Childhood Leukaemia Childhood Leukaemia Aengus S. O’Marcaigh, M.D., F.R.C.P.I., F.A.A.P. Department of Paediatric Haematology &Oncology Our Lady’s Hospital for Sick Children Crumlin, Dublin 12.
Dec 16, 2015
Childhood LeukaemiaChildhood Leukaemia
Aengus S. O’Marcaigh, M.D., F.R.C.P.I., F.A.A.P.Department of Paediatric Haematology &Oncology
Our Lady’s Hospital for Sick ChildrenCrumlin, Dublin 12.
Acute Acute LeukaemiaLeukaemia
ALL AML
80% 15%
2 - 6 yo 0 - 15 yo
2 - 3 yr, mild Rx 6mo, aggressive Rx
80% cure 65% cure
Acute leukaemia - Acute leukaemia - diagnosisdiagnosis
1. Clinical
2. Blood tests
3. Bone marrow tests
Diagnosis - ClinicalDiagnosis - Clinical
History - Fatigue, bruising, bleeding(symptoms) - Bone pain, limping
Examination - Pallor(signs) - Bruising
- Fever / infection
- Organomegaly- Lymphadenopathy- Mediastinal mass
Diagnosis - ClinicalDiagnosis - Clinical
Examination
- Pallor- Bruising- Fever
- Organomegaly- Lymphadenopathy- Mediastinal mass
Diagnosis - ClinicalDiagnosis - Clinical
Examination
- Pallor- Bruising- Fever
- Organomegaly- Lymphadenopathy- Mediastinal mass
Diagnosis - ClinicalDiagnosis - Clinical
Examination
- Pallor- Bruising- Fever
- Organomegaly- Lymphadenopathy- Mediastinal mass
Diagnosis - ClinicalDiagnosis - Clinical
Examination
- Pallor- Bruising- Fever
- Organomegaly- Lymphadenopathy- Mediastinal mass
Diagnosis - ClinicalDiagnosis - Clinical
Examination
- Pallor- Bruising- Fever
- Organomegaly- Lymphadenopathy- Mediastinal mass
Acute leukaemia - Acute leukaemia - diagnosisdiagnosis
FBC - Leucocytosis ? WBC 1.0 - 1000 x 109/LNeutropaenia ANC 0.5 x 109/L Anaemia Hb 7.8 g/dLThrombocytopaenia Plt 40 x 109/L
Chemistry Incerased Uric acidIncreased LDH
B Marrow MorphologyCytochemistryImmunophenotypingGenetics
Diagnosis - Bone marrowDiagnosis - Bone marrow
Bone marrow diagnosis
- Morphology
- Cytochemistry
- Immunophenotyping
- Cytogenetics
Diagnosis - Bone marrowDiagnosis - Bone marrow
Bone marrow diagnosis
- Morphology
- Cytochemistry
- Immunophenotyping
- Cytogenetics
Normal bone marrow
Diagnosis - Bone marrowDiagnosis - Bone marrow
Bone marrow diagnosis
- Morphology
- Cytochemistry
- Immunophenotyping
- Cytogenetics
Acute Leukaemia
Diagnosis - CytogeneticsDiagnosis - Cytogenetics
Translocation
t (1;22)
Infant M7 AML
Very poor prognosis
Initial managementInitial management
1. Pancytopaenia ?
2. Sepsis / infection
3. Mediastinal mass
4. Tumour lysis syndrome
TransfusionCMV-neg, irradiated
Initial managementInitial management
1. Pancytopaenia
2. Sepsis / infection
3. Mediastinal mass
4. Tumour lysis syndrome ?
Uric acid / LDHRenal functionHydrationUrate oxidase
TreatmentTreatment
ALL 2003
Regimen A - Standard risk 60%Regimen B - Intermediate risk 30%Regimen C - High risk 10%
Risk assignment 1. Age2. WBC3. Cytogenetics4. Response to treatment
Treatment - MRC ALL 2003Treatment - MRC ALL 2003
1. Age (years)
< 1 to Interfant protocol
1 - 10 to Regimen A
> 10 to Regimen B
Treatment - MRC ALL 2003Treatment - MRC ALL 2003
2. WBC (x 109/L)
< 50 to Regimen A
>50 to Regimen B
Treatment - MRC ALL 2003Treatment - MRC ALL 2003
3. Cytogenetics
Hypodiploidy to Regimen C
t(9:22) to Regimen C
iAMP 21 to Regimen C