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Flashcards in Malignancy Deck (18):
1

What is the most common leukaemia in children?

acute lymphoblastic (ALL)

2

What are other leukaemia's found in children?

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

3

When is the peak presentation of ALL?

2-5yrs

4

What is the underlying cause of sx in ALL?

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

5

What is the nature of onset of ALL?

insidious over several weeks

6

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

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

7

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

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

8

What are Ix for ALL?

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

9

What indicates poorer prognosis of ALL?

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

10

What are the three phases of treatment of ALL?

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

11

Explain the induction phase of ALL

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

12

Explain the consolidation phase of rx of ALL

cranial irradiation if CNS disease
Further chemo:
cyclophosphamide
cytarabine
mercaptopurine

13

Explain the maintenance phase of rx of ALL

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

14

What are complications of ALL

Neutropenic sepsis
Hyperuricaemia due to massive cell death

15

What is given for renal protection in aLL

increased fluid intake
allopurinol

16

How is relapse of ALL treated?

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

17

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

Induction

18

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

co-trimoxazole to prevent pneumocystis carinii