This document provides an overview of acute leukemia, including:
- Acute leukemia comprises approximately 30% of all childhood malignancies, with an incidence of 2.8 cases per 100,000 children and a peak incidence between ages 2-5 years.
- The differential diagnosis for acute leukemia includes juvenile idiopathic arthritis, osteomyelitis, Epstein-Barr virus, idiopathic thrombocytopenic purpura, and various infections and malignancies.
- Diagnosis of acute leukemia involves examination of the peripheral smear and bone marrow aspirate and biopsy to identify cellular abnormalities and classify the specific leukemia subtype. Prognosis depends on factors like age, white blood cell count, cyt
10. 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
11. Leukaemia
• Pancytopenia or bicytopenia – Can it be
haematological malignancy? CBC &
peripheral smear
• Avoid steroids prior to confirmation of
diagnosis
13. 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
14. Acute leukaemia
• Persistent or progressive lymphadenopathy
that does not respond to antibiotic therapy
suggests the need for more extensive
evaluation.
15. Differential diagnosis
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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
38. 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
39. 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