leukaemia

Question 1

A 5 year old boy presents with increasing pallor, tiredness, complaining of sore legs and is reluctant to walk. On examination he is quiet, has pale conjunctivae and palmar skin creases, palpable cervical, auxiliary and inguinal lymphadenopathy and hepatosplenomegaly.

Blood tests show:

• WCC: 3 x10⁹
• Hb: 76 g/L
• Plt: 60 x10⁹
• Blood film: multiple lymphoblasts

What is the likely diagnosis?

Answer 1

leukaemia

Question 2

What other investigations are required?

Answer 2

1. CXR
2. bone marrow aspirate for histology

Question 3

Bone marrow findings are shown below

What is the most commonest form of leukaemia in children?

Answer 3

acute lymphoblastic leukaemia

Question 4

what is the cure rate for ALL?

Answer 4

>85%

Question 5

name 4 poor prognostic indicators for ALL?

Answer 5

1. age <1 or >10 years
2. male
3. T-cell lineage
4. WCC >50 at presentation
5. chromosomal abnormalities e.g. Philadelphia chromosome t(9,22)
6. failure to respond to induction chemotherapy