Girl, 5 years 1 months Physical Examination:

- fever since 2 weeks before admitted - pallor,fever

- bone pain since 3 weeks before admitted -multiple lymphnode enlargement High Risk B-cell ALL with CNS Leukemia
- pale since 1 month before admitted - hepatosplenomegaly

Hemato - Oncology

Diagnosis High Risk B-cell ALL with CNS Leukemia

Lab Complete blood count, blood smear, bone marrow punction, immunophenotyping, lumbal punction

Currative: ALL high risk chemotherapy Supportive :

Management protocol 2016 with modified for CNS Transfusion
Leukemia Nutrition according to RDA

Problem Early response Ad Vitam : dubia ad malam

Lab evaluation Ad Functionam : dubia ad malam Education
Complication Ad Sanationam : dubia ad malam Monitoring Plan

Pediatr Blood Cancer. 2016. Level of Evidence 1b, recommendation A

Prognosis J Clin Oncol. 2017. Level of Evidence 2b, recommendation B.
Pediatr Blood Cancer. 2017. Level of Evidence 2b, recommendation A
Middle East Journal of Cancer. 2016. Level of Evidence 2b, recommendation B