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11 Cards in this Set
- Front
- Back
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Describe the ALL classification and prognosis?
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Morphologic: L1, L2 etc
Immunologic: - Precursor B cell (80%), good prognosis - Mature B cell/Burkitt (1%), good prognosis - Tcell ALL (19%), worse prognosis |
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Epidemiology of ALL?
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75% of all cases of childhood acute leukemia. More common in boys, and white children
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Which syndromes are at increased risk for leukemia?
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Trisomy 21, Fanconi anemia, Bloom syndrome, ataxia-telangiectasia, X-linked agammaglobulinemia, Diamon-Blackfan, Shwachman, SCID
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Presenting signs/symptoms of leukemia?
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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.
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DDx of leukemia?
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Aplastic anemia, ITP, EBV infection, other malig, lupus, juvenile RA, hemophagocytic syndrome
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Diagnostic eval in child with presentation concerning for leukemia?
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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)
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What is tumor lysis syndrome?
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Triad of metabolic abnormalities - hyperuricemia, hyperphosphatemia, and hyperkalemia resulting from tumor cell death, esp in high growth-rate tumors
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How to manage tumor lysis syndrome?
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Hydration, urine alkalinization, allopurinol for uric acid reduction, and potassium and phsophate reduction
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What are the risks of hyperleukocytosis in ALL?
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Vascular stasis - mental status changes, HA, blurry vision, dizziness, szs, dyspnea
Severe - hpyoxemia, stroke |
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Large concentrations of T cell leukemia malignant cells in the mediastinum can cause...?
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Tracheal compression, SVC syndrome
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Treatment strategy for ALL?
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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 |
