1. JP is a 78-year-old male with newly diagnosed, immunoglobulin heavy chain (IGHV)-unmutated chronic lymphocytic leukemia (CLL). His past medical history includes uncontrolled atrial fibrillation, hypertension, and type 2 diabetes mellitus. His home medication list includes metoprolol, lisinopril, metformin, and apixaban. Which of the following therapies is the most appropriate for first-line treatment of his CLL?
A. BR (bendamustine + rituximab)
B. FCR (fludarabine, cyclophosphamide, rituximab)
C. Obinutuzumab + chlorambucil
D. Venetoclax + obinutuzumab
E. Unsure
2. You have a patient with chronic lymphocytic leukemia starting a clinical trial of venetoclax + ibrutinib. The PET scan demonstrates some lymphadenopathy, with the largest lymph node measuring 4 cm. The most recent laboratory values indicate an absolute lymphocyte count (ALC) of 20 ? 109/L, serum creatinine of 0.8 mg/dL, uric acid of 6 mg/dL, potassium of 4.2 mmol/L, phosphorous of 3.8 mg/dL, and calcium of 10 mg/dL. Which of the following is the best strategy to prevent tumor lysis syndrome (TLS) in this patient?
A. Manage as an outpatient with oral hydration and allopurinol
B. Manage as an inpatient with intravenous (IV) hydration and rasburicase
C. Manage as an outpatient with IV hydration and rasburicase
D. Manage as an inpatient with oral hydration and close monitoring
E. Unsure
3. Which of the following is approved by the United States Food and Drug Administration (FDA) and is recommended by the National Comprehensive Cancer Network (NCCN) guidelines for relapsed/refractory (R/R) follicular lymphoma (FL)?
A. Copanlisib
B. Ibrutinib
C. Polatuzumab
D. Venetoclax
E. Unsure
4. You are providing an in-service on new drug approvals in lymphoma to your infusion nursing staff. Which of the following pieces of information will you include in this presentation?
A. Venetoclax is classified as a proteasome inhibitor
B. Acalabrutinib causes headaches that may be relieved by caffeine
C. Zanubrutinib is more likely to cause atrial fibrillation than ibrutinib
D. Duvelisib strongly inhibits PI3K-?, leading to transient hyperglycemia
E. Unsure
5. You are counseling a patient on idelalisib for their relapsed/refractory follicular lymphoma. Which of the following is a black box warning associated with idelalisib that should be included in your patient education?
A. Bleeding
B. Colitis
C. Hyperglycemia
D. Hypertension
E. Unsure
6. Both ibrutinib and venetoclax are approved by the United States Food and Drug Administration (FDA) and recommended by the National Comprehensive Cancer Network (NCCN) for what B-cell malignancy?
A. Chronic lymphocytic leukemia
B. Mantle cell lymphoma
C. Waldenström macroglobulinemia
D. Follicular lymphoma
E. Unsure
7. JS is an 80-year-old female with treatment-naïve Waldenström macroglobulinemia who was initially followed for 2 years but is now presenting with increased symptom burden. Previously, her treatment plan was to start ibrutinib when treatment was necessary; however, according to recent data from the ASPEN trial, you and your team are considering whether to start zanubrutinib instead. Which of the following benefits of zanubrutinib over ibrutinib were demonstrated in the ASPEN trial?
A. Reduced incidence of neutropenia with zanubrutinib
B. Increased overall response rate with zanubrutinib
C. Reduced incidence of atrial fibrillation with zanubrutinib
D. Increased progression-free survival with zanubrutinib
E. Unsure
8. LB is a 68-year-old female who is going to start idelalisib for her relapsed/refractory follicular lymphoma. Her prior treatment included radiation, bendamustine/rituximab, and lenalidomide. Which of the following infection supportive care measures should be recommended?
A. Antiviral, antibacterial, and antifungal prophylaxis
B. Antiviral prophylaxis and monitoring of Epstein-Barr virus
C. Pneumocystis jirovecii pneumonia (PJP) prophylaxis and monitoring of cytomegalovirus (CMV)
D. Antibacterial and antifungal prophylaxis
E. Unsure
9. Which of the following drugs is correctly matched to its mechanism of action?
A. Venetoclax: binds to the mitochondrion, which releases caspases that inhibit BCL2
B. Venetoclax: releases BH3 proteins from BCL2, which increases binding to BAK and BAX
C. Zanubrutinib: blocks signaling from the B-cell receptor through inhibition of PI3K
D. Zanubrutinib: inhibits BTK, abrogating signaling through the B-cell receptor
E. Unsure
10. GY is a 74-year-old male with mantle cell lymphoma who was started on ibrutinib 560 mg orally daily 3 months ago. He contacts your clinic with diffuse joint pain and muscle aches that are limiting his ability to lift his arms over his head. What is the appropriate management strategy for GY's arthralgias and myalgias?
A. Hold ibrutinib, start acetaminophen, and dose reduce upon restart
B. Reduce the ibrutinib dose and start ibuprofen
C. Permanently discontinue ibrutinib, switch to venetoclax
D. Hold ibrutinib, start naproxen, dose reduce upon restart
E. Unsure
Evaluation Questions
11. How confident are in your treatment decisions for patients with B-cell malignancies?
A. Not at all confident
B. Somewhat confident
C. Confident
D. Highly confident
