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Clinical Radiation Oncology II > Childhood Leukemia > Flashcards

Childhood Leukemia Flashcards

1
Q

What is the origin of the term ‘Leukemia’?

A

From Greek ‘Leukos’ (white) and ‘Haima’ (blood)

Leukemia refers to cancer of the blood or bone marrow characterized by an abnormal increase of white blood cells.

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2
Q

What are the two main types of leukemia?

A

Acute and Chronic

Acute leukemia progresses quickly, while chronic leukemia has a slower progression.

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3
Q

What is Acute Lymphocytic Leukemia (ALL)?

A

A cancer that develops from lymphocytes, originating in the bone marrow and potentially spreading to the bloodstream

ALL accounts for 80% of childhood leukemia.

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4
Q

What are the common symptoms of ALL?

BLEID

A
  • Lethargy
  • Dizziness
  • Easy bruising
  • Frequent infections
  • Bleeding

Symptoms result from the interference of leukemic cells with normal processes.

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5
Q

What is the main treatment for ALL?

A

Chemotherapy, with drugs such as Vincristine and Daunorubicin

Targeted therapies may also be used for specific genetic changes.

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6
Q

What is the average age of diagnosis for Acute Myelogenous Leukemia (AML)?

A

68 years

AML is more prevalent in older individuals compared to ALL.

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7
Q

What are the risk factors for Acute Myelogenous Leukemia (AML)?

BIPS

A
  • Smoking
  • Ionizing radiation
  • Benzene exposure
  • Previous chemotherapy

Certain genetic syndromes also increase risk.

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8
Q

What characterizes Chronic Lymphocytic Leukemia (CLL)?

A

It is the most common leukemia in adults, characterized by slow growth of mature lymphocytes

Symptoms may not appear for years.

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9
Q

What is the average age of diagnosis for Chronic Myeloid Leukemia (CML)?

A

64 years

CML is identified by the presence of the BCR-ABL gene.

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10
Q

What is the role of radiation therapy in leukemia treatment?

A

Used primarily for palliation of symptoms and preparation for stem cell transplants

It is not the main treatment for most forms of leukemia.

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11
Q

What are the common presentations of ALL in children?

PHEAI

A
  • Anemia
  • Infection
  • Hemorrhage
  • Petechiae
  • Epistaxis

Symptoms often include fever, malaise, and bone pain.

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12
Q

What is a significant prognostic factor for ALL?

A

Age < 1 or > 10 years

Other poor indicators include initial high leukocyte count and CNS involvement.

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13
Q

What is the procedure for diagnosing ALL?

BBL

A
  • Blood cell count
  • Bone marrow biopsy
  • Lumbar puncture

A definitive diagnosis requires >25% leukoblasts in the bone marrow sample.

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14
Q

What is the purpose of immunophenotyping in leukemia diagnosis?

Lineage

A

To establish the lineage of leukemic cells

It helps identify whether the cells are B-cell or T-cell lineage.

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15
Q

What does the ‘French American British System (FAB)’ classify?

A

Lymphocytic leukemia based on cell size, nuclear shape, and other characteristics

This system is of historical interest, while newer methods are more accurate.

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16
Q

Fill in the blank: The mainstay of treatment for ALL is _______.

A

[Chemotherapy]

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17
Q

What is the peak incidence age for ALL in children?

A

2-5 years old

Most cases occur between ages 2 and 10, with rare occurrences after age 15.

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18
Q

True or False: CLL is commonly diagnosed in children.

A

False

CLL rarely occurs in individuals under 40.

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19
Q

What is a common genetic marker associated with CML?

A

Philadelphia chromosome (BCR-ABL gene)

This genetic change is crucial for diagnosis and targeted therapy.

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20
Q

What is the treatment duration for the maintenance phase of ALL in boys?

A

3 years

Maintenance therapy aims to kill residual disease and prevent recurrence.

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21
Q

What is the percentage of leukemia blasts in bone marrow and normal blood?

A

5%

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22
Q

What is the route of administration for Methotrexate used for CNS prophylaxis?

A

Intrathecally

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23
Q

What is the purpose of CNS prophylaxis in leukemia treatment?

A

Prevent CNS relapses

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24
Q

YOU GOT THIS!

List some high dose agents used in CNS prophylaxis

VEC

A
  • Vincristine
  • Etoposide
  • Cyclophosphamide
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25
Q

Phase is inducted in the CNS hall of fame

What are the phases of disease management in leukemia?

ICMC

A
  • Induction
  • Consolidation
  • Maintenance
  • CNS prophylaxis
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26
Q

What is the typical duration of maintenance therapy for boys with leukemia?

A

3 years

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27
Q

What is the typical duration of maintenance therapy for girls and adults with leukemia?

A

2 years

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28
Q

What is a significant risk factor for CNS relapses in leukemia patients?

White

A

High initial WBC count

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29
Q

What is Prophylactic Cranial Irradiation (PCI) used for?

A

High-risk patients with higher tendency for CNS relapse

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30
Q

12 cranes

What is the typical dose for cranial field radiation therapy?

A

1200cGy/180-200cGy

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31
Q

True or False: Cranial radiation therapy has no late side effects.

A

False

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32
Q

What was the main drawback of higher doses of cranial radiation therapy recognized in the 1980s and 1990s?

A

Cognitive dysfunction

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33
Q

What is Total Body Irradiation (TBI) primarily used for?

A

Preparation for a bone marrow/stem cell transplant

34
Q

What is the goal of Total Body Irradiation?

uniform

A

Deliver a uniform dose to the whole body

35
Q

What are some acute side effects of Total Body Irradiation?

V-HANDS for TBI

A
  • Nausea
  • Vomiting
  • Diarrhea
  • Anorexia
  • Headaches
  • Skin reactions
36
Q

What is the typical TBI dose regimen?

A

1200cGy – 200 cGy given BID for 3 days

37
Q

What technique is used to ensure uniform dose delivery in TBI?

A

Compensators

38
Q

What is the range of doses for testicular irradiation in cases of relapse?

Relapsed testicles 2415

A

2400-2600cGy/150-200cGy

39
Q

What is the purpose of the CSI technique?

A

To treat positive cells in cerebral spinal fluid

40
Q

What is the typical dose for the whole brain field in CSI?

24 cerebras

A

2400cGy / 150cGy

41
Q

Fill in the blank: The CNS was recognized as a _______ site, protected from chemotherapy by the blood–brain barrier.

California is a ………state

A

sanctuary

42
Q

What two main factors will be used to decide that someone is high risk for ALL?

A
  1. T- cell diagnosis
  2. High initial WBC count
43
Q

The cranial field for PCI must include…

ROP

A

Retina
Optic nerve
Post orbital space

44
Q

What type of stem cell transplant uses the patient’s own stem cells and has relapse as a main drawback ?

A

Autologous

45
Q

What type of stem cell transplant uses a donor’s stem cells and has possible rejection as a main drawback ?

A

Allogeneic

46
Q

TBI is prescribed at what part of the body ?

A

Umbilicus (middle of the body)

47
Q

List the main side effects of TBI.

NVIP

A

Nausea
Vomiting
Itching
Parotitis (inflammation of the parotid gland)

48
Q

RT is used for testicular irradiation. True of False

A

True

49
Q

How does leukemia develop?

A

When underdeveloped cells start overcrowding developed cells.

50
Q

What are the 4 main subtypes of leukemia?

A
  1. Acute Lymphocytic Leukemia (ALL)
  2. Acute Myelogenous Leukemia (AML)
  3. Chronic Lymphocytic Leukemia (CLL)
  4. Chronic Myelogenous Leukemia (CML)
51
Q

What is the main cause of ALL?

A

Unregulated reproduction of lymphoblasts

52
Q

What two genetic syndromes could be a risk factor for leukemia?

A
  1. Bloom’s disease
  2. Down syndrome
53
Q

Petechiae =

A

Little small wounds underneath the skin surface

54
Q

Epistaxis =

A

Nose bleeds

55
Q

What is thrombocytopenia?

A

Persistent decrease in the number of platelets in the blood

56
Q

What cell lineage is worse prognosis for leukemia. B or T

A

T-cell

57
Q

CNS 1 =

A

No CNS involvement

58
Q

CNS 2 =

A

Very low level of leukemia cells present

59
Q

CNS 3 =

A

Definite CNS involvement

60
Q

What are the 3 sanctuary sites for ALL?

CTR

A
  1. CNS
  2. Testes
  3. Retina/Optic nerve
61
Q

Which part of the brain is at risk if there is CNS involvement in ALL?

A

The entire sub-arachnoid space

62
Q

What are the two main ways that ALL is staged?

A
  1. Morphologic apperance
  2. Immunologic surface markings (Mainsystem)
63
Q

What is the main reason for using dexamethasone ?

A

It is a steroid to reduce swelling

64
Q

What are the two main characteristics of Acute Leukemia?

A
  1. Quick progression
  2. Reproduction of UNDIFFERENTIATED/YOUNG cells
65
Q

What are the two main characteristics of Chronic Leukemia?

A
  1. Slow progression
  2. Uncontrolled expansion of MATURE CELLS in bone marrow
66
Q

ALL accounts for what percentage of overall childhood cancer ?

A

80 %

67
Q

Initial remissions accounts for what percentage of cases?

A

90 %

68
Q

CNS involved in roughly _____ of children at diagnosis.

A

5%

69
Q

What is the main method for CNS prophylaxis?

A

Methotrexate that is injected directly into the spinal canal (intrathecally)

70
Q

The inferior border for the Cranial Irradiation Field must include the ff: (2)

A
  1. Cribriform plate
  2. Temporal fossa
71
Q

What is the standard SSD for a TBI?

A

355cm

72
Q

Which 3 parts of the body are compensators used for TBI?

A
  1. Head and Neck
  2. Lower legs
  3. Lung (not always)
73
Q

Name the 7 areas where TLDs are placed when doing TBI.

A
  1. Umbilicus
  2. Head
  3. Neck
  4. Axilla (armpit)
  5. Shoulders
  6. Pelvis
  7. Knees
74
Q

Patients are premedicated with what drug to deal with nausea and vomiting?

A

Ondancitron

75
Q

Xerostomia =

A

Dry mouth

76
Q

What is the main role of Craniospinal Irradiation (CSI) in ALL management?

A

To treat positive cells in cerebral spinal fluid (CNS3)

77
Q

What cell types are involved in chronic leukemia?

A
  1. B lymphocyte
  2. T lymphocyte
  3. Natural killer cell
  4. Granulocyte
  5. Myeloblast
78
Q

List the symptoms that children present with ALL

A
  1. Fever
  2. General malaise
  3. Bruising
  4. Bone pain
  5. Thrombocytopenia
  6. Neutropenia
79
Q

List the symptoms of CNS involvement in ALL

A
  1. Headaches (Intracranial pressure)
  2. Nausea and vomiting
  3. Papilledema (swelling of optic disc)
  4. Neck stiffness
  5. Cranial nerve palsy
80
Q

What 2 conditions do 2/3 of ALL patients present with?

A
  1. Thrombocytopenia
  2. Anemia
81
Q

List RT treatment techniques for ALL

A
  1. Total Body Irradiation (TBI)
  2. Craniospinal Irradiation (CSI)
  3. Prophylactic Cranial Irradiation (PCI)
  4. Testicular Irradiation
  5. Large mediastinal mass
  6. Palliation
82
Q

What is the standard field size for TBI?

A

40 x 40 cm

Clinical Radiation Oncology II (10 decks)

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