Childhood leukemias Prof. Dr. P. Kajtár

Distribution of tumortypes in children Hungary USA

bone marrow peripheral blood +/- peripheral blood

Classification of acute leukemias ALL mainly children M > F curable in 70% of children curable in minority of adults AML mainly adults M > F curable in minority of adults

Distinguishing AML from ALL light microscopy AML: Auer rods, cytoplasmic granules ALL: no Auer rods or granules. special stains (cytochemistry) flow cytometry

Principles of leukemogenesis a multistep process neoplastic cell is a hematopoietic pleuripotent stem cell or early myeloid cell dysregulation of cell growth and differentiation (associated with mutations) proliferation of the leukemic clone with differentiation blocked at an early stage

Clincal manifestations symptoms due to: marrow failure tissue infiltration leukostasis constitutional symptoms other (DIC) usually short duration of symptoms

Marrow failure neutropenia: infections, sepsis anemia: fatigue, pallor thrombocytopenia: bleeding

Principles of treatment combination chemotherapy first goal is complete remission further Rx to prevent relapse supportive medical care transfusions, antibiotics, nutrition psychosocial support patient and family

Chemotherapy for acute leukemias Phases of ALL treatment induction intensification CNS prophylaxis maintenance AML treatment consolidation

Hematopoietic stem cell transplantation permits “rescue” from otherwise excessively toxic treatment additional advantage of graft-vs-leukemia effect in allogeneic transplants trade-off for allogeneic transplantation: greater anti-leukemic effect but more toxic