaluation Questions
11. How confident are you in monitoring MH for toxicity to tisangenlecleucel above?
A. Not at all confident
B. Somewhat confident
C. Confident
D. Highly confident
12. How confident are you in identifying the best practice for treating your ALL patients in house?
A. Not at all confident
B. Somewhat confident
C. Confident
D. Highly confident
