Childhood Cancer: Leukemia

Question 1

What are the two types of blood stem cells?

Answer 1

1) Myeloid stem cells

2) Lymphoid stem cells

Question 2

Which type of blood stem cells are “all about survival” (make RBC’s and platelets)?

Answer 2

Myeloid

Question 3

Which type of blood stem cells make B, T, and Natural Killer cells?

Answer 3

Lymphoids

Question 4

What are the types of white blood cells and from which stem cells do they derive from?

Answer 4

1) Granulocytes (eosinophils, basophils, neutrophils): from myeloblasts (a myeloid stem cell)
2) B cells: from lymphoblasts (a lymphoid stem cell)
3) T cells: from lymphoblasts
4) Natural killer cells (from lymphoblasts)

Question 5

What type of leukemia affects myeloblast cells?

Answer 5

Acute myeloblastic leukemia

Question 6

How does myeloblastic leukemia kill?

Answer 6

It overproduces myeloblastic cells, squeezing out RBC’s

Question 7

What type of leukemia affects lymphoblasts?

Answer 7

Acute lymphoblastic leukemia

Question 8

How does ALL kill?

Answer 8

Overproduces lymphoblasts in the bone marrow that never mature into B or T cells; they eventually squeeze out RBCs (causing suffocation).

Question 9

What are the key features of ALL from lymphoblast slides?

Answer 9

1) Bright purple

2) Can barely see the cytosol

Question 10

What are the key features of AML from myeloblast slides?

Answer 10

1) Big, purple nuclei with a lot of cytosol wrapping around them.

Question 11

What is the treatment for ALL?

Answer 11

1) Chemotherapy until remission (Induction, Consolidation, Maintenance)
2) BMT if there is a severe relapse (kids usually don’t need a BMT transplant)

Question 12

True or false: ALL is less common and harder to treat than AML.

Answer 12

False; AML is less common and harder to treat than ALL.

Question 13

What is the cure rate of ALL?

Answer 13

98%

Question 14

True or false: radiation is used to treat ALL.

Answer 14

False (radiation is targeted)

Question 15

What is the treatment for AML?

Answer 15

1) Chemotherapy until remission

2) BMT (kids usually don’t need BMT)

Question 16

What is the most common age group for ALL?

Answer 16

3-5 y/o

Question 17

What is the most common age group for AML?

Answer 17

All ages

Question 18

What is the long-term remission rate for AML?

Answer 18

60-70%

Question 19

True or false: ALL is most common in white boys (3-5 y/o).

Answer 19

True

Question 20

What are the symptoms of leukemia?

Answer 20

1) Fatigue
2) Pale skin
3) Infections and fever
4) Easy bleeding or bruising
5) Bone or joint pain
6) Swelling of abdomen
7) Loss of appetite/weight-loss
8) Swollen lymph nodes
9) Coughing and trouble breathing
10) Swelling of face and arms
11) Rashes and gum problems

Question 21

What are the steps in diagnosing leukemia?

Answer 21

1) Blood count
2) If increased WBC’s, wait 2 weeks, then do a second blood count.
3) If increased WBC’s again, tap and culture the marrow, looking for either lymphoblasts or myeloblasts dominating

Question 22

Which ALL risk group is most sensitive to chemotherapy? Where does their leukemia originate?

Answer 22

Standard risk group (ages 0-10); originates in B-Cell lymphoblasts

Question 23

What characterizes the ALL high risk group?

Answer 23

1) Over 10 y/o
2) have leukocytes in CSF
3) Originates in B and T cell lymphoblasts
4) Increased risk of relapse

Question 24

What are the three phases of treatment for both AML and ALL?

Answer 24

1) Induction: initial 1 mo of treatment (massive kill-off)
2) Consolidation: 1-2 mo; really intense dose (“the hammer”); longer and more intense than induction, tries to kill off everything left behind
3) Maintenance: 1-2 years long, out-patient, steady treatment

Question 25

What is the purpose of the induction phase of treatment?

Answer 25

Send leukemia into remission (massive kill-off)

Question 26

What is the purpose of the consolidation phase of treatment?

Answer 26

To kill off everything left behind and prevent treatment resistant cancer from arising