Acute Lymphoblastic Leukemia (ALL) Treatment Phases

Study Notes

High-risk cases receive daunomycin at weekly intervals
Remission is defined as less than 5% blasts in the marrow and a return of neutrophil and platelet counts to near-normal levels after 4-5 weeks of treatment
Treatment consists of three phases:
- Induction of remission (4 weeks)
- Consolidation intensification phase (14-28 weeks)
- Maintenance therapy (2-3 years)

Bone marrow relapse: most common and serious, treated with bone marrow transplantation following intensive chemotherapy
CNS relapse: manifests as increased intracranial tension, convulsions, and cranial nerve paralysis, treated with intrathecal medication, craniospinal irradiation, and systemic chemotherapy
Testicular relapse: painless swelling of one or both testes, treated with systemic chemotherapy and local irradiation

Incidence: not common in children, occurs in late childhood to adolescence, males more affected than females
Pathologic classification:
- Nodular sclerosing type
- Mixed cellularity type
- Lymphocytic predominant type
- Lymphocytic depletion type: least common and least favorable
Clinical manifestations:
- General symptoms and signs: lethargy, anorexia, unexplained fever, night sweating, and weight loss
- Painless enlargement of lymph nodes
- Mediastinal syndrome: a common presentation

Embryonal tumor of the kidney
May arise in one or both kidneys
Most common genitourinary malignancy affecting children, accounts for about 6% of childhood malignancies
Occurs in equal frequency in boys and girls, most commonly between 2-5 years
Triphasic appearance, with varying proportions of three cell types (blastemal, stromal, epithelial)
Clinical features:
- Asymptomatic abdominal mass usually discovered accidentally by parents or routine abdominal examination
- Associated symptoms: abdominal pain, fever, and hematuria
- Hypertension may occur in 25% of cases
- Bilateral Wilms tumor may occur

Embryonal tumor derived from neural crest cells that form the adrenal medulla and the sympathetic nervous system
Third most common solid tumor of childhood
Age incidence: 90% are less than 5 years
Etiology: unknown, may be attributed to environmental and genetic factors
Pathology: ranges from undifferentiated small round cells (neuroblastoma) to tumours containing mature ganglion cells (ganglioneuroblastoma or ganglioneuroma)
Clinical manifestations:
- Abdominal mass: commonest presentation, hard, irregular, and non-tender mass located in right or left upper quadrant
- Posterior mediastinal mass: may present with mediastinal syndrome, progressive dyspnea, dysphagia, and stridor
- Proptosis: proptosis may be unilateral or bilateral
- Multiple skin nodules in infancy: firm and purple in color, mainly occur in infants under the age of 6 months
- Spinal cord compression: may cause paralysis and bowel or bladder dysfunction