111.3 🩺 內科專科考前版

111.3.0.1 📌 䞀頁重點

  • 22E:
    • Blinatumomab + chemo + TKI for Ph+ ALL (chemo-free or chemo-light approach; D-ALBA, GIMEMA-LAL2116)
    • Revumenib (FDA 2024) for KMT2A-rearranged + NPM1-mutated R/R AML/ALL
    • CAR-T expansion to adult B-ALL (brexucabtagene FDA 2021)
    • Ph-like ALL recognized; targeted with TKI per fusion (JAK inhibitor, ABL-class)
    • MRD-driven HSCT decision (negativity by NGS or flow)
  • Taiwan: 健保 induction + consolidation + maintenance; 健保 hyper-CVAD; 健保 imatinib + dasatinib for Ph+ ALL 條件; 健保 inotuzumab + blinatumomab + tisagenlecleucel + revumenib + nelarabine 自費 倚 / 條件 limited

111.3.0.2 🌟 Pearls (10)

  1. MRD by NGS-IGH/TRG or flow at end of induction + consolidation: predicts relapse + HSCT decision
  2. D-ALBA trial (NEJM 2020): dasatinib + steroid + blinatumomab for adult Ph+ ALL → high MRD-neg without chemo
  3. GIMEMA-LAL2116: ponatinib + steroid for older Ph+ ALL
  4. Pediatric-inspired regimens for AYA (15-39 yr): CALGB 10403 — better outcomes
  5. MLL/KMT2A infant ALL: most aggressive; revumenib + chemo + HSCT
  6. NOTCH1 mutation T-ALL: gamma-secretase inhibitor trials
  7. Ph-like ALL: 30% recurrent fusions (CRLF2-IGH, JAK1/JAK2, ABL-class) → targeted TKI per fusion
  8. Inotuzumab + HSCT consideration: VOD risk significant; defibrotide prophylaxis sometimes
  9. Blinatumomab CRS less than CAR-T; manageable; use tocilizumab + steroid
  10. Frontline blinatumomab added to chemo (E1910 trial 2024) → improved OS in MRD-neg adult B-ALL

111.3.0.3 📍 Taiwan + 健保

  • 健保 vincristine, dexamethasone, asparaginase (PEG-ASP), daunorubicin
  • 健保 high-dose methotrexate + cytarabine
  • 健保 6-MP + maintenance
  • 健保 cyclophosphamide
  • 健保 rituximab for CD20+ 條件
  • 健保 imatinib + dasatinib + ponatinib for Ph+ ALL 條件
  • 健保 HSCT 條件
  • 健保 nelarabine for T-ALL 條件 (新)
  • Inotuzumab (Besponsa), blinatumomab (Blincyto), tisagenlecleucel (Kymriah), brexucabtagene (Tecartus), revumenib (Revuforj) 自費 倚 / 條件 limited
  • 健保 BCR-ABL PCR + Ph FISH
  • 健保 NGS panel for ALL 條件 (新)
  • 孞會: TSH (Taiwan Society of Hematology) + 兒癌協會

111.3.0.4 🎓 內專必懂 (10)

  1. WHO 2022 ALL classification + driver mutations
  2. Pediatric vs adult outcome difference
  3. B-ALL vs T-ALL biology + treatment
  4. Ph+ ALL: TKI + chemo + chemo-free options (D-ALBA)
  5. Ph-like ALL: TKI per fusion
  6. MRD-driven HSCT decision
  7. Frontline blinatumomab + chemo (E1910)
  8. Inotuzumab + VOD risk
  9. CAR-T + CRS/ICANS
  10. Revumenib for KMT2A/NPM1 R/R (22E)

⚠ AI 草皿。