Term
|
Definition
malignant neoplasm of lymphoblastic cell lineage.
80% - B cell
20% - T Cell |
|
|
Term
| what is the peak onset for ALL? |
|
Definition
4yrs
Gradually increasing risk as age increases so second peak in elderly |
|
|
Term
|
Definition
Morphologically: FAB system L1: small, uniform blasts, L2: Large blasts with dec nucleus:cytoplasm. L3: Basophilic, vacuolated blasts.
Immunologically: According to cell surface antigens. e.g pre B cell etc etc. |
|
|
Term
| What are the clinical features of ALL? |
|
Definition
anaemia - tiredness/weakness/pallor/breathless
Recurrent infections
Bruise/bleed easily
lymphadenopathy/splenohepatomegaly (dissemination of leukaemic cells)
wt. loss/anorexia
CNS involvement = N&V
Bone pain = sore legs |
|
|
Term
| On what evidence is a diagnosis of ALL made? |
|
Definition
Blood count:
dec Hb
pancytopenia
thrombocytopenia
neutropenia (althou init increased - infection)
Blood film:
abnormal blast cells
normochromic normocytic anaemia
aspirate/trephine
increased cellularity
leaukaemic cells seen
cytochemistry - staining
immunohistochemisty - determine lineage
cytogenetics
Others:
U+E's
CXR
LFT's
Coagulation screen
Lumbar Puncture
Urate
Viral titres |
|
|
Term
| On what evidence is a diagnosis of ALL made? |
|
Definition
Blood count:
dec Hb
pancytopenia
thrombocytopenia
neutropenia (althou init increased - infection)
Blood film:
abnormal blast cells
normochromic normocytic anaemia
aspirate/trephine
increased cellularity
leaukaemic cells seen
cytochemistry - staining
immunohistochemisty - determine lineage
cytogenetics
Others:
U+E's
CXR
LFT's
Coagulation screen
Lumbar Puncture
Urate
Viral titres |
|
|
Term
|
Definition
chemo = mainstay.
1. Induction - vincristine, L-asparginase & prednisolone. aimed at eradicating blast from bone marrow.
2. Consolidation - destroy any remaining blasts and prevent resistance.
3. Maintanence - cycles of chemo to complete 2yr Rx.
CNS Protection - cranial irradiation or intrathecal MTX. |
|
|
Term
| In ALL what are the differences in response to treatment between children and adults? |
|
Definition
Children - 90% respond
10% need BMT
Adults - 20-30% (often palliative) |
|
|
Term
| what are the immediate s/e of chemo in ALL? |
|
Definition
1. Infection
esp if indwelling catheters
avoid live vaccines/contact with infection
Short term: Bacterial (Vancomy/teicoplanin)
Long term: Viral/fungal - corsadyl mw
2. Bleeding (thrombocytopenia)
need prophylactic transplant
3. Tumour lysis synd.
chemo causes lysis of blast cells = massive release of cellular breakdown products. Hyperkalcaemia (salbutamol/dialysis) HyperPO4- but hypocalcaemia
4. Decreased cell turnover = alopecia and mouth ulcers. |
|
|
Term
| What are the late s/e of chemo in ALL? |
|
Definition
Cognition - cranial erad/CNS inv
Osteoporosis - corticosteriod Rx
Growth - pit damage/dec GH
Cardiac toxicity
Also - Hep C pre 1991 (blood prod)
Tumours - 2ry to chemo - meningioma |
|
|
Term
| Describe the impact of ALL |
|
Definition
Disrupts family unit
younger pts = more accepting/afraid of tmnt
older = want to be with friends/alopecia a prob
siblings feel neglected
financial difficulties
childs education suffers |
|
|
Term
| What are the ethical issues surrounding the use of siblings as bone marrow doners? |
|
Definition
Risks = anaesthetic/blood trans
Benefits = joy of pts survival!
Need to reassure that if transfusion fails its not their fault. |
|
|
