Leukaemia
Key points
ALL most common childhood cancer
• Acute lymphocytic leukaemia (ALL) - B Cell (85%) or T cell (15%)
• Acute myeloid leukaemia (AML)
• Mixed lineage leukaemia
• Chronic myeloid leukaemia (CML)
Favourable cytogenetics:
ETV6/RUNXI fusion [t(12;21] - 25% ALL have
Hyperploidy + trisomy 4 and 10
Unfavourable:
t(9,22)
Philadelphia chromosome positive ALL
severe hypodiploidy with less than 44 chromosomes
T cell ALL - more likely to present with mediastinal lymphadenopathy and CNS involvement
Management
Treatment for ALL is usually in phases - lasting around 2 years
3 different regimens (A,B, C)
Induction
Consolidation
Interim maintenance
Delayed intensification
Maintenance
Example agents:
Dexamethasone, Vincristine, Pegasparagase, Intrathecal methotrexate, mercaptopurine, septrin
Surgical considerations:
Vascular access for duration of treatment, preservation of central veins
If appendicitis - small studies suggest operation is better than conservative - risk of reactivating with chemotherapy
If haemorrhagic cystitis - washouts. If uncontrolled - may need cystectomy
Asparaginases have risk of acute pancreatitis
Typhlitis: See infective and ischaemic colitis page
Cholecystitis: manage as per Acalculous cholecystitis
References
https://www.cclg.org.uk/csoir/treatment-regimens
https://patient.info/doctor/childhood-leukaemias-pro
Murphy, MD, Joseph . "Leukemia." Pediatric Surgery NaT, American Pediatric Surgical Association, 2020. Pediatric Surgery Library, www.pedsurglibrary.com/apsa/view/Pediatric-Surgery-NaT/829684/all/Leukemia.