Covers childhood leukaemia, starting with its frequency and the main types, acute lymphoblastic and acute myeloid, followed by known risk factors and how the disease presents through marrow failure, infiltration and mediastinal mass. It then goes through investigations, a table of prognostic factors for lymphoblastic leukaemia, the phases of treatment, and emergencies such as tumour lysis and febrile neutropenia. It closes with late effects and dental and oral considerations during and after chemotherapy.
Topic 21 of 30 in the MU Sofia syllabus for Paediatrics and Infectious Diseases (Dental Medicine, Year 4). The free AceMed note covers it in 7 sections, about 353 words (4 min of reading), with 16 flashcards.
In this note
Introduction
Risk factors
How it presents
Investigations
Prognostic factors in ALL
Treatment of ALL (about 2–2½ years)
Emergencies and complications
Introduction
Leukaemia is the commonest cancer of childhood (about a third of all cases). A clone of immature white cells (blasts) fills the bone marrow, crowds out normal blood production and spreads to other organs. Acute lymphoblastic leukaemia (ALL) makes up about 75–80% (peak at 2–5 years), acute myeloid leukaemia (AML) about 15–20%; chronic myeloid leukaemia and juvenile myelomonocytic leukaemia are rare.
Risk factors
Most children have none. Known: Down syndrome (10–20 times the risk; also transient abnormal myelopoiesis in newborns), neurofibromatosis type 1, Li–Fraumeni syndrome, Fanconi anaemia, ataxia telangiectasia, Bloom syndrome, ionising radiation, previous chemotherapy.
How it presents
Do not give steroids for “arthritis” or unexplained symptoms before a blood count and film: they can mask leukaemia and make it harder to treat.
Investigations
Full blood count and film: anaemia, low platelets, white count low, normal or very high, blasts on the film.
Bone marrow aspirate and biopsy: over 20–25% blasts.
Immunophenotyping (flow cytometry): B- or T-ALL, AML.
Cytogenetics and molecular tests for risk group (below).
