1. IDH inhibitors can cause differentiation syndrome, which can be serious and life threatening. Which of the following is the most accurate grouping of symptoms for differentiation syndrome?
A. Nausea, diarrhea, weight loss, and fever
B. Pulmonary symptoms, unexplained fever, weight gain, and hypoxia
C. Disseminated intravascular coagulopathy, constipation, insomnia, and dysgeusia
D. Nausea, pericardial effusion, weight loss, and QT prolongation
E. Unsure
2. In pivotal clinical trials, all of the following medications were given orally on a daily basis for newly diagnosed AML except:
A. Ivosidenib and enasidenib
B. Venetoclax
C. CC-486
D. Glasdegib
E. Unsure
3. Which of the following electrolyte abnormalities can result in tumor lysis syndrome as a result of the use of venetoclax?
A. Hyperkalemia, hyperphosphatemia, hyperuricemia, hypocalcemia
B. Hypocalcemia, hypokalemia, hypophosphatemia, hyperuricemia
C. Hypomagnesemia, hypokalemia, hypercalcemia, hyperphosphatemia
D. Hyperkalemia, hypercalcemia, hypouricemia, hypomagnesemia
E. Unsure
4. Which of the following factors predicts a poorer prognosis in patients with newly diagnosed AML?
A. Inversion 16
B. FLT3 mutations
C. Biallelic CEBPA mutation
D. All of the above
E. Unsure
5. As demonstrated in the QUAZAR AML-001, which of the following is true:
A. CC-486 (oral azacitidine) can substitute for intravenous or subcutaneous azacitabine.
B. CC-486 is administered daily in each 28-day cycle until disease progression or unacceptable toxicity.
C. Upon remission following induction and consolidation therapy, the addition of CC-486 yielded improved overall survival by 9.9 months compared with placebo.
D. Upon remission following induction and consolidation therapy, the addition of CC-486 demonstrated an improvement in progression-free survival of 17 months versus placebo but did not demonstrate an improvement in overall survival.
E. Unsure
6. Which of the following was a key finding in the RATIFY/CALGB 10603 trial?
A. Midostaurin demonstrated an improvement in overall survival of 74.7 months versus 25.6 months for placebo.
B. Grade 3+ rash occurred in more than one quarter of patients.
C. Four-year overall survival was 41.4% in the midostaurin group and 34.3% in the placebo group.
D. Progression-free survival was 86.4 months in the midostaurin group and 65.2 months in the placebo group.
E. Unsure
7. XT is a 77-year-old man with newly diagnosed AML. He is not a candidate for intensive induction chemotherapy. When the AML was recognized, XT was also diagnosed with pulmonary aspergillosis, for which he is receiving posaconazole after having intolerance to voriconazole and itraconazole. Given his therapy with a hypomethylating agent, XT's daily maintenance dose of venetoclax should be:
A. 400 mg
B. 600 mg
C. 70 mg
D. 100 mg
E. Unsure
8. TS is a 62-year-old man newly diagnosed with AML. He is not a candidate for intensive induction chemotherapy because of comorbid conditions. His home medications include dofetilide, furosemide, simvastatin, and metformin. His therapeutic plan includes glasdegib and low-dose cytarabine. He asks you, “Am I gonna make it,” and shares that his new wife desires to have a baby. In responding, you should educate TS on the need to
A. Encourage TS and tell him he can begin his new family while beginning therapy
B. Advise TS to use a barrier method of birth control for at least 30 days after last dose of glasdegib
C. Advise TS that his wife will need to use a hormonal method of birth control while he is taking glasdegib
D. Tell TS that increased monitoring of glucose levels will be needed while he is using metformin and glasdegib together
E. Unsure
9. AZA-AML-001 was a large trial that enrolled patients 65 years of age or older newly diagnosed with AML who were randomized to azacitidine or a conventional care regimen (standard induction chemotherapy, low-dose cytarabine, or supportive care only). All of the following were key findings of this trial except:
A. Azacitidine was administered as 100 mg/m2 per day intravenously for 7 consecutive days of a 28-day cycle for at least 6 cycles.
B. Median overall survival was 10.4 months in the azacitidine arm and 6.5 months in the conventional care arm.
C. The 1-year survival rate was higher in the azacitidine arm (46.5% versus 34.2% in the conventional care regimen group).
D. Median overall survival was double that of patients receiving conventional care for patients with poor-risk cytogenetics at 6.4 months versus 3.2 months.
E. Unsure
10. You are seeing patient AL in clinic for follow-up of IDH-2 mutated AML. She is on oral enasidenib 100 mg daily. She has been on enasidenib for 25 days, and now has fever of 101.5° F, a white blood cell count of 40,000/mm3 (increased from 2,500/mm3 1 week earlier), oxygen saturation of 82%, bilateral pulmonary infiltrates, and a left pleural effusion on chest X-ray films. She complains that she feels terrible, has gained 12 pounds in the past week, and aches all over. Which of the following would be included in your recommended course of action?
A. Start dexamethasone 10 mg orally twice a day.
B. Schedule a follow-up white blood cell count in 1 week.
C. Avoid anti-infectives pending identification of a microbial source of the fever.
D. All of the above
E. Unsure
Evaluation Questions
11. How confident are in your treatment choice for XT?
A. Not at all confident
B. Somewhat confident
C. Confident
D. Highly confident
12. How confident are in your management of TS?
A. Not at all confident
B. Somewhat confident
C. Confident
D. Highly confident
13. How confident are in your treatment choice for AL?
A. Not at all confident
B. Somewhat confident
C. Confident
D. Highly confident
