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MD Anderson Study Material > Childhood Leukemia > Flashcards

Childhood Leukemia Flashcards

1
Q

Malignant cell = what?

A

Blast, cells that fail to mature and crowd normal cells in the bone marrow

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2
Q

What is the most common malignancy in children?

A

Leukemia, 25% of all childhood cancers

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3
Q

What is the peak incidence of childhood leukemia?

A

2-5 years of age

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4
Q

MC population?

A

Whites, boys

Poor prognosis in the US genetically

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5
Q

ALL: age peak, % childhood leukemia, %childhood CA

A

2-4 years
75% of childhood leukemia
25% of childhood cancer

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6
Q

AML age peak, % childhood leukemia, %childhood cancer

A

Age peak: neonates, teens
%Childhood leukemia: 15-20%
5% of childhood cancer

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7
Q

CML age peak, %childhood leukemia, %childhood

A

Age peak: none
<5% childhood leukemia
<1% childhood CA

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8
Q

Survival in childhood leukemia ALL or AML

A

ALL: 80%

AML 45%

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9
Q

Acute leukemia

A

Number of leukemia cells in the bone marrow increase rapidly, death within weeks if left untreated

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10
Q

Chronic leukemia

A

Insidious onset, may be asymptomatic

Death within a few years if left untreated

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11
Q

Classification by cell lineage

A

Lymphoid

Myeloid: 8 subtypes of AML, much harder to treat

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12
Q

ALL prognosis

A

95% in remission at end of induction, 75-85% survival at end of 2-3 years of tx

Recurrence: 50-60% chance of remission with first relapse

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13
Q

AML prognosis

A

Much worse than ALL
80% remission at end of induction
50-60% relapse

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14
Q

Acute leukemia clinical presentation

A
  • Fatigue, pallor, anorexia
  • Bruising, bleeding (low platelets)
  • Fever, infection
  • Bone/joint pain or refusal to bear weight/play
  • Abd pain
  • HA, vomiting, visual disturbances
  • Tachy, petechiae/purpura
  • Lymphadenopathy, HSM, CN palises, testicular involvement
  • Chloromas (AML), leukemia cutis, gingivitis
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15
Q

Acute leukemia symptom onset

A

-Typically 1-6 weeks prior to diagnosis

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16
Q

Who looks sicker at diagnosis, AML or ALL?

A

AML

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17
Q

What will you see on CBC of acute leukemia?

A

Thrombocytopenia, hgb down, neutropenia and blasts

18
Q

Chemsitry panel of acute leukemia

A

Everything up EXCEPT calcium, likely tumor lysis syndrome

19
Q

What diagnostic step is crucial in order to rule out the most important additional finding in acute leukemia?

A

CXR, must rule out mediastinal mass

20
Q

How do you obtain a definitive diagnosis of acute leukemia?

A
  • Biopsy

- Get preliminary results and start tx immediately

21
Q

With cytogenetics, is hyper or hypoploidy a good prognostic factor?

A 
Hyper = good
Hypo = bad
22
Q

What are you looking for on LP for diagnostic workup of acute leukemia?

A

Presence of blasts in CSF

23
Q

What is the most common subtype of ALL

A

Precursor B cell, commonly seen in preschoolers

24
Q

What subtype of ALL is commonly seen in adolescent males and is associated with mediastinal mass?

A

T cell

25
Q

What subtype of ALL responds poorly to standard ALL therapy?

A

Mature B cell

26
Q

What is the pneumonic for ALL tx and which CD is each associated with?

A

CD19 Bleotumimab
CD20 Rituximab
CD22 Inotuzimab
CD30 Brintuximab

27
Q

Name the common immunophenotypes associateed with B lineage, T lineage, and all subtypes

A

B: 19, 22, 24, 79
T: 2, 3, 5, 7
All: CD10, TdT

28
Q

What is the absence of CD10 associated with and what is the prognosis?

A

MLL, poor prognosis

29
Q

Over what number of chromosomes is favorable?

A

Over 50, also trisomies 4, 10, and 17 favorable

30
Q

What number of chromosomes has the worst outcome?

A

Below 45, but 24-28 have the WORST

31
Q

What two associated gene products have unfavorable prognostic indications?

A

MLL and BCR/ABL (philly)

32
Q

Prognostic factors in childhood ALL (VERY HIGH RISK)

A
  • BCR/ABL (philly)
  • Hypodiploid (<45)
  • Induction failure, Me by day 29
33
Q

What would lead you to believe there is remission in childhood ALL?

A

Absence of clinical signs of disease
M1 marrow
ANC >500 and platelets over 100k

34
Q

A patient presents with NV, HA, rash, scratchy throat, high fever, hypoTN, and tachycardia. What is going on?

A

Cytokine release syndrome, associated with high levels of IL06

35
Q

What subtype of AML is associated with down syndrome?

A

M7 (megakaryocytic)

36
Q

What 3 stains may be helpful in confirming AML diagnosis?

A

Myeloperoxidase
Sudan Black B
Esterase stains

37
Q

What CD are associated with AML?

A

In the middle!
CD 13-15, CD 33/34, 65
HLA-DR expressed in 80% of AMLs

38
Q

Type 11 AML is what?

A

BAD, associated with MLL

39
Q

Prognostic factors in AML – WBC, down syndrome, fab subtype, etiology

A
  • Over 100k is unfavorable (more wiggle room)
  • Down syndrome - favorable
  • M3 is favorable
  • Treatment related etiology is unfavorable
40
Q

Potential complications of AML are similar to ALL, what is the main difference?

A

Prolonged pancytopenia

41
Q

Highlights of CML

A

Philly chromosome positive

TKI given daily

MD Anderson Study Material (9 decks)

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