Devita, Hellman, and Rosenberg's Cancer

LWBK1006-32 LWW-Govindan-Review November 24, 2011 11:28

CHAPTER 32 CHRONIC

LEUKEMIAS

JAMES C. MOSLEY III•KEITH STOCKERL-GOLDSTEIN

DIRECTIONS Each of the numbered items below is followed by lettered answers. Select the

ONE lettered answer that is BEST in each case unless instructed otherwise.

QUESTIONS

Question 32.1. A 54-year-old white man with chronic-phase chronic myeloid leukemia

(CML) has quickly obtained a complete hematologic response while

receiving imatinib 400 mg daily. He has been receiving therapy for

5 months, but you have noticed that his neutrophil count has gradually

decreased to 0.9× 109 /L and now has a platelet count of 42× 109 /L.

What is the MOST appropriate therapeutic intervention?

A. Decrease dose of imatinib to 200 mg by mouth every day

B. Interrupt therapy until recovery of blood counts

C. Discontinue therapy with imatinib and initiate therapy with dasatinib

D. Discontinue therapy with imatinib and initiate therapy with inter-

feron

Question 32.2. Which of the following statements is correct, regarding response to ima-

tinib therapy in patients with CML?

A. Patients with low-risk Sokal scores have a 91% rate of complete

cytogenetic response.

B. In patients who achieve a complete cytogenetic response, Sokal risk

score is not predictive of disease progression.

C. Of patients who have a complete cytogenetic response after 12

months, 97% remain in chronic phase at 5 years.

D. All of the above.

Question 32.3. Which of the following mechanisms is responsible for relapse in patients

with CML?

A. Point mutations in the BCR-ABL kinase

B. BCR-ABL gene amplification

C. Clonal evolution

D. All of the above

Corresponding Chapters inCancer: Principles & Practice of Oncology,Ninth Edition: 132 (Molecular Biology of

Chronic Leukemias), 133 (Chronic Myelogenous Leukemia), and 134 (Chronic Lymphocytic Leukemias).

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