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Acute Leukemia
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.
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Acute Leukemia
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- 2. Definition Acute leukemiais a disease in which the hematopoietic stem cells undergoes malignant transformation into a primitive, undifferentiated cell with abnormal longevity
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- 5. Epidemiology ALL ALL isthe 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 Itseems to develop from a combination of genetic and environmental factors.
- 7. Risk factor Beingexposed 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 leukocytecount of more than 10 × 109/L Neutropenia
- 10. peripheral bloodsmear
- 11. Bone marrowexamination 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 generalphases 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 dailyoral 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 Hydrationand urine alkalinization urine alkalinization (pH 7 to 8) & electrolyte monitoring can prevent the hyperuricemia, hyperphosphatemia, hypocalcemia, and hyperkalemia (tumor lysis syndrome)
- 18. Key Points forALL 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 forAML 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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