1. Which of the following is a known negative prognostic factor for patients with chronic lymphocytic leukemia?
A. 12q trisomy
B. Del(17p)
C. Lymphocyte count greater than 5000 µL
D. CD5 positivity
E. Unsure
2. Which of the following is believed to contribute to the molecular pathology of patients with mantle cell lymphoma?
A. Expression of the programmed cell death ligand (PD-L1)
B. The cytogenetic abnormality t(9;22)
C. Overexpression of cyclin D1
D. The cytogenetic abnormality del(13q)
E. Unsure
3. Which of the following treatments is considered a standard-of-care option for patients with newly diagnosed mantle cell non-Hodgkin lymphoma?
A. Bortezomib
B. Acalabrutinib
C. Venetoclax
D. Rituximab-hyperCVAD
E. Unsure
4. Which of the following is most correct regarding the impact of front-line treatment on overall survival for patients younger than 70 years old with chronic lymphocytic leukemia?
A. Rituximab plus chlorambucil is equivalent to rituximab plus ibrutinib
B. The combination of fludarabine, cyclophosphamide, and rituximab (FCR) is superior to ibrutinib plus rituximab
C. FCR is inferior to ibrutinib plus rituximab
D. Acalabrutinib plus rituximab is superior to ibrutinib plus rituximab
E. Unsure
5. GH is a 73-year-old patient with newly relapsed/refractory chronic lymphocytic leukemia that was previously treated with the combination regimen of fludarabine, cyclophosphamide, and rituximab 3 years ago; he achieved a complete remission. Which of the following treatments is likely to achieve the best prolonged disease response for GH now?
A. Chlorambucil plus prednisone
B. Rituximab
C. Ibrutinib
D. Ofatumumab
E. Unsure
6. Which of the following treatments requires dose adjustments when given with drugs that inhibit cytochrome P450 isoenzymes?
A. Ofatumumab
B. Chlorambucil
C. Acalabrutinib
D. Fludarabine, cyclophosphamide, and rituximab
E. Unsure
7. JM is a 72-year-old male who has been diagnosed with relapsed/refractory mantle cell lymphoma. His local oncologist would like to start ibrutinib monotherapy. Which of the following statements is true?
A. The dose of ibrutinib should be 420 mg by mouth daily
B. JM is having his dentures fixed: ibrutinib should be held 7 days prior to his dental appointment
C. Ibrutinib showed an approximately 2-fold increase in progression-free survival over temsirolimus
D. The most common adverse event related to ibrutinib from the RAY study was hemorrhagic bleeding
E. Unsure
8. YL is an 82-year-old female who has been receiving ibrutinib for mantle cell lymphoma for the last 6 months. She presents to the emergency room (ER) with sudden onset shortness of breath and fever. The physician in the ER wants to bridge her therapy with concurrent warfarin. Which of the following statements is correct?
A. Ibrutinib has no drug-drug interactions with warfarin and concurrent administration should present no risk
B. Ibrutinib is associated with an increased risk of bleeding and should not be administered concurrently with warfarin
C. Ibrutinib is associated with a decreased risk of bleeding and there is no harm in administering concurrently with warfarin
D. Ibrutinib was found to prevent formation of blood clots and no other anticoagulation is needed
E. Unsure
9. Which of the following is an accurate description of the benefit conferred by acalabrutinib in patients who are receiving monotherapy in the relapsed/refractory setting for mantle cell lymphoma?
A. Nearly all patients will achieve a clinical response and, at 12 months, approximately two-thirds of patients will not have experienced disease progression
B. The median overall survival is approximately 8 months
C. Nearly all patients will achieve a clinical response; however, by 6 months, the majority of patients will have relapsed
D. Approximately one-third of patients will achieve a clinical response and the duration of that response is 8 months at most
E. Unsure
10. Which of the following groups of toxicities is notable for patients who receive treatment with either ibrutinib or acalabrutinib?
A. Acute hepatic failure, thromboembolism, and neuropathy
B. Alopecia, mucositis, and severe nausea/vomiting
C. Hemorrhage, myelosuppression, and atrial fibrillation
D. Ileus, ototoxicity, and endocrinopathies
E. Unsure
Evaluation Questions
11. How confident are you in your decision about treatment for GH in the above question?
A. Not at all confident
B. Somewhat confident
C. Confident
D. Highly confident