Acute leukemias are cancers that develop from hematopoietic stem cells and cause abnormal white blood cell production. The two main types are acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML). ALL is most common in children under 5 years old, while AML occurs more in children under 2 years old and teenagers. Risk factors include exposure to radiation or certain genetic conditions. Treatment involves chemotherapy in multiple phases for ALL or induction and consolidation for AML, and may include stem cell transplants in some cases. The goal is to achieve remission and prevent relapse or progression of the disease.

1. ACUTE
LEUKEMIAS
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Group 88

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

3. Leukemias
Acute
ALL AML
Chronic
CLL CML

5. Epidemiology
ALL
 ALL is the most common type of childhood cancer
 It is most common in children younger than 5
AML
 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.

6. Etiology
 Unknown
 It seems to develop from a combination of genetic
and environmental factors.

7. Risk factor
 Being exposed to xrays before birth.
 Being exposed to radiation
 Having certain genetic conditions, such as
Down syndrome
Neurofibromatosis type 1 (NF1).
Shwachman syndrome
Bloom syndrome
Ataxia-talangiectasia

8. 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

9. Diagnosis
 CBC
Anemia
Thrombocytopenia
elevated leukocyte count of more than 10 × 109/L
Neutropenia

10.  peripheral blood smear

11.  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

14. Treatment
The 4 general phases of
chemotherapy for ALL
include:-
1. Remission induction
2. CNS prophylaxis
3. Postremission
consolidation or
intensification
4. Maintenance
2 general phases of
chemotherapy for AML include :-
1. Induction therapy
2. Consolidation /intensification
therapy
Chemotherapy

15. 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

16.  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.

17.  Supportive care
Transfusions
Antimicrobials
Hydration and urine alkalinization
urine alkalinization (pH 7 to 8) & electrolyte
monitoring can prevent the hyperuricemia,
hyperphosphatemia, hypocalcemia, and
hyperkalemia (tumor lysis syndrome)

18. 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.

19. 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.

20. THANK YOU