Paediatric Leukaemia Flashcards
What is the difference between acute and chronic leukaemia.
Acute leukaemias result from failure of lymphoid or myeloid progenitor cells to differentiate, with resultant uncontrolled proliferation of these immature blast cells.
Chronic leukaemias result from the uncontrolled proliferation of cells at a later stage of differentiation.
How is leukaemia classified?
Leukaemia is categorised based up whether cells originate from lymphoid precursors (lymphocytic) or myeloid precursors (myelogenous), and by the degree of cell differentiation.
Name some risk factors of developing leukaemia.
Down’s syndrome: patients are 30 times more likely to develop ALL, and 150 times more likely to develop AML. The characteristic leukaemia seen in Down’s syndrome is M7 acute megakaryoblastic AML. Fanconi anaemia Li Fraumeni syndrome Ataxia telangiectasia Nijmegen breakage syndrome Other risk factors include:
Exposure to ionising radiation
Pesticides
Viruses such as Epstein-Barr virus (EBV), human immunodeficiency virus (HIV)
Describe how a patient with leukaemia would present.
Fatigue and malaise
Bone and joint pain: particularly affecting the legs
Dyspnoea: caused by anaemia, mediastinal mass or infection
Dizziness and palpitations
Recurrent and/or severe infections
Fevers
Thrombocytopenia: bleeding tendency (epistaxis, bleeding gums), easy bruising, rashes
Describe the positive clinical findings of leukaemia.
Weight loss Skin: pallor, petechial rash, bruising Cardiovascular: tachycardia, flow murmur Abdomen: distension, hepatomegaly and/or splenomegaly Lymphadenopathy
What are bone marrow aspirations and trephine biopsy used for?
Bone marrow aspiration and trephine biopsy are used for both diagnosis and monitoring. A biopsy may be used for:
Diagnosis (presence of ≥20% blasts)
Minimal residual disease analysis after treatment (see below)
Cytogenetics: detects chromosomal aberrations
Immunophenotyping: uses flow cytometry analysis to characterise the leukaemia blasts
What investigation can be carried out to look for the presence of leukaemia cells in the cerebrospinal fluid?
Lumbar puncture
Name 2 classification systems of ALL and AML.
French-American-British (FAB) classification is based on morphology (the appearance of cells under a microscope) and cytochemical staining of leukaemic cells.
World Health Organisation (WHO) classification system uses cytogenetics (chromosomal analysis) and immunophenotyping (use of antibodies to detect white blood cell antigens).
Name some supportive measures in leukaemia.
Education for families: it is vital that children present quickly when they are unwell, particularly when febrile.
Broad-spectrum antibiotics urgently for children presenting with suspected neutropenic sepsis.
Prophylactic antimicrobials: particularly co-trimoxazole (to prevent pneumocystis jirovecii) in ALL, and antifungals in AML.
Blood transfusions.
Allopurinol (prevention of tumour lysis syndrome).
Insertion of a central venous catheter for chemotherapy and blood sampling.
Granulocyte-colony stimulating factor (G-CSF): to support cell counts (e.g. prolonged neutropenia).
Psychosocial support, educational support, advice about financial support for families.
Name some early complications of leukaemia .
Neutropenic sepsis
Thrombocytopenia: bleeding, stroke, haemorrhage (lung or gastrointestinal)
Blast cell lysis
Leucostasis: stroke, pulmonary oedema, heart failure
CNS infiltration: seizures, stroke
Name some therapy related complications of leukaemia.
Corticosteroid side effects: behavioural issues, weight gain Neutropenic sepsis Tumour lysis syndrome Mucositis, gastrointestinal inflammation Renal and hepatic toxicity Neurotoxicity Venous thromboembolism Alopecia
Name some long term complications of leukaemia.
Secondary cancers
Avascular necrosis (a complication of high-dose steroids)
Cardiotoxicity (e.g. secondary to anthracycline treatment)
Reduced growth hormone: short stature and obesity
Fertility issues
