Case 100: Acute Leukemias

PATIENT PRESENTATION

Chief Complaint

Cough and fever

History of Present Illness

WC is a 5-year-old male who presented with a one-week history of respiratory illness and associated fevers. Four days prior to admission mother noted he started having a decreased appetite, increased fatigue, and overall generalized weakness. At PCP office, CBC was significant for white blood cells of 14.3K/uL, hemoglobin of 6.3g/dL, hematocrit 18.7%, platelets of 17K/uL, and 61% blasts. Patient was directly admitted to Pediatric Hematology and Oncology unit for new diagnosis of acute leukemia.

Link to EMR

Student Work-Up

TARGETED QUESTIONS

1. What are common presenting signs and symptoms of acute leukemia in pediatric patients?

   Hint: See Treatment in PPP

2. What are prognostic factors for pediatric acute lymphoblastic leukemia (ALL)? What is the patient’s risk of relapse?

   Hint: See Pathophysiology and Table 96-5 in PPP

3. What are immunophenotypic markers that are consistent with preB cell ALL?

   Hint: See Table 96-4 in PPP

4. What is the goal of remission induction and what are the medications given during this time frame?

   Hint: See Treatment in PPP

5. Recognize the importance of minimal residual disease evaluation. What is this patient’s probability of event-free survival (EFS)?

   Hint: See Pathophysiology in PPP

FOLLOW-UP

What specific laboratory values are monitored for tumor lysis and at what value would you to give the patient rasburicase?

Hint: See Treatment in PPP

CASE SUMMARY

Global Perspective

Pediatric cancer is very rare with pediatric acute lymphoblastic leukemia (ALL) accounting for one-third of all pediatric malignancies. Pediatric ALL is the most common form of childhood cancer with preB-Cell ALL accounting for 80% of cases of pediatric ALL. In the United States there approximately 2500 to 3500 new cases for pediatric ALL diagnosed each year. The incidence is higher in Latino and White individuals than in Black and Asian individuals with a peak incidence between ages two to five years of age and more common among males than females.