BIBLIOGRAPHY: Datta Parul, Textbook of Pediatric Nursing, edition 4, The medical sciences publishers, 4838/24 Ansari road, Daryaganj, New Delhi, 110002, India INTRODUCTION Leukemia is the most common type of childhood malignancy. It is characterized by persistent and uncontrolled production immature and abnormal WBCs. It is a disease of abnormal proliferation and maturation of bone marrow which interferes with the production of normal RBCs, WBCs and platelets. Leukemia is defined as uncontrolled neoplastic proliferation of leukocyte precursors. According to National Cancer Institute, Leukemia is defined as a cancer that starts in blood-forming tissue, such as the bone marrow, and causes large number of abnormal cells to be produced and enter the bloodstream. 95-98% of childhood leukemia are acute type. 70-75% of acute lymphocytic leukemia. common malignancy of children less than 15 years. peak incidence is four years of age. males are more affected than females. twice more common in white then black in children. The exact cause is unknown. viruses like HPV ,Epstein Barr virus ,human T cell lymphoma leukemia virus (HTLV). Radiations exposure to chemicals and drugs like benzene and Dilantin familial predisposition chromosomal abnormalities like Down syndrome Genetic like Fanconi's anemia ,bloom syndrome ACUTE LYMPHOCYTIC LEUKEMIA Primary disorder of bone marrow in which normal bone marrow elements are replaced by immature or undifferentiated blast cells. develop when lymphoid cell line is affected. characterized by anemia, thrombocytopenia, neutropenia, especially granulocytopenia. the incidence rate is one in 2000 live birth. the peak age of onset is 3 to 7 years and males are more affected than females According to French American British classification on the basis of cell morphology it is classified as L1 L2 L3 According to type of cell it is classified as T cell B cell Pre-B cell Null cell T cell 10 to 15% ,high risk ,seen in older children especially males ,featured as mediastinal mass ,hepatosplenomegaly ,high WBC count ,CNS involvement and has poor prognosis. B cell 1 to 2% children ,aggressive form ,poor prognosis and high-risk type. Pre-B cell Good prognosis and respond well to therapy. Null cell No cellular surface markers (80% ). Great imitator, with vague and varied signs and symptoms, resembling almost any disease. Peripheral blood examination which shows decrease hemoglobin, RBC, hematocrit and platelet count bone marrow analysis in which large number of lymphoblasts and lymphocytes with hypercellular visible. chest X-ray CSF Chemotherapy radiation therapy bone marrow transplantation supportive and symptomatic management Chemotherapy Remission induction chemotherapy Vincristine, Prednisolone, Asparaginase and Adriamycin are given for 4-6 weeks. maintenance therapy or systemic continuation 6 MP (Mercaptopurine) and MTX (Methotrexate) are given for 2.5-3 years. late intensification or THERAPY