Leukemia (peds): Difference between revisions
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''This page is for pediatric patients. For adults, see [[leukemia]]'' | |||
==Background== | ==Background== | ||
*Most common cancer in children (33% of all malignancies) | *Most common cancer in children (33% of all malignancies) | ||
===ALL=== | ===[[acute lymphocytic leukemia|ALL]]=== | ||
*3/4 of pediatric leukemias | *3/4 of pediatric leukemias | ||
*5-year survival 75%-80% | *5-year survival 75%-80% | ||
*Peak incidence 3-5yr old | *Peak incidence 3-5yr old | ||
===AML=== | ===[[AML]]=== | ||
*1/5 of pediatric leukemias | *1/5 of pediatric leukemias | ||
*Worse prognosis | *Worse prognosis | ||
| Line 22: | Line 23: | ||
*Cerebral circulation: [[headache]], [[altered mental status]], [[visual disturbances]], [[seizure]], [[CVA]] | *Cerebral circulation: [[headache]], [[altered mental status]], [[visual disturbances]], [[seizure]], [[CVA]] | ||
*Pulmonary circulation: [[shortness of breath]], [[hypoxemia]] | *Pulmonary circulation: [[shortness of breath]], [[hypoxemia]] | ||
===Complications=== | |||
*[[Tumor lysis syndrome]] | |||
*[[Neutropenic fever]], [[Sepsis]], overall increased risk of [[infection]] | |||
**[[Neutropenic enterocolitis (typhlitis)]] | |||
*[[Leukostasis and hyperleukocytosis]] | |||
*[[Hyperviscosity syndrome]] | |||
*[[Thromboembolism]] | |||
*Treatment-related complications | |||
**Chemotherapy-induced [[nausea and vomiting]] | |||
**[[Cytokine release syndrome]] | |||
**Chemotherapeutic drug extravasation | |||
**[[Differentiation syndrome]] ([[retinoic acid syndrome]]) in APML | |||
**[[Stem cell transplant complications]] | |||
**Catheter-related complications | |||
**Tunnel infection | |||
***Exit site infection | |||
***CVC obstruction (intraluminal or catheter tip thrombosis) | |||
***Catheter-related venous thrombosis | |||
***Fracture of catheter lumen | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
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*[[Aplastic anemia]] | *[[Aplastic anemia]] | ||
*Iron deficiency [[anemia]] | *Iron deficiency [[anemia]] | ||
*Viral infection ([[EBV]], [[CMV]], Parvo) | *Viral infection ([[EBV]], [[CMV]], [[parvovirus B19|Parvo]]) | ||
*Immune [[thrombocytopenia]] | *Immune [[thrombocytopenia]] | ||
*Rheumatologic diseases | *Rheumatologic diseases | ||
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***Viral titers cytomegalovirus, EBV, HIV, HBV, varicella zoster | ***Viral titers cytomegalovirus, EBV, HIV, HBV, varicella zoster | ||
***[[CXR]] | ***[[CXR]] | ||
***Consider [[DIC]] labs | |||
==Management== | ==Management== | ||
Revision as of 01:31, 1 October 2019
This page is for pediatric patients. For adults, see leukemia
Background
- Most common cancer in children (33% of all malignancies)
ALL
- 3/4 of pediatric leukemias
- 5-year survival 75%-80%
- Peak incidence 3-5yr old
AML
- 1/5 of pediatric leukemias
- Worse prognosis
- More complications (more intense chemo treatment required)
Clinical Features
Bone marrow infiltration and failure
- Pallor, fatigue, easy bleeding, fever, infection
- Bone pain/arthralgia
- Hepatomegaly or splenomegaly
Hyperleukocytosis
- Clinically significant when WBC > 200K in AML, >300K in ALL
- Cerebral circulation: headache, altered mental status, visual disturbances, seizure, CVA
- Pulmonary circulation: shortness of breath, hypoxemia
Complications
- Tumor lysis syndrome
- Neutropenic fever, Sepsis, overall increased risk of infection
- Leukostasis and hyperleukocytosis
- Hyperviscosity syndrome
- Thromboembolism
- Treatment-related complications
- Chemotherapy-induced nausea and vomiting
- Cytokine release syndrome
- Chemotherapeutic drug extravasation
- Differentiation syndrome (retinoic acid syndrome) in APML
- Stem cell transplant complications
- Catheter-related complications
- Tunnel infection
- Exit site infection
- CVC obstruction (intraluminal or catheter tip thrombosis)
- Catheter-related venous thrombosis
- Fracture of catheter lumen
Differential Diagnosis
Leukemias will often involve >1 cell line; other conditions restricted to single line
- Aplastic anemia
- Iron deficiency anemia
- Viral infection (EBV, CMV, Parvo)
- Immune thrombocytopenia
- Rheumatologic diseases
Evaluation[1]
- CBC with manual differential
Management
Transfusion
- Options
- Irradiated: for very immunosuppressed (to prevent graft vs host)
- Leukocyte-reduced: for patients likely to receive multiple RBC or platelets in future
- CMV seronegative: for <1yr old, if might need bone marrow transplant in future
- Anemia
- 10 cc/kg of pRBCs raises hemoglobin by 3 gm/dL
- Raise hemoglobin to >8
- Thrombocytopenia
- 0.1 unit/kg platelets results in 30-50K increase in platelet count
- Risk of spontaneous ICH is extremely low until platelets <5K
- Transfuse if:
- Asymptomatic with platelets <10K
- Invasive procedures require platelets >50K
Leukostasis and Hyperleukocytosis
- Aggressive IV hydration
- Urinary alkalinization (pH 7-7.5)
- Allopurinol (for Tumor Lysis Syndrome (TLS))
- Avoid diuretics and pRBC transfusion (platelets ok)
- Give platelets if <20K
- Leukapheresis
Disposition
- admit
See Also
References
- ↑ Horton TM and Steuber CP. Overview of the presentation and diagnosis of acute lymphoblastic leukemia in children and adolescents. UpToDate.