Devita, Hellman, and Rosenberg's Cancer

LWBK1006-31 LWW-Govindan-Review December 12, 2011 19:43

440 DeVita, Hellman, and Rosenberg’s CANCER: Principles and Practice of Oncology Review

Questions 31.14.

–31.18.

You are consulted to see a 20-year-old Hispanic woman who presented

with progressive fatigue during the last week and then significant epis-

taxis. Her WBC is 12,000/L with 40% promyelocytes and a platelet

count of 15,000/L. Her international normalized ratio (INR) is 2.7 with

a prothrombin time of 45 and partial thromboplastin time of 65. Her

fibrinogen is 82. On review of her peripheral smear, you observe many

promyelocytes with large granules and multiple Auer rods.

Question 31.14. After review of her peripheral smear, you suspect that she has APL. Your

initial therapy would include all of the following, EXCEPT:

A. Fresh-frozen plasma

B. Cryoprecipitate

C. All-trans retinoic acid (ATRA)

D. Arsenic trioxide

Question 31.15. Three days after starting daunorubicin and ATRA, her coagulopathy has

improved. She has shortness of breath in the morning and rapidly becomes

hypoxic over the course of the day. Which of the following would prove

most helpful in treating her hypoxia?

A. High-flow facemask oxygen

B. Lasix

C. Methylprednisolone

D. Albuterol

Question 31.16. Fifteen days into treatment she develops a severe headache. Her neuro-

logic examination results are normal, as are her funduscopic examination

results. Review of her morning laboratory tests reveal a WBC of 0.6/L,

hematocrit of 9.8, platelet count of 25,000/L, INR of 1.4, and fibrino-

gen of 190. You obtain a noncontrast head computed tomography scan

but are more worried that this is a result of:

A. Relapse

B. ATRA

C. Daunorubicin

D. Transfusion reaction

Question 31.17. Six months later you are reviewing her chart. Her CBC has normalized,

and she has tolerated consolidation therapy. Her most recent PCR showed

no sign of residual disease. You are most concerned about relapse because

of:

A. Her microgranular variant presentation

B. Her presenting coagulopathy

C. Her presenting WBC

D. Her ethnicity