Question

Chronic leukemia in children: Management.

Hint:

The treatment of chronic leukemia is primarily based on molecular and genetic factors, with TKIs being the cornerstone for CML and chemotherapy/immunotherapy for CLL.

Answer 1

Step 1: Management of Chronic Leukemia.
Management of chronic leukemia in children varies depending on the type (CML or CLL) and the individual patient's characteristics.
For Chronic Myelogenous Leukemia (CML):
(1) Tyrosine Kinase Inhibitors (TKIs): The first-line treatment for CML is Imatinib, which targets the BCR-ABL fusion gene. Other TKIs like Dasatinib and Nilotinib may be used in resistant cases.
(2) Stem Cell Transplantation: For patients who do not respond to TKIs, a bone marrow or stem cell transplant may be considered.
For Chronic Lymphocytic Leukemia (CLL):
(1) Chemotherapy: Common regimens include Fludarabine, Cyclophosphamide, and Rituximab.
(2) Immunotherapy: Rituximab, an anti-CD20 monoclonal antibody, is used to target malignant B-cells.
(3) Stem Cell Transplantation: This may be considered for high-risk cases or when chemotherapy is ineffective.
Step 2: Supportive Care.
(1) Blood Transfusions: To treat anemia and thrombocytopenia.
(2) Infection Control: As both CML and CLL can lead to an increased risk of infections, antibiotics, and vaccines may be used as part of supportive care.