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    Acute Lymphoblastic Leukemia

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    zahraa
    1. Ahmed presented with fever, pallor, lethargy and bruising. Examination found hepatosplenomegaly. CBC showed anemia, leukocytosis and thrombocytopenia. Bone marrow biopsy found immature lymphoblasts, confirming acute lymphoblastic leukemia. 2. Treatment involves intensive chemotherapy targeting lymphoblasts. Supportive care is needed to prevent infections during neutropenia. Long term monitoring is also required to watch for complications from chemotherapy and radiation treatment. 3. ALL classification is based on immunophenotype, such as pre-B-cell seen in Ahmed's case. Prognosis and treatment depends on classification and other risk factors.

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    Acute Lymphoblastic Leukemia

    Uploaded by

    zahraa
    8 views20 pages
    1. Ahmed presented with fever, pallor, lethargy and bruising. Examination found hepatosplenomegaly. CBC showed anemia, leukocytosis and thrombocytopenia. Bone marrow biopsy found immature lymphoblasts, confirming acute lymphoblastic leukemia. 2. Treatment involves intensive chemotherapy targeting lymphoblasts. Supportive care is needed to prevent infections during neutropenia. Long term monitoring is also required to watch for complications from chemotherapy and radiation treatment. 3. ALL classification is based on immunophenotype, such as pre-B-cell seen in Ahmed's case. Prognosis and treatment depends on classification and other risk factors.

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    1. Ahmed presented with fever, pallor, lethargy and bruising. Examination found hepatosplenomegaly. CBC showed anemia, leukocytosis and thrombocytopenia. Bone marrow biopsy found immature lymphoblasts, confirming acute lymphoblastic leukemia. 2. Treatment involves intensive chemotherapy targeting lymphoblasts. Supportive care is needed to prevent infections during neutropenia. Long term monitoring is also required to watch for complications from chemotherapy and radiation treatment. 3. ALL classification is based on immunophenotype, such as pre-B-cell seen in Ahmed's case. Prognosis and treatment depends on classification and other risk factors.

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    8 views20 pages

    Acute Lymphoblastic Leukemia

    Uploaded by

    zahraa
    1. Ahmed presented with fever, pallor, lethargy and bruising. Examination found hepatosplenomegaly. CBC showed anemia, leukocytosis and thrombocytopenia. Bone marrow biopsy found immature lymphoblasts, confirming acute lymphoblastic leukemia. 2. Treatment involves intensive chemotherapy targeting lymphoblasts. Supportive care is needed to prevent infections during neutropenia. Long term monitoring is also required to watch for complications from chemotherapy and radiation treatment. 3. ALL classification is based on immunophenotype, such as pre-B-cell seen in Ahmed's case. Prognosis and treatment depends on classification and other risk factors.

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    Download as PPTX, PDF, TXT or read online from Scribd
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    of 20

    ACUTE LYMPHOBLASTIC LEUKEMIA

    Case scenario:
    Ahmed is a 3 year old Bahraini boy presented to the
    ER with fever (38.3 C) of 2 week duration. The
    mother said that it continuous and not responding
    to the oral antipyretics given by the local health
    center 3 days ago.
    Upon inspection you noticed that the child was pale,
    lethargic and had up-slanting of the eyes, low set
    ears, flat nasal bridge and protruding tongue. You
    noticed some bruises over his legs and when you
    asked her about his activity she said that he refuses
    to walk own his own for the past week. She also
    mentioned that he wakes up multiple times during
    the night crying and refuses to eat.
    Impression?
    • Fever? Why?
    • Inspection findings?
    • Pallor? Lethargy?
    • Bruises?
    • Activity?
    Vitals
    • HR: 130 BPM
    • BP: 140/95 mmHg
    • RR: 29 Breaths/min
    • O2%: 96% on room air
    What are your next steps?
    • Medics?
    • Any further physical examination?
    • Investigations? What will you focus on?
    Physical examination:

    • His abdomen was soft and nontender, the liver was palpated
    3 cm below the right costal margin, and the spleen was
    palpated 2 cm below the left costal margin. No
    lymphadenopathy was detected.
    • Impression? Is this normal?
    CBC (focused)

    • Hemoglobin: 8 g/dL
    • Leukocyte count: 63,000 mm3
    • Platelet count: 27,000 mm3
    R/O infections
    • Throat swab culture/ blood culture/ PCR…,etc
    • Patient doesn’t have any symptoms of infection
    • Fever without infection  suspect malignancies!
    Peripheral smear:
    Bone marrow aspiration:
    • You proceeded with bone marrow biopsy which showed
    you immature cells that stained positive for CD10, CD19
    and terminal deoxynucleotidyl transferase (TdT)
    Cytogenetics
    • Not required in this case: he has trisomy 21 but in other cases
    you might need to do it to classify the leukemia.
    • Can be associated with translocations like Philadelphia
    chromosome t(9;22) and t(12;21)
    Liver function panel and renal function
    tests
    • Normal
    • Why do you need them?
    You confirmed the diagnosis of ALL,
    what’s next?
    • Prognostic factors
    Extramedullary infiltration
    • CNS, how?
    • Testes, how?
    • Others: thymic infiltration, LN, hepatosplenic
    infiltration.
    Management?
    • Depends on the phenotype of the leukemia, he
    has pre-B cell leukemia +CALLA
    • Mainly chemotherapy (very intensive regimen) 
    1st induction, 2nd consolidation, 3rd delayed
    intensification, 4th maintenance.
    • Chemo target?
    • Bone marrow transplant  high risk child OR
    failure/slow remission entrance OR relapse
    (problem in the BM remember?)
    • Can you do cranial irradiation?
    While giving him chemotherapy, what
    should you watch out for?
    • Supportive care: watch out for anemia, &thrombocytopenia.
    • Infections related to neutropenia. (fever+ neutropenia= sepsis until proven
    otherwise!) give antibiotic empirically (DO NOT WAIT FOR CULTURE)
    • Opportunistic infections: HSV, P. jirovenci, candida albicans or aspergillus
     give prophylaxis trimethoprim and sulfamethoxazole (PCP)
    • Metabolic complications
    After 3 years, Ahmed was fully cured from the
    leukemia. Are there any things to watch out in
    him?
    • Medication-induced/ iatrogenic complications
    • CS + L-asparaginase  pancreatitis
    • Doxorubicin  cardiomyopathy
    • Cyclophosphamide  cystitis
    • Cranial irradiation 

    cognitive impairment, stroke, endocrine abnormalities, 2ry


    malignancy
    Classification
    • Immunophenotype.
    • B-cell
    • Mature
    • Pro-B-cell
    • Pre-B-cell (CALLA+/CALLA-)
    • T-cell
    Thank you!
    • References:
    • Amboss
    • BRS pediatrics

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