ACUTE LEUKEMIASTan Yuet NgerGroup 88

Definition

Acute leukemia is a disease in which the hematopoietic stem cells undergoes malignant transformation into a primitive, undifferentiated cell with abnormal longevity

Leukemias

Acute

ALL AML

Chronic

CLL CML

EpidemiologyALL ALL is the most common type of childhood cancer It is most common in children younger than 5AML AML is the second most common form of leukemia

in children, after acute lymphoblastic leukemia (ALL)

AML occurs more often in children younger than two. The number of people with AML increases again in late childhood (during the teenage years) and continues to increase throughout later adulthood.

Etiology

Unknown It seems to develop from a combination of

genetic and environmental factors.

Risk factor Being exposed to xrays before birth. Being exposed to radiation Having certain genetic conditions, such as

Down syndromeNeurofibromatosis type 1 (NF1).Shwachman syndromeBloom syndromeAtaxia-talangiectasia

Signs and symptoms easy bruising and bleeding pallor, fatigue, fever, malaise, weight loss, tachycardia,

chest pain infection Bone marrow and periosteal infiltration may cause bone

and joint pain Extramedullary infiltration by leukemic cells may cause

lymphadenopathy, splenomegaly, hepatomegaly, and leukemia cutis (a raised, nonpruritic rash)

Gum hyperplasia Symptoms of CNS involvement, such as headache,

vomiting, lethargy, and nuchal rigidity

Diagnosis CBC

AnemiaThrombocytopeniaelevated leukocyte count of more than 10 ×

109/LNeutropenia

peripheral blood smear

Bone marrow examination Histochemical studies, cytogenetics,

immunophenotyping, and molecular biology studies Lumbar puncture Imaging

A chest x-ray can help detect an enlarged thymus or lymph nodes in the chest. If the test result is abnormal, a computed tomography (CT) scan of the chest may be done to get a more detailed view.

Chest x-rays can also help look for pneumonia if your child might have a lung infection

Treatment

The 4 general phases of chemotherapy for ALL include:-1. Remission induction2. CNS prophylaxis3. Postremission

consolidation or intensification

4. Maintenance

2 general phases of chemotherapy for AML include :-1. Induction therapy2. Consolidation

/intensification therapy

Chemotherapy

1. Induction daily oral prednisone and weekly

IV vincristine with the addition of an anthracycline or asparaginase

2. CNS prophylaxis prophylaxis and treatment may

include intrathecal methotrexate, cytarabine, and corticosteroids in combination or methotrexate and cytarabine singly

3. Consolidation therapy Allogeneic stem cell

transplantation is recommended as consolidation therapy for Ph chromosome–positive ALL in adults or for 2nd or later relapses or remissions.

4. Maintenance methotrexate and

mercaptopurine

1. Induction cytarabine by continuous IV

infusion or high doses for 5 to 7 days

2. Consolidation High-dose cytarabine

regimens

ALL AML

Radiation therapy Stem cell transplant Targeted therapy

ALL• Tyrosine kinase

inhibitor• Imatinib (gleevec)

children with Philadelphia chromosome –positive ALL

AML• Monoclonal antibody therapy• Gemtuzumab treatment of

a subtype of AML called acute promyelocytic leukemia (APL)

• Proteasome inhibitor therapy• Bortezomib is a

proteasome inhibitor used to treat childhood APL.

Supportive careTransfusionsAntimicrobialsHydration and urine alkalinizationurine alkalinization (pH 7 to 8) & electrolyte

monitoring can prevent the hyperuricemia, hyperphosphatemia, hypocalcemia, and hyperkalemia (tumor lysis syndrome)

Key Points for ALL

ALL is the most common cancer in children but also occurs in adults.

CNS involvement is common; most patients receive intrathecal chemotherapy and corticosteroids and sometimes CNS radiation therapy.

Response to treatment is good, with cure possible in about 75% of children and 30 to 40% of adults.

Stem cell transplantation may be helpful for relapse.

Key Points for AML

There are a number of subtypes, typically involving very immature myeloid cells.

Chromosomal abnormalities are common and have implications for prognosis and treatment.

Chemotherapy often prolongs survival. Stem cell transplantation may help patients

who do not respond to treatment and younger patients.

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