Acute lymphoblastic leukaemia Flashcards
What cells are affected?
lymphoid progenitor cells become genetically altered -> uncontrolled proloiferation
early lymphoid precursors replace normal haematopoietic cells of BM + tissue infiltration
What age group is mostly affected?
children 75% occur in under 6 yrs
What are the signs and sx?
- BM failure - anaemia, infection, bleeding
- Infiltration - lymphadenopathy (painless and mobile), hepatosplenomegaly, CNS involvement
- Fever
What features suggest CNS involvement?
Meningism, papilloedema, cranial nerve palsies
Where do infections commonly occur ?
bacterial septicaemia zoster CMV measles candidiasis
What investigations would you do?
- FBC - normocytic, normochromic anaemia w low reticulocyte count, leukocytosis
- Peripheral blood smear
- U&ES, LFTs
- BM biopsy
- CXR, CT scan
- LP - look for CNS involvement
What supportive treatment twould you give?
- Blood/platelet transfusion
- IV fluids
- allopurinol to prevent tumour lysis syndrome
How would you treat neutropenia/
Prophylactic:
- abx
- antivirals
- antifungals
What regimen of chemotherapy would you give?
- Remission induction
- Consolidation
- CNS prophylaxis
- Maintenance
What drugs would you give to induce remission?
Vincristine
Pred
L-asparaginase
Daunorubicin
What drugs would u give for CNS prophylaxis
intrathecal methotrexate +/- CNS irradiation
What drugs would u give to maintain remission?
Prolonged chemo: mercaptopurine methotrexate vincristine pred
What treatment aims to give complete remission
Matched related allogeneic marrow transplantations
What are the 3 ways in which ALL can be classified?
- Morphologically
- Immunologically - precursor B cell (75%), T-cell, B cell
- Cytogenetically - chromosomal analysis
What is used to detect residual disease?E
PCR
