Leukemia (peds)

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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/joint pain
  • Hepatomegaly or splenomegaly

Hyperleukocytosis

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
    • If suggestive of leukemia also order:
      • Chemistry, Ca, Phos, Mg, Uric acid, LFT, LDH, coags, T+S, UCG (if applicable)
      • Viral titers cytomegalovirus, EBV, HIV, HBV, varicella zoster
      • CXR

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 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

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

See Also

References

  1. Horton TM and Steuber CP. Overview of the presentation and diagnosis of acute lymphoblastic leukemia in children and adolescents. UpToDate.