Odds ratio for VTE
- Heterozygous Prothrombin- less than 2
- FVL heterozygous- a little greater than 2
- Prothrombin homozygous- 3
- FVL homozygous- 6
- Double prothrombin + FVL heterozygous= 2+3= 5 ( additive risk not synergistic risk if heterozygous with double) Odds ratio of VTE 5 times.
ALL ph+
- Imatinib or Nilotinib can be used with induction. Don't omit cytarabine because relapse is higher if you do, although mortality was unchanged.OS 79% 4 yr survival.
- ALL relapse look for T 315 mutation, ponatinib may be needed
- Is allo HCT necessary if cytarabine is part of the consolidation regimen? There did not seem to be a necessity.
- A blinatumomab based approach may be needed in over 60 yr when combined with TKI. However, CNS relapses are a problem with Blinatumomab + TKI. So CNS prophy needs to be optimized.
Ref: blood June 2024
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