1. Childhood Leukaemia Aengus S. O’Marcaigh, M.D., F.R.C.P.I., F.A.A.P. Department of Paediatric Haematology &Oncology Our Lady’s Hospital for Sick Children Crumlin, Dublin 12.

3. Acute Leukaemia ALLAML 80%15% 2 - 6 yo0 - 15 yo 2 - 3 yr, mild Rx6mo, aggressive Rx 80% cure65% cure

4. Acute leukaemia - diagnosis 1. Clinical 2. Blood tests 3. Bone marrow tests

5. Diagnosis - Clinical History-Fatigue, bruising, bleeding (symptoms) -Bone pain, limping Examination- Pallor (signs)-Bruising -Fever / infection -Organomegaly -Lymphadenopathy -Mediastinal mass

6. Diagnosis - Clinical Examination - Pallor -Bruising -Fever -Organomegaly -Lymphadenopathy -Mediastinal mass

7. Diagnosis - Clinical Examination - Pallor -Bruising -Fever -Organomegaly -Lymphadenopathy -Mediastinal mass

8. Diagnosis - Clinical Examination - Pallor -Bruising -Fever -Organomegaly -Lymphadenopathy -Mediastinal mass

9. Diagnosis - Clinical Examination - Pallor -Bruising -Fever -Organomegaly -Lymphadenopathy -Mediastinal mass

10. Diagnosis - Clinical Examination - Pallor -Bruising -Fever -Organomegaly -Lymphadenopathy -Mediastinal mass

11. Acute leukaemia - diagnosis FBC-Leucocytosis ? WBC 1.0 - 1000 x 10 9 /L NeutropaeniaANC 0.5 x 10 9 /L AnaemiaHb 7.8 g/dL ThrombocytopaeniaPlt 40 x 10 9 /L ChemistryIncerased Uric acid Increased LDH B MarrowMorphology Cytochemistry Immunophenotyping Genetics

12. Diagnosis - Bone marrow Bone marrow diagnosis -Morphology -Cytochemistry -Immunophenotyping -Cytogenetics

13. Diagnosis - Bone marrow Bone marrow diagnosis -Morphology -Cytochemistry -Immunophenotyping -Cytogenetics Normal bone marrow

14. Diagnosis - Bone marrow Bone marrow diagnosis -Morphology -Cytochemistry -Immunophenotyping -Cytogenetics Acute Leukaemia

15. Diagnosis - Cytogenetics Translocation t (1;22) Infant M7 AML Very poor prognosis

16. Initial management 1.Pancytopaenia ? 2. Sepsis / infection 3. Mediastinal mass 4. Tumour lysis syndrome Transfusion CMV-neg, irradiated

17. Initial management 1. Pancytopaenia 2. Sepsis / infection 3. Mediastinal mass 4. Tumour lysis syndrome ? Uric acid / LDH Renal function Hydration Urate oxidase

18. Treatment ALL 2003 Regimen A-Standard risk60% Regimen B-Intermediate risk30% Regimen C-High risk10% Risk assignment1. Age 2. WBC 3. Cytogenetics 4. Response to treatment

19. Treatment - MRC ALL 2003 1. Age (years) < 1to Interfant protocol 1 - 10to Regimen A > 10to Regimen B

20. Treatment - MRC ALL 2003 2. WBC (x 10 9 /L) < 50to Regimen A >50to Regimen B

21. Treatment - MRC ALL 2003 3. Cytogenetics Hypodiploidyto Regimen C t(9:22)to Regimen C iAMP 21 to Regimen C

22. Treatment - MRC ALL 2003 4. Response to therapy - Day 8 bone marrow>25% blasts- B to C Day 15 bone marrow >25% blasts- A to C - Day 28 MRD (minimal residual disease)