109.3 🩺 內科專科考前版

109.3.0.1 📌 䞀頁重點

  • 22E:
    • Revumenib (Revuforj, FDA 2024) menin inhibitor for KMT2A + NPM1
    • Olutasidenib IDH1 (FDA 2022 R/R AML)
    • Quizartinib (Vanflyta, FDA 2023) FLT3-ITD; +chemo + maintenance (QuANTUM-First)
    • Venetoclax + AZA standard older AML; expanding to other settings
    • MRD-driven HSCT decision + post-HSCT MRD monitoring
    • WHO 2022 + ICC 2022 harmonized classification (driver-defined)
  • Taiwan: 健保 7+3, HiDAC, ATRA, arsenic, midostaurin (FLT3+), gemtuzumab (條件), venetoclax + AZA 條件; gilteritinib + ivosidenib + enasidenib + revumenib + olutasidenib + quizartinib + CPX-351 自費 倚 / 條件 limited

109.3.0.2 🌟 Pearls (12)

  1. WHO 2022 vs ICC 2022: ICC requires 10% blasts for AML if recurrent abnormality (vs WHO no threshold for some)
  2. CR vs CRh vs MRDneg CR: hierarchy of remission depth; MRD predictor
  3. Day 14 BM: if > 5% blasts → consider re-induction; varies by protocol
  4. Quizartinib + 7+3 + maintenance for FLT3-ITD (QuANTUM-First; FDA 2023)
  5. Olutasidenib (Rezlidhia, FDA 2022) IDH1 inhibitor — alternative to ivosidenib
  6. Revumenib menin inhibitor: blocks menin-KMT2A interaction; effective in KMT2A-rearranged + NPM1-mutated R/R
  7. Differentiation syndrome with menin inhibitor (revumenib): similar to ATRA + IDH inhibitors
  8. Hyperleukocytosis / leukostasis: leukapheresis + cytoreduction; avoid RBC transfusion until WBC reduced
  9. Tumor lysis syndrome venetoclax: slow 5-day ramp + monitor; especially CLL but also AML
  10. HSCT post-CR: MRD-positive → HSCT in 1st CR even favorable risk; MRD-negative + favorable → consolidation only
  11. Therapy-related AML: dismal prognosis; CPX-351 (Vyxeos) better than 7+3
  12. CAR-T for AML: CD33, CD123, CLL-1 in trials; not yet standard

109.3.0.3 📍 Taiwan + 健保

  • 健保 7+3 (cytarabine + idarubicin/daunorubicin)
  • 健保 HiDAC consolidation
  • 健保 ATRA + arsenic for APL
  • 健保 azacitidine + decitabine
  • 健保 midostaurin for FLT3+ frontline 條件
  • 健保 venetoclax + AZA for older AML 條件 (新)
  • 健保 gemtuzumab ozogamicin for CBF / CD33+ 條件
  • 健保 HSCT 條件
  • Gilteritinib (Xospata), ivosidenib (Tibsovo), enasidenib (Idhifa), revumenib (Revuforj), olutasidenib (Rezlidhia), quizartinib (Vanflyta), CPX-351 (Vyxeos), glasdegib (Daurismo) 自費 倚 / 條件 limited
  • 健保 NGS panel 條件 (新, AML)
  • 孞會: TSH (Taiwan Society of Hematology) + 國家衛生研究院 leukemia consortium

109.3.0.4 🎓 內專必懂 (12)

  1. WHO 2022 + ICC 2022 driver-defined classification
  2. ELN 2022 risk stratification + MRD
  3. APL low vs high risk Sanz + Lo-Coco
  4. APL DIC + DS prophylaxis
  5. 7+3 induction + targeted addition (FLT3 midostaurin/quizartinib)
  6. Older AML venetoclax + AZA (VIALE-A)
  7. FLT3 R/R: gilteritinib (ADMIRAL)
  8. IDH1: ivosidenib + olutasidenib; IDH2: enasidenib
  9. KMT2A/NPM1: revumenib menin inhibitor (22E)
  10. HSCT decision + MRD-driven
  11. Therapy-related AML + CPX-351
  12. CAR-T trials + future

⚠ AI 草皿。