110.2 📚 國考版醫垫國考 / PGY OSCE

110.2.0.1 📌 Cram Sheet

110.2.0.1.1 🔥 高 yield 12
  1. CML = Ph t(9;22) BCR-ABL constitutive tyrosine kinase
  2. 3 phases: CP / AP (10-19% blasts) / BP (≥ 20%)
  3. CBC: WBC ↑ + basophilia + left shift + LAP low
  4. TKI 1st gen: imatinib (Gleevec)
  5. TKI 2nd gen: dasatinib (pleural effusion), nilotinib (CV/PAOD/QT), bosutinib (diarrhea)
  6. TKI 3rd gen: ponatinib (T315I; CV black box)
  7. TKI 4th gen STAMP: asciminib (Scemblix, FDA 2024 1st line)
  8. Response milestones: 3 mo ≀ 10%, 6 mo ≀ 1%, 12 mo ≀ 0.1% (MMR)
  9. TFR at MR4/4.5 stable ≥ 2 yr (~ 50% maintain)
  10. T315I: ponatinib / asciminib / olverembatinib
  11. HSCT: refractory + blast phase + young
  12. CML smear vs leukemoid: CML LAP low; leukemoid LAP high
110.2.0.1.2 🔢 必背
項目 æ•žå­—
Imatinib 400 mg/d
Dasatinib 100 mg/d
Nilotinib 600-800 mg/d (BID, fasting)
MMR BCR-ABL ≀ 0.1% (IS)
3 mo target ≀ 10%
6 mo target ≀ 1%
12 mo target ≀ 0.1% (MMR)
TFR criteria MR4 / 4.5 sustained ≥ 2 yr
AP blast 10-19%
BP blast ≥ 20%
Basophil cutoff > 2%

110.2.0.2 ⭐ 高 yield

110.2.0.2.1 TKI Side Effects Quick
TKI Notable SE
Imatinib Fluid retention, edema, GI, muscle cramps
Dasatinib Pleural effusion, pulmonary HTN, thrombocytopenia
Nilotinib QT prolong, hyperglycemia, PAOD, MI
Bosutinib Diarrhea (50%), LFT
Ponatinib Thrombosis (CV/MI/stroke) — black box
Asciminib Better tolerability; pancreatitis, HTN
110.2.0.2.2 Response Definitions (BCR-ABL IS)
Response BCR-ABL %
MMR (Major Molecular Response) ≀ 0.1%
MR4 ≀ 0.01%
MR4.5 ≀ 0.0032%
MR5 ≀ 0.001%
Undetectable < detection limit
110.2.0.2.3 TFR Eligibility (NCCN/ELN)
  • ≥ 8 yr CML
  • TKI ≥ 5 yr
  • MR4/4.5 sustained ≥ 2 yr
  • Stable (no AP/BP history)
  • Reliable monitoring plan
  • ~ 50% maintain remission off therapy
110.2.0.2.4 Resistance Mutation Quick
  • T315I: gatekeeper; resistant to imatinib/dasatinib/nilotinib/bosutinib; sensitive to ponatinib + asciminib + olverembatinib
  • F317L, V299L, T315A: dasatinib resistance
  • Y253H, E255K/V, F359C/V: nilotinib resistance

110.2.0.3 🎯 自我檢枬

  1. CML translocation? → t(9;22) Ph
  2. CML LAP score? → Low
  3. Leukemoid reaction LAP? → High
  4. CML 3 phases blast %? → CP < 10%, AP 10-19%, BP ≥ 20%
  5. Imatinib 1st line dose? → 400 mg/d
  6. Dasatinib SE? → Pleural effusion
  7. Nilotinib SE? → QT, PAOD, MI
  8. Ponatinib black box? → CV thrombosis
  9. Asciminib mechanism? → STAMP allosteric (myristoyl pocket)
  10. T315I sensitive TKIs? → Ponatinib + asciminib + olverembatinib
  11. MMR? → BCR-ABL ≀ 0.1%
  12. TFR criteria? → MR4/4.5 ≥ 2 yr
  13. CML smear? → Full myeloid spectrum + basophilia
  14. CML BM? → Hypercellular + myeloid hyperplasia
  15. HSCT for? → Refractory / blast phase / young

⚠ AI 草皿。