109.2 📚 國考版醫垫國考 / PGY OSCE

109.2.0.1 📌 Cram Sheet

109.2.0.1.1 🔥 高 yield 15
  1. APL (M3) t(15;17) PML-RARA: DIC + ATRA + arsenic (low-risk no chemo)
  2. CBF (t(8;21), inv(16)): better; HiDAC consolidation; gemtuzumab CD33+
  3. NPM1 + FLT3-low: favorable
  4. FLT3-ITD high / TP53 / monosomy 7 / complex: adverse
  5. 7+3 induction: cytarabine 7 d + idarubicin/daunorubicin 3 d
  6. + Midostaurin for FLT3+ frontline (RATIFY)
  7. + Gemtuzumab for CBF
  8. Older unfit: venetoclax + azacitidine (VIALE-A) standard
  9. CPX-351 (Vyxeos) for therapy-related / MDS-related
  10. FLT3 relapsed: gilteritinib (ADMIRAL)
  11. IDH1: ivosidenib; IDH2: enasidenib
  12. KMT2A/NPM1 relapsed: revumenib (Revuforj, FDA 2024) menin inhibitor
  13. HSCT for intermediate/adverse in 1st CR
  14. MRD PCR (NPM1, FLT3, PML-RARA)
  15. Differentiation syndrome with ATRA/IDH inhibitor: dexa prophylaxis
109.2.0.1.2 🔢 必背
項目 æ•žå­—
Blast cutoff AML ≥ 20% (or recurrent abnormality regardless)
7+3 cytarabine 100-200 mg/m²/d × 7
7+3 anthracycline Idarubicin 12 / Daunorubicin 60-90
HiDAC 1-3 g/m² q12h × 3 d × 4 cycles
APL low-risk WBC < 10K
Leukostasis WBC > 100K
Day 14 BM Assess response
Venetoclax ramp 5-day ramp-up

109.2.0.2 ⭐ 高 yield

109.2.0.2.1 Cytogenetic Risk (ELN 2022)
Risk Markers
Favorable t(8;21), inv(16), NPM1 + FLT3-low
Intermediate NPM1 + FLT3-high, KMT2A-PTD
Adverse TP53, monosomy 7, monosomy 5, complex, MECOM, FLT3-ITD high alone
109.2.0.2.2 Targeted Drugs Quick
Mutation Drug Setting
FLT3-ITD/TKD Midostaurin (frontline + 7+3) 1st line
FLT3-ITD/TKD Gilteritinib Relapsed
IDH1 Ivosidenib (Tibsovo) Frontline + AZA, R/R
IDH2 Enasidenib (Idhifa) R/R
KMT2A rearranged Revumenib (Revuforj) R/R (FDA 2024)
NPM1 mutated Revumenib R/R (FDA 2024 expanded)
BCL-2 (any) Venetoclax + AZA Older unfit (VIALE-A)
CD33+ (CBF) Gemtuzumab ozogamicin Frontline
Smoothened (Hh) Glasdegib + LDAC Older alt
MDS-related CPX-351 (Vyxeos) Therapy-related
109.2.0.2.3 APL Treatment
  • Low-risk (WBC < 10K): ATRA + arsenic (no chemo, Lo-Coco trial; OS > chemo)
  • High-risk (WBC > 10K): ATRA + arsenic + idarubicin or gemtuzumab
  • DS prophylaxis: dexamethasone 10 mg BID
  • DIC: cryo + FFP + plt
  • MRD: PML-RARA PCR
109.2.0.2.4 Differentiation Syndrome
  • Triggers: ATRA, arsenic, ivosidenib, enasidenib
  • Sx: fever, SOB, hypoxia, edema, weight gain
  • Treat: dexamethasone 10 mg BID
  • High mortality if missed
109.2.0.2.5 Trials Quick
  • VIALE-A: venetoclax + AZA in unfit AML
  • VIALE-C: venetoclax + LDAC
  • RATIFY: midostaurin + 7+3 in FLT3+
  • ADMIRAL: gilteritinib R/R FLT3+
  • AGILE: ivosidenib + AZA in IDH1+
  • AUGMENT-101: revumenib R/R KMT2A/NPM1
  • Lo-Coco: ATRA + arsenic for low-risk APL

109.2.0.3 🎯 自我檢枬

  1. APL translocation? → t(15;17) PML-RARA
  2. APL DIC management? → Cryo + FFP + plt + ATRA STAT
  3. APL low-risk Tx? → ATRA + arsenic (no chemo)
  4. APL DS prophylaxis? → Dexamethasone
  5. CBF translocations? → t(8;21), inv(16)
  6. ELN favorable mutations? → NPM1 + FLT3-low
  7. ELN adverse mutations? → TP53, monosomy 7, complex
  8. 7+3 regimen? → Cytarabine 7 d + idarubicin/dauno 3 d
  9. FLT3+ frontline? → Midostaurin (RATIFY)
  10. Older unfit AML 1st? → Venetoclax + AZA (VIALE-A)
  11. FLT3 relapsed? → Gilteritinib
  12. KMT2A/NPM1 R/R 22E? → Revumenib (FDA 2024)
  13. CPX-351 indication? → Therapy-related / MDS-related AML
  14. HSCT timing? → Intermediate/adverse risk in 1st CR
  15. Auer rods? → Pathognomonic myeloid (faggot in APL)

⚠ AI 草皿。