Leukaemia:

Question 1

List 3 features of bone marrow failure:

Answer 1

• Anaemia - pallor, tiredness, dizzy, SOB
• Infection - recurrent fever
• Thrombocytopenia - bruising petechiae, bleeding

(general symptoms: Irritability, bony/muscular pain, failure to thrive)

Question 2

List 3 symptoms of bone marrow failure:

Answer 2

• Irritability
• Bony/muscular pain
• Failure to thrive

Question 3

What is the commonest cancer of childhood?

Answer 3

Acute lymphoblastic leukaemia (ALL)

Question 4

What is ALL?

Answer 4

Malignant disease of the bone marrow in which lymphoid precursors proliferate and replace normal haemopoietic cells.

Question 5

How is the diagnosis of ALL confirmed?

Answer 5

Bone marrow aspirate + trephine (hollow saw to remove part of bone or tissue)

Question 6

What investigation results are seen in ALL?

Answer 6

FBC:
- Pancytopenia
- Clotting
- CRP
Blood film:
- Blasts may be present
U+Es: Tumour lysis syndrome

Question 7

List 3 drugs that can be used in the treatment of ALL:

Answer 7

• Vincristine
• Methotrexate
• Steroids

Question 8

What two other non-pharmaceutical Rx can be used in ALL?

Answer 8

• Bone marrow transplant

- CNS radiotherapy

Question 9

How long is chemotherapy for ALL in boys vs. girls?

Answer 9

Boys - 3 years (prognosis worse in boys)

Girls - 2 years

Question 10

Give 3 main complications of ALL:

Answer 10

• Bone marrow failure
• Sepsis
• Tumour lysis syndrome

Question 11

What is tumour lysis syndrome?

Answer 11

Renal failure secondary to increase levels of urate, phosphate and potassium at initiation of chemotherapy. Basically overwhelming levels of crap that the kidney cant remove. This crap is from broken down tumour cells.

Question 12

What is the treatment for bone marrow failure?

Answer 12

• Transfusion of blood products

- Granulocyte colony stimulating factor (GCSF - stimulated bone marrow to produce RBC)

Question 13

What is the treatment during tumour lysis syndrome?

Answer 13

• Hyperhydration

- Allopurinol (decreases levels of uric acid)

Question 14

What is the overall cure rate for those with ALL?

Answer 14

80%

Question 15

What factors predict a poor prognosis in ALL?

Answer 15

• Boys
• <1yrs, >10yrs
• Poor cytogenetics
• ^ residual disease