Childhood leukemia Flashcards
3 childhood red flags
- back pain must be investigated
- supraclavicular LAD is patho until proven otherwise
- hepatosplenomegaly = systemic process
what is sig. of childhood CA
rare but leading cause of death beyond infancy
- blood and bone CA
what is genral outcome
good cure rate
- many have chronic health conditions
what types are most childhool
95% acute leukemia
-ALL - 80%
-AML - 15%
chroinc
what is epi of ALL
- most common peds
- M>F
- whitw>black
- peak 2-5yrs
what are leukemia outcomes
ALL - 90% survival
AML - 60% survivial
4 tests for leukemia
- blood count and smear
- bone marrow aspirate and biopsy
- LP for CSF exam
- testicular exam
what is seen in ALL peripheral blood
- WBC may be low, norm, or high
- Hgb may be normal or low
- 20% don;t have blasts
3 risk factors for leuk
genetic - in utero - polymorphisms - down's syndrome env - rads - chems infection
what is clinical presentation
- non specific
- lack of marrow output
- related to extramedullary disease
3 problems due to lack of marrow output
- Hb
- pallor, fatigue, irritable - WBC
- fever, sepsis - platelets
- bruising, bleeds
5 Sx related to blasts
- bone pain
- hepatosplenomegaly
- lymphadenopathy
- lymph presentation
- hyperleukocytosis ( sludging)
2 types of extramedullary disease
- CNS
- most asymptomaitc
- may be ICP
- may be parenchymal - seizure, plasies - testicles
- painless enlargement
5 things that can harm patient in first 24 hours
- hyperleuko
- tumor lysis syndrome
- mediastinal mass
- infection
- bleeding
5 further tests
- chemisties
- CXR
- blood cultures
- type and screen
- INR/PTT
what is tumor lysis syndrome
metabolic derangement resulting from cell lysis with tumor kill
3 components
incr K
incr urate
incr Ph
approach to TLS
- freq bloods
- hyperhydratiokn
- forced diureisis
- allopurinol
- dyalisis if bad
what is issue with mediastinal mass
- SVC compression
- airway compression
4 phases of chemo
- 5-3 years
- induction
- consolidation
- re-intensification
- maintenance
7 prognostic factors
- age - younger better
- intial WBC
- CNS or test disease
- T cell worse
- cytogenetics
- intial response - most important
- pharmoacognetics
how to measuer intial response
- minimal residual disease
- blast count in marrow
late effects of chemo
- obesity
- bone health
- endo
- neurotox
- cardiotox
- secondary neoplasm
4 designer approaches
- naked antibodies
- AB delivery
- bi-specific T cell engaging ABs
- CAR-T cells
