FRCPath Haem Part 1 MCQs-Oncology 508

A 74-year-old man is referred to the haematology department with a 3-week history of increasing fatigue, bruising and recurrent episodes of epistaxis. His full blood count shows haemoglobin 78 g/L, white cell count 18.5 × 10⁹/L and platelet count 32 × 10⁹/L. Blood film demonstrates circulating myeloblasts.

Bone marrow examination confirms acute myeloid leukaemia (AML). Molecular testing identifies an IDH1 R132 mutation. His medical history includes ischaemic heart disease, chronic heart failure (NYHA class III), type 2 diabetes mellitus and chronic kidney disease stage 3. Following multidisciplinary assessment, he is considered unsuitable for standard intensive induction chemotherapy.

He is commenced on ivosidenib in combination with azacitidine, in accordance with NICE guidance.

During routine treatment monitoring, he reports episodes of chest discomfort, palpitations and dizziness. His serum potassium is 3.1 mmol/L and magnesium is 0.55 mmol/L. He is otherwise afebrile.

Which of the following is the important treatment-related toxicity related to this patient?

A. Differentiation syndrome.

B. QTc prolongation

C. Azacitidine-induced cardiomyopathy.

D. Tumour lysis syndrome

E. Ivosidenib-induced acute coronary syndrome.