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- John J. Hutter, MD*
- *Professor Emeritus of Pediatrics, University of Arizona, Tucson, Ariz.
Author Disclosure
Dr Hutter has disclosed no financial relationships relevant to this article. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/ device.
Objectives
After completing this article, readers should be able to:
Discuss the potential roles of genetic and environmental influences in causing leukemia, including congenital disorders that carry an increased risk for developing leukemia.
Explain why proliferation of leukemic cells and the subsequent reduction in production of normal blood cells contribute to clinical manifestations of leukemia.
Recognize the importance of a bone marrow aspiration or biopsy procedure in establishing the diagnosis of leukemia.
Delineate current initial remission rates and 5-year survival rates achievable for children who have acute lymphoblastic leukemia and who reside in developed countries.
Describe potential problems that may occur in some children who have leukemia after completion of therapy, including recurrence of leukemia in extramedullary sites and long-term treatment complications.
Case Study
A 6-year-old boy who has Down syndrome presents with a 2-day history of fever (temperature to 39.0°C) and a painful limp and favoring of his right leg. During the past 2 weeks, he has had decreased appetite, increased pallor, and increased bruises on his upper and lower extremities. Physical examination reveals pallor and multiple ecchymoses on his arms, legs, and trunk. Bilateral cervical and supraclavicular lymph nodes are palpable; the nodes are firm, nontender, and 1 to 2 cm in size. The liver is palpable 3 cm below the right costal margin, and the spleen is palpable 2 cm below the left costal margin. Tenderness is elicited over the right distal femur. Radiographs of the right distal femur reveal osteopenia plus a small lytic lesion. A chest radiograph shows normal results with no mediastinal mass or pulmonary infiltrate. His white blood cell count is 2.8×103/mcL (2.8×109/L) …
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