Acute Lymphoblastic Leukaemia

Question 1

What is the commonest type of cancer in childhood?

Answer 1

Acute lymphoblastic leukaemia

Question 2

What is the Peak incidence of acute lymphoblastic leukaemia?

Answer 2

2 to 3 years of age and declines afterwards

Question 3

What is the pathophysiology of acute lymphoblastic leukaemia?

Answer 3

Abnormal proliferation of immature lymphocytes, usually B-cells, called lymphoblasts.

Question 4

What is this a presentation of?
Easy bruising, lethargy, frequent infections (often serious), lymphadenopathy, long bone pain, hepatosplenomegaly, orchidomegaly, headaches, cranial nerve palsies, neck stiffness.

Answer 4

Acute lymphoblastic leukaemia

Question 5

What causes the symptoms in acute lymphoblastic leukaemia?

Answer 5

1. Thrombocytopenia
2. Anaemia
3. Dysfunctional WBCs
4. Accumulation of leukemic cells
5. CNS involvement

Question 6

How is acute lymphoblastic leukemia diagnosed?

Answer 6

1. FBC - anaemia, thrombocytopenia, lymphocytosis
2. Peripheral blood smear - lymphoblasts
3. Bone marrow biopsy showing lymphoblasts confirms the diagnosis
4. LP determines CNS invasion of leukemic cells
5. Chest x-ray made show mediastinal mass
6. Examine testes

Question 7

What is the management of the induction phase and what is its general aim in acute lymphoblastic leukaemia?

Answer 7

1. 4 weeks of - vincristine, dexamethasone, asparaginase and intrathecal methotrexate and hydrocortisone.
2. Achieve bone marrow remission.

Question 8

What is the management of the consolidation phase and what is its general aim in acute lymphoblastic leukaemia?

Answer 8

1. 4 to 12 weeks of - cyclophosphamide, cytarabine, mercaptopurine.
2. Aim to eliminate all leukemic cells.

Question 9

What is the management of the maintenance phase and what is its general aim in acute lymphoblastic leukaemia?

Answer 9

1. 2-3 years of - daily mercaptopurine and weekly methotrexate, vincristine and prednisolone.
2. Aim to prevent recurrence after remission.

Question 10

What are the complications of acute lymphoblastic leukaemia?

Answer 10

1. Neutropenic sepsis
2. Hyperuricaemia - hyperhydration and allopurinol to treat
3. Infection, sepsis
4. Additional cancers elsewhere

Question 11

What is the prognosis of acute lymphoblastic leukaemia?

Answer 11

5-year survival of 80 to 90%