Which medication is associated with hypertrichosis and gum hyperplasia?
B. Cyclosporin. Causes hypertrichosis and gum hyperplasia in 5-19%
All other medications cause alopecia.
What is the single most common malignancy of childhood?
What is this a picture of?
Note no granules in cytoplasm.
What is pathogenesis of ALL?
Aetiology is unclear but must have
Maturation arrest and
What is peak age for ALL?
3 years then steadily decreases with another much smaller peak at approx 16 years.
What is second most common leukaemia of childhood?
What is cure rate of AML?
What is treatment of AML?
Cytarabine base chemo for 6-9 months
What are some presenting features of AML?
Leucopenia or leucocytosis
What is this and what does diagnosis do you consider?
Auer Rod = AML (pathognomonic)
In the FAB classification of AML, M7 is megakaryoblastic leukaemia. What population of people are more likely to have this diagnosis?
In the FAB classification of AML, M3 is APML (Acute Promyelocytic Leukaemia).
What do you need to be careful to look for on diagnosis of APML?
Need full coag profile plus fibrinogen and then serial measurements.
What is treatment of APML?
Anthracycline & ATRC - Al Trans Retinoic Acid
Anthracycline and ATRA are used in treatment of APML. What does these drugs do, what is a significant side effect and what is survival?
Anthracycline helps mature blasts into healthier cells.
Beware ATRA syndrome - acute resp failure with pulmonary oedema.
Good outcomes if survive induction.
What are prognostic features of AML?
Age - worse with increasing age
Presentation WCC count - higher wcc = higher risk
CNS disease - poorer prognosis
favourable 8:21, 15:17
bad = monosomy 7, complex karyotype
- favourable 8:21, 15:17
- bad = monosomy 7, complex karyotype
When is Hodgkins Lymphoma more common?
What is usual presentation of Hodgkins Lymphoma?
Slowly progressing lymphadenopathy - often in teenage girl.
Paraneoplastic syndromes ie itch.
Prognosis of Hodgkin Lymphoma?
Good. 80% at 5 years depending on B symptoms.
5 lines on Burkitts Lymphoma
most common NHL
usually presents at high stage often with large abdominal mass
frequently bone marrow involvement
Cure in 85%
Treatment very intensive
Tumour Lysis Syndrome
Seen in malignancies with high tumour burden and high mitotic rate
might be present at diagnosis
usually commences after starting chemo
Lysis of tumour cells leads to release of intracellular electrolytes incl K+, Ca2+, phosphate and uric acid.
What usually causes fatality in tumour lysis syndrome?
Why does renal impairment/failure occur in tumour lysis syndrome?
Precipitation of calcium phosphate and uric acid in the tubules.
Calcium phosphate most likely to precipitate but most damage done by uric acid crystals.
What is management of tumour lysis syndrome?
Hyperhydration -NEVER with potassium
Allopurinol or rasburicase (uric oxidase) NOT both
Treat hyperkalaemia (sodibic)
Check electrolytes, phosphate and uric acid.
Why should you avoid giving Allopurinol and rasburicase together in treatment of tumour lysis sydrome?
Allopurinol - prevents formation of uric acid
Rasburicase - breaks down uric acid
allopurinol with decrease substrate for rasburicase so waste of medication.
Acrolein produced from degradation of cyclophosphamide causing haemorrhagic cystitis.
Mercaptoethane sulphonate (MESNA) used to prevent.
Where should vincristine NEVER be given?
Should only be via central IV - causes tissue chemical burns peripherally.
Hemihypertrophy and hemihyperplasia are associated with what oncological condition?
Beckwith-Wiedeman Syndrome associated with
- Wilms Tumour
What cells are depleted to minimise graft vs host disease?
This CT plus 2/12 progressive ataxia and headaches =?
35-40% posterior fossa tumours
2-3 month hx of headache, vomiting and truncal ataxia
Describe veno-occlusive disease of the liver.
Occurs in first 3/52 after transplant
Fibrous obliteration of terminal hepatic venules and small lobular veins. Results in damage to surrounding hepatocytes and sinusoids.
Most common cause of hepatic vein obstructioin in children
Cause of VOD after bone marrow transplant not clear
- painful hepatomegally
- rapid weight gain