Childhood Leukemia

The term Leukemia is derived from the Greek word “White blood”
which refers to concerns of blood Forming or Hematopoietic tissue.

Leukemia is a disease of abnormal maturation and proliferation of

Bone marrow. It interferes with normal proliferation of RBC, WBC and

Platelets.

It occurs in any cell in the white cell line in the form of young
undifferentiated blast cell.

 Commonest neoplasm in the children

 Male female ratio is 3:1

 Previously 30 years ago - Fatal illness, now 75% cure rate and

95% long term survival.

Undifferentiated pluripotent stem cells

MyeloidSeries Lymphoid series

RBC, Monocytes, Granulocytes, Platelets B cells, T cells

 Cells are Unable to divide and differentiated in to the mature

and functional cells of the differentiate cell line.

 Leukemia can develop at any point during the multiple stage of

normal differentiation in bone marrow.

 Can spread to the blood, lymph nodes, spleen, liver, CNS and

other tissue.
Etiology:
90% Unknown and rest 10% have high risk conditions i.e.

1. Chromosomal abnormalities- Klinefelter’s Syndrome, Down

Syndrome, Trisomy

2. Genetic Disease- Bloom’s Syndrome, Fanconi’s Anaemia

3. Exposure to Radiation and toxic chemicals, Antineoplastic drugs

4. Siblings of Child with Leukemia

Classification:
Classification based on the predominant cell line affected and the

level of cellular differentiation

Both Myeloid and Lymphoid can proliferate in to Acute and Chronic

form.

1. Acute Leukemia: Rapidly progressing, Affect immature and

undifferentiated cells, these cells are unable to perform their

normal function.

2. Chronic leukemia – less rapidly progressing and allow production

of mature and more differentiated cells. These cells maintain

some of their normal functions.

ALL – 75 – 80%

AML – 20 – 25%

CLL – 5%

CML – Rare in children

Clinical presentation:
1. Anaemia (Hb <10g/dl) in 80% cases – fatigue

2. Thrombocytopenia (Platelets <100,000 mm3) – bleeding

3. Pain – bone pain, refusal to walk

4. Abnormal calcium level

5. Hepatospleanomegaly (50%) Lymphadenopathy

6. CNS involvement – Headache, nauseam vomiting and stiff neck

7. Non specific – anorexia, Chronic cough, malise, weight loss,

fatigue, tonsillitis

8. Life threatening sepsis –

9. Traid of

bleeding
anaemia sepsis

Investigation:
- Complete blood count

- Peripheral smear
- BMA - >60% of immature cells,

- Hypercellular bone marrow

- Increased uric acid

- X-ray – Wide mediasternum, infiltration

 Treatment:
1. Vigorous treatment of Sepsis: UTI, Chest infection
2. Blood Transfusion

3. Chemotherapy

a. Induction: Decreases leukemic cells to undetectable level,

90% remission within a month

-Vincristin- 1.5 mg/m2

-Predinisolone- 60mg/m2
-Adriamycin- 20mg/m2

L – asparaginase- 10,000 unit/m2/ 3times a week for 2 weeks

B. Consolidation: Maintain remission and prevent CNS

invasion
-Cyclophosphamide

-Methotrexate-

-6 MP (Mercaptopurine)- 6 cycles very 2 weeks

C. Maintenance : Till 130 weeks of remission

-6 MP- 50mg/m2/day

Methotrexate- 20mg/m2/weeks orally

Every 16 weeks, a 3 weeks Vincristin, Predinisolone with

single dose of Adriamysin 20 mg/m2 is recommended for

maintenance.
4. CNS Prophylaxis: Antileukemic drugd do not penetrate CNS, thus

whole cranium radiation 2000 rads with intrathecal

Methotrexate 12mg/m2 for 2 weeks plus Predinisolone 12/m2

5. Bone marrow transplantation: Preparation of Patient and Family

Nursing Management:
a) Psychological Care: Family coping, Financial concern,

Explanation.

b) Physical Care: Isolation, Medication, Personal Hygiene,

Reduction of Fever, Vital Monitoring, Investigation, Visitor

Control

c) Dental and Oral hygiene: Soft brush

d) Pain Management, Blood Transfusion

e) Nutritional Support

f) Side effects of Drugs

g) Play and recreationi

i☻Child with Leukemia: Basant Kumar Karn