Acute Lymphoblastic Leukemia (ALL)

What are the most common types of leukemia in children

ALL is the most common pediatric leukemia (~80%), followed by AML (~15%), with CML and CLL being rare (<5% combined).

Clinical sx of Acute Lymphoblast Leukemia (ALL)

Fatigue(bc of anemia), pallor, bruising/bleeding (due to thrombocytopenia), Fever, lymphadenopathy, hepatosplenomegaly, medistinal mass, bone pain

Differential diagnosis with ALL

Consider infections (EBV), ITP, juvenile idiopathic arthritis, aplastic anemia, lymphoma, and neuroblastoma

Identify prognostic factors of ALL

Ages 1–9.99 years are favorable, <1 or ≥10 years are unfavorable.

WBC <50,000 is favorable, ≥50,000 is unfavorable.

Favorable Hyperdiploidy (>50 chromosomes), t(12;21) is favorable

Minimal residual disease (MRD)=lower the MRD the better prognosis

ALL t(9:22) translocation aka ___. treated with

BCR-ABL or Philadephia chromosome; Treated with Tyrosine Kinase Inhibitors(tyrosine kinase increases cell growth)

Describe CNS-directed therapy in Acute Lymphoblast Leukemia (ALL)

Intrathecal methotrexate throughout treatment, radiation only for select cases.

List therapy used in ALL:

Steroids

Vincristine

Daunorubicin

Methotrexate

Cytarabine

Blinatumomab, if CD19+ (for B-ALL not T-ALL)

ALL emergencies

Sepsis, bleeding(from thrombocytopenia), tumor lysis syndrome, hyper leukocytosis, tracheal compression and/or superior vena cava syndrome(compressed SVC causing swelling of face and limbs)

List therapy used in ALL: Blinatumomab

CD19+/CD3 BiTE used in B-ALL.

List therapy used in ALL: CAR-T therapy

CD19-directed tisagenlecleucel for relapsed/refractory B-ALL.

List therapy used in ALL: TKIs targeting what?

Imatinib/dasatinib for BCR-ABL–positive »t(9:22) philadelphia chromosome ALL.

List side effects of ALL therapy:

Short term: Infection, myelosuppression, bleeding/bruising, hair loss, N/V, fatigue, weight loss, mout sores, HTN, peripheral neuropathy, hyperglycemia

Long term: neurocognitive delay, endocrinopathies, gonadal failure, cardiac dysfunction, osteonecrosis, secondary malignancies

Difference between Acute and Chronic Leukemias

Acute:”: proliferate and lack differentiation(immature)

Chronic: proliferation of mature cells; often seen in adults

Lab findings in Acute Lymphoblastic Leukemia (ALL)

WBC count change, Anemia, Thrombocytopenia, BLASTS (>20% lymphoblasts on smear)

Diagnosis of ALL requires

>20% lymphoblasts in bone marrow= acute leukemia

Peak age for ALL

2-4 years old

Sanctuaries for ALL relapse

CNS, testicles and bone marrow again

ALL phases of treatment

Induction (1 mo), Consolidation (2-6 mo), Delayed Intensification (2 mo), Maintencance (~2 yrs)