2: ALL Flashcards
What is ALL
Malignant proliferation lymphoblasts
What classification system is used to distinguish types of ALL
French-American-British (FAB)
What is the commonest cancer of childhood
ALL
What age does ALL usually onset
2-5 Years-Old
What gender is ALL more common in
Male
What are 5 RF for ALL
- Chemoradiotherapy
- Irradiation in utero
- Down Syndrome
- Ataxic telangiectasia
- NF1
- Philidelphia chromosome (9:22)
What are the ‘general’ symptoms of leukaemia
Bone marrow failure
How does RBC deficiency present in leukaemia
- Lethargy
- Pallour
- Dyspneoa
How does WBC deficiency present in leukaemia
- Recurrent Infections
- Fever
How does platelet deficiency present in leukaemia
- Bleeding gums
- Epistaxis
- Non-blanching Petechial rash
what are constitutional symptoms in children
- Night sweats
- Fever
- Weight Loss
what are other symptoms of ALL in children
- Painless lymphadenopathy
- Bone pain: limping child
- Hepatomegaly
- Testicular enlargement
what can T cell ALL cause
mediastinal enlargement
how can mediastinal enlargement present
airway obstruction
how will FBC present in ALL
- Low Hb and Thrombocytopenia
- WCC High
how will a blood smear present in ALL
- Blast cells
what is diagnostic of ALL
Bone marrow aspiration and biopsy
what is diagnostic on bone marrow biopsy of ALL
> 20% lymphoblasts
what is looked for on bone marrow biopsy and why
Philadelphia chromosome - poor prognostic factor
why may CXR and CT Chest be ordered in ALL
T-ALL is associated with mediastinal lymphadenoapthy
why is LP ordered in ALL
Determine CNS involvement
why are cytogenetics ordered in ALL
Philadelphia chromosome
what should be performed in all boys with ALL and why
Testicular exam, as those where crossed blood-testes barrier has poorer outcomes
what is the haematological regimen children are put on at the start of ALL treatment depend on
- Age
- WCC
- Cytogenetics
what are indications for regimen A
- Under 10
- Low WCC
what are indications for regimen B
- Over 10
- High WCC
explain regimen C
- No child starts on regimen C. Children may be stepped up due to not enough WCC destruction on A or B. Or, due to philadelphia chromosome.
what is the total treatment time in boys
3-years
what is the total treatment time in girls
2-years
what are the 5 stages
Induction Consolidation Interim maintenance Delayed intensification Maintenance
what is the aim of induction
To eliminate as many immature blast cells as possible
what is CNS prophylaxis in ALL
Intrathecal methotrexate
Cranial Irradiation
What are 5 adverse prognostic factors
- Male
- Age: 1-9 years = better outcomes
- African- American
- Poor response end of induction
- WCC >100
- Philadelphia chromosome
- Spread to CNS
