Childhood Leukemias

A 6-year-old girl with newly diagnosed acute myeloid leukemia (AML) and t(15;17) translocation (acute promyelocytic leukemia, APL) is being prepared for induction therapy. She has a platelet count of 28,000/μL and elevated D-dimer. Which is the drug of choice for induction in this patient?

A 4-year-old boy from Delhi presents with a 3-week history of fever, pallor, and petechiae. On examination, he has hepatomegaly (3 cm below costal margin) and splenomegaly (4 cm). Complete blood count shows hemoglobin 7.2 g/dL, WBC 85,000/μL with 70% blasts, and platelets 35,000/μL. Peripheral blood smear confirms acute leukemia with Auer rods. What is the most appropriate next step in management?

A 6-year-old girl from Mumbai with newly diagnosed B-cell acute lymphoblastic leukemia (ALL) has completed 4 weeks of induction chemotherapy. Bone marrow aspirate shows <5% blasts (complete remission achieved). However, she now presents with severe mucositis, oral candidiasis, and a fever of 39.2°C. Her absolute neutrophil count (ANC) is 200/μL. What is the most appropriate next step in management?

A 6-year-old girl from rural India presents with a 2-week history of fever, bone pain, and easy bruising. Investigations reveal WBC 8,500/µL with 85% blasts, hemoglobin 7.2 g/dL, and platelets 45,000/µL. Flow cytometry shows CD19+, CD10+, TdT+, MPO−. Which single feature most reliably distinguishes common B-cell ALL (cALL) from T-cell ALL (T-ALL) in this age group?

A 4-year-old boy from rural India presents with a 2-week history of fever, pallor, petechiae, and hepatosplenomegaly. Bone marrow examination shows >80% blasts with morphology consistent with acute myeloid leukemia (AML). Regarding the management and prognostic factors of pediatric AML, all of the following statements are true EXCEPT: