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TRAINING and EDUCATION
Ruben Mesa , MD
How I Treat Patients With Problematic Cases of Polycythemia Vera
A 60-year-old man has had JAK2V617F-mutated polycythemia vera for four years and is on phlebotomy and aspirin . He has not experienced any thrombotic events . He has a palpable spleen and his MPN 10 ( a tool for tracking symptoms of myeloproliferative neoplasms ) score is 40 out of 100 . He also experiences frequent migraines that improve after phlebotomy .
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His lab results are as follows :
• Hemoglobin 15.8 g / dL ( hematocrit [ HCT ] 49 %)
• White blood cells 14 × 10 9 / L
• Platelets 670 × 10 9 / L
According to clinical guidelines from the National Comprehensive Cancer Network and European Society of Medical Oncology , which of the following would not be appropriate firstline management for high-risk polycythemia vera ?
A . Phlebotomy ( HCT < 45 %), aspirin , and hydroxyurea
B . Phlebotomy ( HCT < 45 %), aspirin , and pegylated interferon
C . Phlebotomy ( HCT < 45 %), aspirin , and ruxolitinib
D . Phlebotomy ( HCT < 45 %), aspirin
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A . 8 % B . 15 % C . 35 % D . 42 %
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A . 11 % B . 9 % C . 27 % D . 53 %
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Jessica K . Altman , MD
A 39-year-old male was noted to have anemia in July 2017 . Evaluation revealed a vitamin B12 deficiency and his counts normalized within two months of B12 supplementation . In December 2017 , he developed dyspnea on exertion and fatigue that he initially attributed to stress . However , his symptoms progressed , and he presented to his primary-care provider in February 2018 .
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How would you characterize this patient ’ s disease ?
How I Treat Mutations and Minimal Residual Disease in the Care of Patients With Acute Myeloid Leukemia
A . Favorable risk
B . Intermediate risk
Peripheral blasts were noted and his lab results were as follows : C . Unfavorable risk
• white blood cells 5.56 × 10 9 / L
• hemoglobin 10.4 g / dL
• platelets 33 × 10 9 / L
Bone marrow evaluation revealed AML ( 30 % blasts ) involving a normocellular bone marrow with marked erythroid predominance , erythroid dysplasia , and mild granulocytic and megakaryocytic dysplasia . These results raised the possibility of a subclassification of AML with myelodysplasia-related changes , although the degree of dysplasia in the myeloid and megakaryocytic lineages was < 50 percent of the cells .
After performing genetic studies , there were no mutations identified on a 30-gene myeloid panel and cytogenetic testing showed 47 , XY , + 8 , del20 ( q11.2q13.3 ) [ 20 ].
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A . 9 % B . 64 % C . 27 %
ASH CLINICAL NEWS READERS ’ RESPONSE
A . 12 % B . 47 % C . 41 %
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