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28. Bone radiographs with ALL may demonstrate?
1. Altered medullary trabeculation
2. Cortical defects
3. Transverse radiolucent lines.
b. These radiologic findings lack prognostic significance and usually are unnecessary.
29. Rx for ALL overview?
a. Combination chemo is principal therapy.
b. Involves remission induction and consolidation, prophylactic CNS therapy, and maintenance.
30. Induction therapy for ALL?
a. Prednisone + Vincristine + Asparaginase.
b. Produces remission w/I 4 weeks in approximately 98% of children w/non-high-risk ALL.
31. Consolidation treatment for ALL?
a. Aimed at further reducing residual leukemia, delivers multiple chemotherapies in a relatively short period of time.
32. Prophylactic therapy for CNS leukemia in ALL?
a. Intrathecal cytarabine and/or methotrexate (± craniospinal radiation) has decreased the incidence of CNS leukemia as a primary site of relapse from 50% to ~3-6%.
33. Maintenance therapy for ALL to prevent relapse?
a. Combination of the following:
1. Methotrexate
2. 6-Mercaptopurine
3. Vincristine
4. Prednisone
b. Therapy is D/C for children who remain in remission for 2-3 yrs.
34. 5 yr survival for childhood ALL?
a. >80%.
35. Late effects to be considered w/ALL?
a. Neuropsychological deficits
b. Seizures
c. Endocrine disturbances (ie, growth hormone deficiency) related to CNS prophylaxis
d. Spermatogenesis dysfunction related to cyclophosphamide
e. Delayed sexual maturation in boys who received irradiation of gonadal tissue due to leukemic invasion of the testes.
f. Leukoencephalopathy and neurodevelopmental problems (especially in post-cns radiation patients).
g. Secondary malignancies.
36. What conditions have a high susceptibility to leukemia?
a. Klinefelter syndrome
b. Blood syndrome
c. Fanconi syndrome
d. Ataxia telangiectasia
e. Neurofibromatosis
f. Down syndrome
37. Vaccine contraindications for ALL?
a. Live virus vaccines are contraindicated for the child w/ALL (and all members of the household) during chemo and for at least 6 months after completion of treatment.
38. Platelet count in ITP?
a. Frequently, <20,000.
b. But Bone marrow aspiration may show increase in megakaryocytes