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11 Cards in this Set

  • Front
  • Back
Describe the ALL classification and prognosis?
Morphologic: L1, L2 etc
- Precursor B cell (80%), good prognosis
- Mature B cell/Burkitt (1%), good prognosis
- Tcell ALL (19%), worse prognosis
Epidemiology of ALL?
75% of all cases of childhood acute leukemia. More common in boys, and white children
Which syndromes are at increased risk for leukemia?
Trisomy 21, Fanconi anemia, Bloom syndrome, ataxia-telangiectasia, X-linked agammaglobulinemia, Diamon-Blackfan, Shwachman, SCID
Presenting signs/symptoms of leukemia?
Const symptoms: malaise, fever, anorexia. Bone pain, arthralgias. Sequelae of anemia (pallor) and thrombocytopenia (petechiae). WBC count can be high, normal, or low. HSM, LAD. Extramedullary involvement in the CNS, skin, testicles.
DDx of leukemia?
Aplastic anemia, ITP, EBV infection, other malig, lupus, juvenile RA, hemophagocytic syndrome
Diagnostic eval in child with presentation concerning for leukemia?
CBC, blood smear, BM bx, CMP, LDH, uric acid, Ca, Mg, PO4, coags, cultures if suspected infection, CXR to eval for mediastinal mass, LP (eval for CNS disease)
What is tumor lysis syndrome?
Triad of metabolic abnormalities - hyperuricemia, hyperphosphatemia, and hyperkalemia resulting from tumor cell death, esp in high growth-rate tumors
How to manage tumor lysis syndrome?
Hydration, urine alkalinization, allopurinol for uric acid reduction, and potassium and phsophate reduction
What are the risks of hyperleukocytosis in ALL?
Vascular stasis - mental status changes, HA, blurry vision, dizziness, szs, dyspnea
Severe - hpyoxemia, stroke
Large concentrations of T cell leukemia malignant cells in the mediastinum can cause...?
Tracheal compression, SVC syndrome
Treatment strategy for ALL?
Induction - 1 month vincristine, steroids, intrathecal MTX, asparaginase
Consolidation to prevent relapse, intrathecal therapy
Interim maintenance --> maintenance with intrathecal MTX q3months, mothly vincristine/steroids, weekly oral MTX, daily oral 6MP