2: ALL

Question 1

What is ALL

Answer 1

Malignant proliferation lymphoblasts

Question 2

What classification system is used to distinguish types of ALL

Answer 2

French-American-British (FAB)

Question 3

What is the commonest cancer of childhood

Answer 3

ALL

Question 4

What age does ALL usually onset

Answer 4

2-5 Years-Old

Question 5

What gender is ALL more common in

Answer 5

Male

Question 6

What are 5 RF for ALL

Answer 6

• Chemoradiotherapy
• Irradiation in utero
• Down Syndrome
• Ataxic telangiectasia
• NF1
• Philidelphia chromosome (9:22)

Question 7

What are the ‘general’ symptoms of leukaemia

Answer 7

Bone marrow failure

Question 8

How does RBC deficiency present in leukaemia

Answer 8

• Lethargy
• Pallour
• Dyspneoa

Question 9

How does WBC deficiency present in leukaemia

Answer 9

• Recurrent Infections

- Fever

Question 10

How does platelet deficiency present in leukaemia

Answer 10

• Bleeding gums
• Epistaxis
• Non-blanching Petechial rash

Question 11

what are constitutional symptoms in children

Answer 11

• Night sweats
• Fever
• Weight Loss

Question 12

what are other symptoms of ALL in children

Answer 12

• Painless lymphadenopathy
• Bone pain: limping child
• Hepatomegaly
• Testicular enlargement

Question 13

what can T cell ALL cause

Answer 13

mediastinal enlargement

Question 14

how can mediastinal enlargement present

Answer 14

airway obstruction

Question 15

how will FBC present in ALL

Answer 15

• Low Hb and Thrombocytopenia

- WCC High

Question 16

how will a blood smear present in ALL

Answer 16

• Blast cells

Question 17

what is diagnostic of ALL

Answer 17

Bone marrow aspiration and biopsy

Question 18

what is diagnostic on bone marrow biopsy of ALL

Answer 18

> 20% lymphoblasts

Question 19

what is looked for on bone marrow biopsy and why

Answer 19

Philadelphia chromosome - poor prognostic factor

Question 20

why may CXR and CT Chest be ordered in ALL

Answer 20

T-ALL is associated with mediastinal lymphadenoapthy

Question 21

why is LP ordered in ALL

Answer 21

Determine CNS involvement

Question 22

why are cytogenetics ordered in ALL

Answer 22

Philadelphia chromosome

Question 23

what should be performed in all boys with ALL and why

Answer 23

Testicular exam, as those where crossed blood-testes barrier has poorer outcomes

Question 24

what is the haematological regimen children are put on at the start of ALL treatment depend on

Answer 24

• Age
• WCC
• Cytogenetics

Question 25

what are indications for regimen A

Answer 25

- Under 10 | - Low WCC

Question 26

what are indications for regimen B

Answer 26

- Over 10 | - High WCC

Question 27

explain regimen C

Answer 27

- No child starts on regimen C. Children may be stepped up due to not enough WCC destruction on A or B. Or, due to philadelphia chromosome.

Question 28

what is the total treatment time in boys

Answer 28

3-years

Question 29

what is the total treatment time in girls

Answer 29

2-years

Question 30

what are the 5 stages

Answer 30

``` Induction Consolidation Interim maintenance Delayed intensification Maintenance ```

Question 31

what is the aim of induction

Answer 31

To eliminate as many immature blast cells as possible

Question 32

what is CNS prophylaxis in ALL

Answer 32

Intrathecal methotrexate | Cranial Irradiation

Question 33

What are 5 adverse prognostic factors

Answer 33

- Male - Age: 1-9 years = better outcomes - African- American - Poor response end of induction - WCC >100 - Philadelphia chromosome - Spread to CNS