childhood acute lymphoblastic leukemia

Leukemias

Seyed Morteza MahmoodiMaryam BulooshiNadia choudhry

Acute Lymphoblastic Leukemia

Acute and Chronic Myelogenous Leukemia

Leukemia with Down syndrome

Contents

Acute Lymphoblastic Leukemia

Contents

INTRODUCTION

TREATMENT

CLASSIFICATION EITIOLOGY

DIAGNOSIS

CLINICAL PRESENTATION

Acute Lymphoblastic Leukemia

Contents

INTRODUCTION

TREATMENT

CLASSIFICATION EITIOLOGY

DIAGNOSIS

CLINICAL PRESENTATION

The most common malignant neoplasms of childhood are………………

INTRODUCTION

The most common malignant neoplasms of childhood are Leukemias.

INTRODUCTION

The most common malignant neoplasms of childhood are Leukemias.

Which one is the commonest type of childhood Leukemias?

AML

ALL

CML

JCML

INTRODUCTION

The most common malignant neoplasms of childhood are Leukemias

Which one is the commonest type of childhood Leukemias?

AML …………….%

ALL …………….%

CML .……………%

JCML …………….%

INTRODUCTION

The most common malignant neoplasms of childhood are Leukemias

Which one is the commonest type of childhood Leukemias?

AML …………….%

ALL 80%

CML .……………%

JCML …………….%

INTRODUCTION

The most common malignant neoplasms of childhood are Leukemias

Which one is the commonest type of childhood Leukemias?

AML 10%

ALL 80%

CML 2-3%

JCML 1-2%

INTRODUCTION

Acute Lymphoblastic Leukemia

Contents

INTRODUCTION

TREATMENT

CLASSIFICATION EITIOLOGY

DIAGNOSIS

CLINICAL PRESENTATION

CLASSIFICATION EITIOLOGY

FAB

WHO

Immunophenotypic

L1 L2

L3

1- Acute lymphoblastic leukemia/lymphoma Synonyms: Former Fab L1/L2

• Precursor B acute lymphoblastic leukemia/lymphoma. Cytogenetic subtypes:

t(12;21)(p12,q22) TEL/AML-1 t(1;19)(q23;p13) PBX/E2A t(9;22)(q34;q11) ABL/BCR T(V,11)(V;q23) V/MLL • Precursor T acute lymphoblastic

leukemia/lymphoma 2-Burkitt's leukemia/lymphoma Synonyms: Former

FAB L3 3-Biphenotypic acute leukemia

CLASSIFICATION EITIOLOGY

B-cell ALL • Early pre-B ALL (pro-B ALL) - 10%• common ALL - 50%• pre-B ALL - 10%• mature B-cell ALL (Burkitt leukemia) - 4% T-cell ALL • pre-T ALL - 5% to 10%• mature T-cell ALL - 15% to 20%

CLASSIFICATION EITIOLOGY

Acute Lymphoblastic Leukemia

Contents

INTRODUCTION

TREATMENT

CLASSIFICATION EITIOLOGY

DIAGNOSIS

CLINICAL PRESENTATION

CLINICAL PRESENTATION

CLINICAL PRESENTATION

Common presentations of all acute Leukemias?

1)2)3)

CLINICAL PRESENTATION

Common presentations of all acute Leukemias?

1) Fever2) Fatigue 3) Bleeding

  Feature Percent of Total

Children

 Fever 57

 Fatigue 50

 Bleeding 43

 Bone or joint pain 25

Lymphadenopathy 70

 Marked (>3 cm) 15

Hepatomegaly 66

 Marked (below umbilicus) 17

Splenomegaly 60

 Marked (below umbilicus) 17

Mediastinal mass 8

CNS leukemia 3

Testicular leukemia 1

An anterior mediastinal mass Superior vena cava syndrome • Cough, dyspnea, orthopnea, dysphagia, stridor,

cyanosis, facial edema, increased intracranial pressure, syncope

Ocular involvement Cranial nerve palsy Epidural spinal cord compression Enlarged salivary glands (Mikulicz syndrome) Subcutaneous nodules (leukemia cutis) Priapism Infiltration of tonsils, adenoids, appendix, or

mesenteric lymph nodes

CLINICAL PRESENTATION

Differential Diagnosis At early presentations Late presentation CBC picture Microscopic blood picture

Differential Diagnosis Aplastic anemia Idiopathic thrombocytopenic purpura Recent viral infection Infectious mononucleosis Pertussis or parapertussis Small round cell tumors involving the bone

marrow, including neuroblastoma, rhabdomyosarcoma, and retinoblastoma

Juvenile rheumatoid arthritis, rheumatic fever, other collagen diseases, or osteomyelitis

Acute Lymphoblastic Leukemia

Contents

INTRODUCTION

TREATMENT

CLASSIFICATION EITIOLOGY

DIAGNOSIS

CLINICAL PRESENTATION

DIAGNOSIS

DIAGNOSIS

ESR, CRP Bleeding profile Electrolytes LDH LFT RFT Serum Igs Urinalysis

DIAGNOSIS

What should we do if we found blasts?

F_ _ _ C _ _ _ _ _ _ _ _

DIAGNOSIS

FLOW CYTOMETRY

DIAGNOSIS

EGIL-Score for biphenotypic leukemias

Score B-lymphocytic T-lymphocytic Myeloid

2 CD79(cyt/membrane)

CD22(cyt/membrane)

cyt.IgM

CD3(cyt/membrane)

TCR-a/bTCR-g/d

Myelo-peroxidase

(cytopl.)

1 CD19CD10CD20

CD2CD5CD8

CD10

CD13CD33

CDw65

0.5 TdTCD24

  CD14CD15CD64

CD117*

B Lineage T Lineage

CD19/CD79a/CD22 CD3 (surface/cytoplasmic)

Pre-pre-B ALL — Precursor T ALL CD1a, CD2, CD5, CD7, CD8, cCD3

Common ALL CD10 (CALLA) Mature T ALL Surface CD3 (plus any other T-cell markers)

Pre-B ALL Cytoplasmic IgM

Mature B-cell ALL

Cytoplasmic or surface Ig

ALLAML

Acute Lymphoblastic Leukemia

Contents

INTRODUCTION

TREATMENT

CLASSIFICATION EITIOLOGY

DIAGNOSIS

CLINICAL PRESENTATION

How much is the cure rate?????????

TREATMENT

Around 85%

TREATMENT

TREATMENT

Remission Induction

Intensification

Maintenance Therapy

Outcomes of treatment A remission (complete remission) Minimal residual disease Active disease

Prognosis Sex Ethnicity Age at diagnosis Whether the cancer has spread to the brain or

spinal cord Initial white blood cell count Response of patient to initial treatment Genetic disorders such as Down's Syndrome ALL subtype Cytogenetics Chromosome translocations