Malignancy

Question 1

What is the most common leukaemia in children?

Answer 1

acute lymphoblastic (ALL)

Question 2

What are other leukaemia’s found in children?

Answer 2

acute myeloid  (AML)
acute non-lymphocytic leukaemia (ANLL)

Question 3

When is the peak presentation of ALL?

Answer 3

2-5yrs

Question 4

What is the underlying cause of sx in ALL?

Answer 4

infiltration of the bone marrow or other organs.w leukaemia blast cells

Question 5

What is the nature of onset of ALL?

Answer 5

insidious over several weeks

Question 6

What are the signs and symptoms of leukaemia? divide them into categories of effects of infiltration

Answer 6

1. general - malaise and anorexia
2. BM infiltration: anaemia (pallor, lethargy)
   neutropenia (infection)
   thrombocytopenia (bruising, nose bleeds, petechiae)
3. Reticuloendothelial infiltration:
   - hepatosplenomegaly
   - lymphadenopathy
4. CNS - headaches, vomiting, nerve palsies
5. Testes - testicular enlargement

Question 7

What are the types of ALL? which is most common/?

Answer 7

Common ALL (75%) - CD10 present
T-cell ALL (15-20%)
B-cell ALL

Question 8

What are Ix for ALL?

Answer 8

1. FBC - low Hb, thrombocytopenia, circulating leukaemic blast cells
2. bone marrow examination - confirms diagnosis
3. CXR - identify mediastinal mass characteristic of T cell disease
4. immunological phenotyping to sub classify ALL

Question 9

What indicates poorer prognosis of ALL?

Answer 9

age < 2 years or > 10 years
WBC > 20 * 109/l at diagnosis
T or B cell surface markers
non-Caucasian
male sex

Question 10

What are the three phases of treatment of ALL?

Answer 10

1. INDUCTION therapy
2. CONSOLIDATION phase
3. MAINTENANCE phase

Question 11

Explain the induction phase of ALL

Answer 11

1. induction (4weeks):
   - Vincristine
   - Dexamethasone
   - Asparaginase
   Intrathecal therapy
   Methotrexate +/- cytarabine + hydrocortisone

Question 12

Explain the consolidation phase of rx of ALL

Answer 12

cranial irradiation if CNS disease
Further chemo:
cyclophosphamide 
cytarabine
mercaptopurine

Question 13

Explain the maintenance phase of rx of ALL

Answer 13

Daily mercaptopurine
Weekly methotrexate
vincristine/steroid pulses
3monthly intrathecal drugs

Question 14

What are complications of ALL

Answer 14

Neutropenic sepsis

Hyperuricaemia due to massive cell death

Question 15

What is given for renal protection in aLL

Answer 15

increased fluid intake

allopurinol

Question 16

How is relapse of ALL treated?

Answer 16

FLAG
Clofarabine
Bone marrow transplant (if high risk e.g. WCC>200, MLL rearrangement gene)

Question 17

Which phase of treatment intends to kill most of the leukaemia cells in ALL/

Answer 17

Induction

Question 18

What prophylactic drug is given during treatment of ALL and why?

Answer 18

co-trimoxazole to prevent pneumocystis carinii