LEUKEMIAS.

Question 1

Definition of leukemia

Answer 1

Group of malignant diseases in which genetic abnormalities in a hematopoietic cell gives rise to an unregulated clonal proliferation of cells resulting in marrow failure.

OR

ALL is defined as presence of more than 25% blast on bone marrow aspirate.

Question 2

What percentage of all childhood cancers (in children under 15 years) is accounted for by Leukemia, according to the text?

Answer 2

• 41%
  of all childhood cancers are due to Leukemia in children under 15 years.

Question 3

What percentage of all Leukemia cases worldwide is accounted for by Acute Lymphoblastic Leukemia (ALL)?

Answer 3

•Worldwide ALL accounts for 75% of all leukemia cases with peak

This makes ALL the most common type of leukemia, especially in children.

Question 4

Here’s the next question:
At what age range does Acute Lymphoblastic Leukemia (ALL) typically peak in incidence, according to the text?

Answer 4

2-5 yrs

Question 5

ALL more common ok makes it
Females

Answer 5

Acute Lymphoblastic Leukemia (ALL) affects males more often than females.

Question 6

What are the two types of Acute Leukemia listed in the text?

Answer 6

the two types of Acute Leukemia:
1. Acute Lymphoblastic Leukemia (ALL)
2. Acute Myelogenous/Myeloblastic Leukemia (AML)

Question 7

Next question:
What are the two types of Chronic Leukemia listed in the text?

Answer 7

Chronic lymphocytic leukemia CLL
-Chronic myelogenous / myeloid leukemia CML

Question 8

What type of leukemia is the most common in children, according to the text?

Answer 8

Acute lymphoblastic leukemia

Question 9

What is the minimum percentage of blast cells in the bone marrow that defines a diagnosis of ALL, according to the text?

Answer 9

25%

Question 10

Is ALL generally considered a curable type of cancer, according to the text?

Answer 10

ALL is considered curable

Question 11

Does ALL result from the uncontrolled proliferation of mature or immature lymphocytes?

Answer 11

immature lymphocytes

Question 12

What two subtypes of ALL are identified based on immunophenotyping, according to the text?

Answer 12

two subtypes of ALL:
1. B-cell ALL
2. T-cell ALL
These subtypes are determined by immunophenotyping,

Question 13

At what age range does the peak incidence of Acute Lymphoblastic Leukemia (ALL) occur, according to the text?

Answer 13

2-3 yrs

Though the commonest age range of occurrence is indeed slightly broader: 2-10 years.

Question 14

Does ALL affect males more often than females, according to the text?

Answer 14

• ALL affects males more than females

Ratio of 1.3:1** (males:females)
Meaning males are affected at a rate 1.3 times higher than females.

Question 15

Next question:
Is ALL more common in white children than in black children, according to the text?

Answer 15

ALL is:

• More common in white children
  than in black children, according to the text.

Question 16

Which type of children are at higher risk for ALL?

Answer 16

• 1) chromosomal abnormalities –Downs’, Bloom, Fanconi anaemia, ataxia-telangiectasia.
  •2 Increased incidence among twins.

Question 17

Which ALL is associated with EBV.

Answer 17

B-cell ALL

Question 18

The following classify ALL according to?

FRENCH AMERICAN BRITISH (FAB) CLASSIFICATION

•2. World Health Organization (WHO) Classification

•3. CYTO-GENETIC CLASSICATION

Answer 18

FRENCH AMERICAN BRITISH (FAB) CLASSIFICATION == Cryptogenic subtype

•2. World Health Organization (WHO) Classification== IMMUNOLOGIC SUBTYPE

•3. CYTO-GENETIC CLASSICATION ==
TRANSLOCATIONS IN ALL

Question 19

What are the malignant cells of ALL

Answer 19

lymphoid precursor cell (lymphoblast)

Question 20

What’s the cause of anemia, neutropenia and thrombocytopenia.

Answer 20

The arrest of lymphoblast causes replace normal marrow elements decreasing production of normal cells leading to anemia, neutropenia and thrombocytopenia.

Question 21

Lymphoblast also proliferate in organs other like ??

Answer 21

bone marrow;
liver,
spleen, and
lymph nodes.

Question 22

What percentage of children show signs and symptoms of the disease within 4 weeks at the time of diagnosis?

Answer 22

About 66% of children have signs and symptoms of the disease within 4 weeks at the time of diagnosis.

Question 23

What are some possible causes of the fever mentioned in the text?

Answer 23

M the fever is indeed due to:

1. Infections from neutropenia
2. Cytokines from the tumor

Question 24

What percentage of T-cell Acute Lymphoblastic Leukemia (T-ALL) cases does the text mention, and which demographic group is it common in?

Answer 24

T-cell ALL:

1. Accounts for 15% of cases
2. Is common in adolescent boys
3. Is often associated with large anterior mediastinal masses that can cause airway obstruction.

Question 25

sanctuary sites

Answer 25

testes and CNS-diffuse meningeal infiltration

Question 26

How to confirms diagnosis of ALL

Answer 26

Bone marrow aspiration confirms diagnosis by atleast >25% lymphoblast

Question 27

Investigation for classification of ALL

Answer 27

Flow cytometry, cytogenetic studies, molecular studies

Question 28

Poor prognostic factors

Answer 28

•Age at time of diagnosis. <1 year and >10years •High leukocyte count > 50,000 at diagnosis •Male sex •Non lymphoid •T-cell •Presence of Philadelphia. •Hypodiploidy •CNS involvement at diagnosis

Question 29

Favourable factors

Answer 29

•Age 1-9 years •Leukocyte count <10,000 •Female sex •Lymphoid •Caucasian •TEL-AML 1 t(12;21) •B-cell •hyperploidy

Question 30

So of treatment

Answer 30

Aim is to 1) achieve remission by eliminating blast cells from marrow. •2) Supportive and definitive. •3) To minimize drug toxity.

Question 31

Supportive treatment for ALL

Answer 31

== prevent tumour lysis syndrome-hyperuricaemia, hyperphosphataemia, hyperkalaemia, hypocalcaemia by: .1) adequate hydration 2-3L/m2 .2) allopurinol orally /rasburicase -== antibiotics for neutropenic patients with fever and infection -== prophylaxis against pneumocystis carinii with trimethoprim-sulfamethxaxole P.O -== Myelosupression- transfusions(platelets and red cells) and granulocyte

Question 32

Definitive Treatment-

Answer 32

Treatment of ALL involves several phases: 1). induction of remission, 2) consolidation of induction 3) intensification(continuation/maintenance). •== Induction of remission (remission < 5% blast cells in marrow with return of normal cell counts) agents-prednisolone/dexamethasone, vincristine, asparaginase—for 4-6 weeks in phase. •==Consolidation with prednisolone and vincristine for 4-8 weeks and CSF medications. •Intensification: last 14-28 weeks with multiagents: methotrexate, cytarabine, asparaginase and vincristine to eradicate residual disease. •== Continuation/maintenance with 6-Mercaptopurine, prednisolone, methotrexate and vincristine for 2-3 years. •== Use of intrathecal use of methotrexate, cytosine arabinoside and hydrocortisone for CNS prophylaxis and to prevent relapse.

Question 33

ACUTE MYELOID LEUKAEMIA-AML Definition

Answer 33

AML is a heterogenous group of haematological malignancies involving the precursors of the myeloid, monocyte, erythroid and megaryocyte cell lines.

Question 34

Accounts for how many percent childhood leukaemia ??

Answer 34

20%

Question 35

When does acute myloid leukemia have its Greatest incidence in ?

Answer 35

adolescents

Question 36

Subcutaneous nodules in AML called ?

Answer 36

blueberry muffins or leukaemic Curtis

Question 37

Localised mass of leukaemic cells seen in clinical presentation of AML is called ??

Answer 37

chloroma or granulocytic sarcoma

Question 38

chloroma or granulocytic sarcoma commonly occurs in which site of the body ?

Answer 38

retro-orbital and epidural locations

Question 39

paraplegia in AML is due to ?

Answer 39

Epidural chloroma.

Question 40

biopsy specimens of AML reveals??

Answer 40

hypercellular marrow consisting of monotonous pattern of cells.

Answer 41

•>30% of blast cells in bone marrow.

Question 42

CHRONIC MYELOCYTIC(MYELOID) LEUKAEMIA ??

Answer 42

characterized by a specific translocation, the t (9;22) (q34;q11) known as the Philadelphia chromosome.

Question 43

What are the Two childhood variants ?

Answer 43

a). Philadelphia chromosome t(9;22) –positive form (adult CML) b). Juvenile myelomonocytic leukaemic (JMML)

Question 44

Philadelphia chromosome is detected by ?

Answer 44

cytogenetic studies.