Acute Lymphoblastic Leukaemia COPY Flashcards
What is the most common leukaemia in children?
Acute Lymphoblastic leukaemia (ALL kids)
What increases risk of ALL
Trisomy 21
Chromosolmal translocation
Prenatal exposure to X-rays. in utero infection
What are the classifications of ALL?
B cell ALL
T cell ALL
Mature B-ALL = Burkitt’s lymphoma/leukaemia
How does ALL present?
Pancytopenia - Pallor, infection, bleeding Fatigue Anorexia Fever Bone pain Painless lumps in neck, axilla, groin
cranial infiltration may lead to CNS effects - palsies
Testicular infiltration can lead to orchidomegaly
What do bloods show in ALL?
Raised, normal or low WCC Normochronic, normocytic anaemia Thrombocytopenia Raised Urate Raised LDH
What does the marrow show in ALL?
50-80% of nucleated cells will be blasts (immature)
What tests in ALL?
Bloods, bone marrow aspirate CSF analysis Cytogenetic analysis - 80% genetic abnormality at diagnosis Flow cytometry CXR - may show mediastinal mass
What will CSF show in ALL?
Pleocytosis (raised lymphocytes) with blast forms
Increased protein
Reduced glucose
What factors worsen prognosis in ALL? Survival?
Unfavourable genetics - philadelphia chormosome (9,22)
Poor response to initial chemotherapy
Extra-medullary involvement - brain, testis
Age- children at 1-9 have better cure rates but under 1 and over 10 are higher risk
Initial WBC count > 50 is higher risk
Hyperdiploidy trisomy 4,10 or 17 is associated with better survival
Overall survival 80%
Describe treatment of ALL
Induction therapy: 3drugs (vincristine, dex,L-asparaginase + intrathecal therapy (methotrexate+hydrocortisone)
In high risk, further daunorubicin
Consolidation phase - cranial irradiation if known CNS disease, further chemo
Maintenance phase - 2.5 years daily mercaptopurine, 3 monthly intrathecal drugs
What are complications of ALL treatment? How to prevent?
Neutropenic sepsis- Revaccinate 6 months after chemotherapy
Hyperuricaemia - From massive cell death at induction - pre treat with increased fluid intake and allopurinol
Poor growth - monitor carefully
Cancer elsewhere - risk of CNS tumours or 2nd leukaemia is 3%
Thiopurine methyltransferse deficiency may cause a fatal myelosuppression when 6-MP is given - pre-treatment pharmagenomic TPMT analysis
Side effects - give ondansetron for sickness
How does allopurinol work?
Reduces uric acid formation through enzyme inhibition
