FN: Acute Lymhoblastic Leukaemia

Question 1

epi

Answer 1

Children 2-5 years (commonest childhood cancer)

Rare in adults

Question 2

Aetiology

Answer 2

Arrest of maturation and proliferation of lymphoblasts
-80% B lineage
20% T lineage

Question 3

B lineage

Answer 3

t12,21

Question 4

T lineage

Answer 4

T cells present
Thymus mass
Teenage
forms lymphoma

Question 5

risk factors

Answer 5

Genetic susceptibility (often Chr translocations)
Environmental triggers
-radiation (e.g. during pregnancy)
- Downs

Question 6

Features

Answer 6

BM failure

Infiltration

Question 7

Bm failure features

Answer 7

anaemia
Thrombocytopenia - bleeding
Leukopenia - infection

Question 8

Infiltration features

Answer 8

Lymphadenopthy
Orchidomegaly
Thymic enlargemebt
HSM
CNS: CNS palsies, meninigism
Bone pain

Question 9

Investigations bloods show

Answer 9

raised WCC: lymphoblasts

Reduced RBC, reduced PMN, reduced platelets

Question 10

BM aspirate shows

Answer 10

20% blasts

Cytogenic and molecular analuysis

Question 11

CXR and CT shows

Answer 11

Mediastinal and abdominal LNS

Question 12

LP shows

Answer 12

CNS involvement

Question 13

Management

Answer 13

Supportive
Infections
Chemo
BMT

Question 14

Supportive therapy

Answer 14

Blood products
Allopurinol
Hickman line or Portacath

Question 15

Infections

Answer 15

Gentamicin + tazocin

Prophylaxis e.. co-timoxazole, ciprofoxacin

Question 16

Chemotheray (recruited into national trials)

Answer 16

1. Remission induction
2. consolidation + CNS Rx
3. Maintenance for 2-3 yrs

Question 17

BMT

Answer 17

Best option for younger adults

Question 18

Prognosis

Answer 18

85% survival in children

Worse in adults