Peripheral smear• Oval macrocytes, hypersegmented neutrophils – megaloblastic anaemia• Leuko-erythroblastic blood picture – marrow infiltration• Leuko-erythroblastic picture with tear drop cells – marrow fibrosis• Blast or atypical lymphoid cells – haematological malignancy• Dysplastic feature – MDS, drugs or HIV infection
Leukaemia• Pancytopenia or bicytopenia – Can it be haematological malignancy? CBC & peripheral smear• Avoid steroids prior to confirmation of diagnosis
Bone marrow aspirate andbiopsy both are essential.
Acute Leukaemia• Comprises approximately 30 percent of all childhood malignancies• An incidence of 2.8 cases per 100,000• The peak incidence 2-5 Yrs• Studies of the relationship between childhood ALL, urban/rural status and population density, as well as other possible etiologic factors (eg, environmental exposures, abnormal immune response to common infections) have yielded inconsistent results
Acute leukaemia• Persistent or progressive lymphadenopathy that does not respond to antibiotic therapy suggests the need for more extensive evaluation.
Differential diagnosis• Juvenile idiopathic arthritis• Osteomyelitis• Epstein-Barr virus• Idiopathic thrombocytopenic purpura• Pertussis, parapertussis• Aplastic anemia• Acute infectious lymphocytosis• Other malignancies with bone marrow involvement (eg, neuroblastoma, retinoblastoma, rhabdomyosarcoma, and Ewing sarcoma
Acute lymphoblastic leukaemia• INDUCTION THERAPY – To eradicate more than 99 percent of the initial burden. – to restore normal hematopoiesis – Usually last for 4-5 weeks• Intensification (consolidation) therapy – High dose methotrexate – Reinduction therapy• CNS targeted therapy – Intrathecal chemo, cranial RT, High Mtx• Maintenance therapy – Oral 6MP and Mtx• Allogenic bone marrow transplantation
Acute myeloid leukaemia• Induction therapy – Cytarabine (7 days) & Daunorubicine (3days)• Consolidation therapy – 3-4 cycles of high dose cytarabine• Autologous and allogenic bone marrow transplantation