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Childhood Acute Lymphoblastic Leukemia

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Information about Childhood Acute Lymphoblastic Leukemia
Health & Medicine

Published on March 11, 2014

Author: mahmoodi2000

Source: slideshare.net

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Leukemias Seyed Morteza Mahmoodi Maryam Bulooshi Nadia choudhry

Acute Lymphoblastic Leukemia Acute and Chronic Myelogenous Leukemia Leukemia with Down syndrome Contents

Acute Lymphoblastic Leukemia Contents INTRODUCTION TREATMENT CLASSIFICATION EITIOLOGY DIAGNOSIS CLINICAL PRESENTATION

Acute Lymphoblastic Leukemia Contents INTRODUCTION TREATMENT CLASSIFICATION EITIOLOGY DIAGNOSIS CLINICAL PRESENTATION

 The most common malignant neoplasms of childhood are……………… INTRODUCTION

 The most common malignant neoplasms of childhood are Leukemias. INTRODUCTION

 The most common malignant neoplasms of childhood are Leukemias.  Which one is the commonest type of childhood Leukemias? AML ALL CML JCML INTRODUCTION

 The most common malignant neoplasms of childhood are Leukemias  Which one is the commonest type of childhood Leukemias? AML …………….% ALL …………….% CML .……………% JCML …………….% INTRODUCTION

 The most common malignant neoplasms of childhood are Leukemias  Which one is the commonest type of childhood Leukemias? AML …………….% ALL 80% CML .……………% JCML …………….% INTRODUCTION

 The most common malignant neoplasms of childhood are Leukemias  Which one is the commonest type of childhood Leukemias? AML 10% ALL 80% CML 2-3% JCML 1-2% INTRODUCTION

Acute Lymphoblastic Leukemia Contents INTRODUCTION TREATMENT CLASSIFICATION EITIOLOGY DIAGNOSIS CLINICAL PRESENTATION

CLASSIFICATION EITIOLOGY FAB WHO Immunophenotypic

L1 L2 L3

 1- Acute lymphoblastic leukemia/lymphoma Synonyms: Former Fab L1/L2 • Precursor B acute lymphoblastic leukemia/lymphoma. Cytogenetic subtypes: t(12;21)(p12,q22) TEL/AML-1 t(1;19)(q23;p13) PBX/E2A t(9;22)(q34;q11) ABL/BCR T(V,11)(V;q23) V/MLL • Precursor T acute lymphoblastic leukemia/lymphoma  2-Burkitt's leukemia/lymphoma Synonyms: Former FAB L3  3-Biphenotypic acute leukemia CLASSIFICATION EITIOLOGY

 B-cell ALL • Early pre-B ALL (pro-B ALL) - 10% • common ALL - 50% • pre-B ALL - 10% • mature B-cell ALL (Burkitt leukemia) - 4%  T-cell ALL • pre-T ALL - 5% to 10% • mature T-cell ALL - 15% to 20% CLASSIFICATION EITIOLOGY

Acute Lymphoblastic Leukemia Contents INTRODUCTION TREATMENT CLASSIFICATION EITIOLOGY DIAGNOSIS CLINICAL PRESENTATION

CLINICAL PRESENTATION

CLINICAL PRESENTATION  Common presentations of all acute Leukemias? 1) 2) 3)

CLINICAL PRESENTATION  Common presentations of all acute Leukemias? 1) Fever 2) Fatigue 3) Bleeding

  Feature Percent of Total Children Fever 57 Fatigue 50 Bleeding 43 Bone or joint pain 25 Lymphadenopathy 70 Marked (>3 cm) 15 Hepatomegaly 66 Marked (below umbilicus) 17 Splenomegaly 60 Marked (below umbilicus) 17 Mediastinal mass 8 CNS leukemia 3 Testicular leukemia 1

 An anterior mediastinal mass  Superior vena cava syndrome • Cough, dyspnea, orthopnea, dysphagia, stridor, cyanosis, facial edema, increased intracranial pressure, syncope  Ocular involvement  Cranial nerve palsy  Epidural spinal cord compression  Enlarged salivary glands (Mikulicz syndrome)  Subcutaneous nodules (leukemia cutis)  Priapism  Infiltration of tonsils, adenoids, appendix, or mesenteric lymph nodes CLINICAL PRESENTATION

Differential Diagnosis  At early presentations  Late presentation  CBC picture  Microscopic blood picture

Differential Diagnosis  Aplastic anemia  Idiopathic thrombocytopenic purpura  Recent viral infection  Infectious mononucleosis  Pertussis or parapertussis  Small round cell tumors involving the bone marrow, including neuroblastoma, rhabdomyosarcoma, and retinoblastoma  Juvenile rheumatoid arthritis, rheumatic fever, other collagen diseases, or osteomyelitis

Acute Lymphoblastic Leukemia Contents INTRODUCTION TREATMENT CLASSIFICATION EITIOLOGY DIAGNOSIS CLINICAL PRESENTATION

DIAGNOSIS

DIAGNOSIS

 ESR, CRP  Bleeding profile  Electrolytes  LDH  LFT  RFT  Serum Igs  Urinalysis DIAGNOSIS

 What should we do if we found blasts?  F_ _ _ C _ _ _ _ _ _ _ _ DIAGNOSIS

 FLOW CYTOMETRY DIAGNOSIS

EGIL-Score for biphenotypic leukemias Score B-lymphocytic T-lymphocytic Myeloid 2 CD79 (cyt/membrane) CD22 (cyt/membrane) cyt.IgM CD3 (cyt/membrane) TCR-a/b TCR-g/d Myelo- peroxidase (cytopl.) 1 CD19 CD10 CD20 CD2 CD5 CD8 CD10 CD13 CD33 CDw65 0.5 TdT CD24 CD14 CD15 CD64 CD117*

B Lineage T Lineage CD19/CD79a/CD22 CD3 (surface/cytoplasmic) Pre-pre-B ALL — Precursor T ALL CD1a, CD2, CD5, CD7, CD8, cCD3 Common ALL CD10 (CALLA) Mature T ALL Surface CD3 (plus any other T-cell markers) Pre-B ALL Cytoplasmic IgM Mature B-cell ALL Cytoplasmic or surface Ig

A LL AM L

Acute Lymphoblastic Leukemia Contents INTRODUCTION TREATMENT CLASSIFICATION EITIOLOGY DIAGNOSIS CLINICAL PRESENTATION

 How much is the cure rate????????? TREATMENT

 Around 85% TREATMENT

TREATMENT Remission Induction Intensification Maintenance Therapy

Outcomes of treatment  A remission (complete remission)  Minimal residual disease  Active disease

Prognosis  Sex  Ethnicity  Age at diagnosis  Whether the cancer has spread to the brain or spinal cord  Initial white blood cell count  Response of patient to initial treatment  Genetic disorders such as Down's Syndrome  ALL subtype  Cytogenetics  Chromosome translocations

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