ALL_Flashcards
What age groups are considered high-risk features for prognosis in Acute Lymphoblastic Leukaemia (ALL)?
Age <1 year or >10 years.
Which gender and ethnic group are considered high-risk features for prognosis in ALL?
Male, non-Caucasian.
What tumour load (measured by WBC) is considered a high-risk feature for prognosis in ALL?
> 50x10^9/L.
What cytogenetic/molecular genetic abnormalities in tumour cells are considered high-risk features in ALL?
t(9;22), t(8;14), MLL rearrangement, t(4;11), hypodiploidy, presence of T or B cell markers.
What does persistence of leukaemic blasts in bone marrow indicate in ALL?
It indicates a high-risk feature and a poor prognosis.
What is the significance of minimal residual disease assessment in ALL?
It indicates a high risk of relapse if submicroscopic levels of leukaemia are detected by PCR.
What factors are considered when deciding on treatment intensity for ALL?
These factors are considered when deciding on the treatment intensity for ALL.
What are the components of supportive therapy in the management of ALL?
Supportive therapy includes sufficient fluid intake, allopurinol or rasburicase, transfusions for bleeding patients or low platelet count, prophylactic antibiotics, antifungals, and antivirals, prophylactic use of haematopoietic growth factors (e.g., CSF (filgrastim)), and norethisterone for female patients.
What is given to prevent tumour lysis syndrome in ALL patients?
Allopurinol or rasburicase.
What prophylactic measures are taken for patients at risk of febrile neutropenia in ALL?
Prophylactic use of haematopoietic growth factors such as CSF (filgrastim).
What is given to female patients to suppress periods during therapy and periods of thrombocytopenia in ALL?
Norethisterone.
What may need to be corrected using blood transfusions before starting treatment for ALL?
Anaemia.
What are the components of standard induction chemotherapy for newly diagnosed ALL patients without CNS disease?
Standard induction includes prednisolone, vincristine, anthracyclines (e.g., doxorubicin, daunorubicin), and/or L-asparaginase.
What drug is used to prevent cardiotoxicity from doxorubicin in ALL treatment?
Dexrazone.
What drug is used for CD20+ ALL patients?
Rituximab.
What drug is used for Philadelphia chromosome-positive ALL patients?
Tyrosine kinase inhibitors (e.g., imatinib).
What is required for ALL patients with CNS involvement to prevent CNS relapse?
Standard induction therapy with intensified intrathecal chemotherapy.
What are the components of the currently recommended regimen for ALL patients with CNS involvement?
Frequent intrathecal methotrexate alone or with cytarabine and hydrocortisone (‘triple’), and consolidation therapy containing systemic treatment with high-dose cytarabine (HDAC) or high-dose methotrexate (HDM).
What does the second phase of treatment after induction of remission in ALL consist of?
It consists of consolidation and maintenance therapy.
What is the remission rate achieved by current induction regimens in ALL?
95%.
How long is continuing chemotherapy of moderate-high intensity usually continued for in ALL?
Up to 3 years.
What is the treatment approach for relapse, refractory, or residual disease in ALL?
High-dose chemotherapy, with or without total body irradiation followed by bone marrow transplantation.
