Pathology EMQ template.

Name: Majd El-Harasis       

Theme: Chronic myeloid leukaemia

OPTION LIST

A	IFN-α	I	Dosatinib
B	Hydroxycarbamide	J	Chemotherapy + all-trans-retinoic acid
C	Allogeneic stem cell transplantation	K	Chemotherapy (R-CHOP regimen)
D	Imatinib	L	Chemotherapy (ABVD regimen)
E	Chlorambucil	M	Chemotherapy (R-CVP regimen)
F	Cyclosphosphamide	N	Donor lymphocyte infusion
G	Monitor clinically and give annual influenza vaccine	O
H	Radiotherapy and 6-8 cycles of chemotherapy	P

For each scenario below, choose the most appropriate treatment option from the list above. Each option may be used once, more than once or not at all.

1. A 50 year old man presented with fatigue, lethargy and weight loss. On examination, he was pale and had gross splenomegaly. His blood film showed an increase in white blood cells (both myelocytes and mature granulocytes). Cytogenetic analysis showed a t(9;22) chromosomal translocation.

2. A 74 year old patient has been diagnosed with chronic myeloid leukaemia and 6 months after starting therapy with the first line drug has shown no improvement in FBC or cytogenetics. His physician switches him to another drug.

3. A 48 year old patient with chronic myeloid leukaemia becomes acutely unwell. A peripheral blood film shows 30% myeloblasts.

4. A 59 year old patient with chronic myeloid leukaemia has been found to be positive for the Philadelphia chromosome several years following his stem cell transplantation.

5. A 61 year old patient with chronic myeloid leukaemia has not responded to different tyrosine kinase inhibitors available.

ANSWERS

1. D

2. I

3. C

4. N

5. C