1. Childhood
leukemias
Prof. Dr. P. Kajtár

2. Distribution of tumortypes in children
Hungary
USA

3. bone marrow
peripheral blood +/-
peripheral blood

4. 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

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

8. 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

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

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

13. 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

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

16. 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