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17 Cards in this Set
- Front
- Back
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Treatment of tumor lysis syndrome
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forced diuresis with alkalinization to facilitate uric acid secretion
inhibit uric acid production - allopurinol rasburicase - destroys uric acid watch hyperkalemia, hyperphosphatemia |
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lab tests for acute leukemia
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flow cytometry and cytogenetics are most important
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ALL epidemiology
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most common cancer in children and adolescence
exception: neonates (birth to 1 month) - acute myelogenous leukemia is more common |
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TdT
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indicates immature T or B cell
lost as T or B cell mature |
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ALL management
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platelet/RBC transfusion for bleeding anemia
antibody therapy if neutropenic chemo - 4 phase - remission induction, consolidation, CNS prophylaxis, maintenance watch for tumor lysis syndrome |
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definition of remission in ALL
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<5% blasts in BM
self sustaining - no transfusion needed no symptoms failed remission is after 6months of therapy |
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consolidation/intensification phase
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elimination of leukemic cells in sacturary sites - testes or meningies
cyclic chemo to prevent myelosepression, reduce leukemic cell burden further |
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CNS prophylaxis ALL
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worried about meningeal leukmia because its hard to treat
intraethacal chemo or irradiation |
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prognosis of ALL
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presence of t(9,22) translocation is BAD
2-9yo do better CNS disease - bad |
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AML epidemiology
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most common from birth to 1mo
incidence increases in teens and more rapidly after 55 |
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M4 with eosinophilia (M4Eo)
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associated with inversion of chr 16
good prognosis |
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AML symptoms
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bleeding due to thrombocytopenia and coagulopathy
DIC (especially M3) gingival swelling (with monocytic) - lymphadenopathy, skin nodules, splenomegaly |
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cytogenetics in AML
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t(15,17) in APL (M3 or M3v)
t(8,21) in M2 (favorable) inv(16) in M4Eo (favorable) t(9,22) philly chromosome in AML - BAD PROGNOSIS |
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Acute promyelocytic leukemia
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generally present with DIC
t(15,17) transolcation - fusion protein involving retinoic acid receptor treat with all-trans retinoic acid - allows differentiation of pyomyelocytes |
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ATRA syndrome
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all trans retinoic acid therapy used in treatment of M3 can cause increased ICP, pleural effusion
treat with steroids |
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T/F maintenance therapy is always needed in ALL
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True
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T/F maintenance therapy is always needed in AML
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False; maintenance has limited benefit in AML EXCEPT for M3
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