Term
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Definition
| Neoplasms of hematopoietic precursor cells in the lymphoid lineage, characterized by the accumulation of excess blasts in the bone marrow. |
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Term
| prevalence of PreB vs PreT ALL |
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Definition
Precursor B-lymphoblastic ALL (Pre-B ALL)
Majority of ALLs
Occurs most frequently in childhood, but can also be seen in adults
slightly more frequently in males than females
Precursor T-lymphoblastic ALL (Pre-T ALL)
15-25% of ALL
occurs most frequently in late childhood, adolescence, and young adulthood
male >female 2:1 |
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Term
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Definition
most = idiopathic
Ionizing radiation
Chemicals/drugs
-benzene
-chemotherapeutic agents (more frequently AML)
Viruses
-HTLV-1 (Human T cell Leukemia/Lymphoma Virus) : T-cell ALL
-EBV: Burkitt’s
Hereditary genetic associations
-increased risk if sibling has acute leukemia
Hematologic disorders predisposing to acute leukemia
-CML (more frequently AML than ALL) |
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Term
| 6 broad categories of clinical signs of ALL |
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Definition
Rapid onset
Bone marrow infiltration
-anemia -fatigue, pallor,
-thrombocytopenia -bleeding, spontaneous bruising
-neutropenia -infections, sepsis
Infiltration of other organs
-lymphadenopathy
-hepatosplenomegaly
-mediastinal masses (T-ALL)
-bone pain, esp. in children with ALL
-skin -leukemia cutis
-soft tissue -chloromas
-testis
-CNS
leukostasis (only seen with WBC > 50 x 109/L)
-CNS, strokes
-lungs, pulmonary infiltrates, hypoxemia
Constitutional symptoms
-fevers, sweats are common
-weight loss uncommon
Coagulopathy
-exposure of substances that can initiate coagulation, can cause DIC |
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Term
| Lab features of ALL: BM biopsy, hematologic, chemistry |
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Definition
Hematologic
WBC usually elevated, but can be normal or low
normocytic anemia
thrombocytopenia
blasts are usually seen in the peripheral blood
coagulopathy/DIC sometimes seen
Bone marrow biopsy
hypercellular marrow
excess number of lymphoblasts
Chemistry
increased uric acid
electrolytes abnormality
increased LDH |
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Term
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Definition
Made by bone marrow biopsy
>20% lymphoblasts |
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Term
| Histo features (see slide for picture!) |
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Definition
Cells with variable size and indistinct nucleoli
High nuclear/cytoplasmic ratio
Fine chromatin |
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Term
| ALL vs lymphoblastic lymphoma DDx! |
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Definition
Clinically, a case is defined as lymphoma (LBL) if there is a mass lesion in the mediastinum or elsewhere and <25 percent blasts in the bone marrow.
It is classified as leukemia (ALL) if there are >25 percent bone marrow blasts, with or without a mass lesion.
It’s really the same disease with different presentations |
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Term
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Definition
light microscopy morphology
AML blasts: Auer rods, cytoplasmic granules helpful if
present.
ALL blasts do not have Auer rods or granules.
special stains (cytochemistry)
Myeloperoxidase negative in ALL, positive in AML
deoxytransferase (TdT) positive in ALL, negative in AML
flow cytometry
Surface markers |
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Term
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Definition
Age
Cytogenetics
Numerical changes
Hyperdiploidy >50 chromosomes
Translocations
The Philadelphia chromosome: t(9;22), BCR/ABL: poor prognosis
t(v;11q23); MLL rearranged: poor prognosis
t(12;21)(p12;q22) TEL/AML1: a good prognosis and associated with hyperdiploidy |
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Term
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Definition
Chemotherapy
Combination chemotherapy is the mainstay of treatment
Management of complications
Infection – Abx
Leukostasis – leukopheresis
tumor lysis syndrome – hydration, allopurinol, rasburicase
Allopurinol => reduced prd of uric acid…rasburicase breaks down uric acid too…
Coagulopathy – supportive
transfusion of red cells and platelets – cautious when leukostasis coexist
Supportive care
Nutritional support
Psychosocial support for patient and family |
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Term
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Definition
Remission induction – try to resume normal hematopo
Consolidation (intensification) – prevent relapse…
Maintenance – all px needs this! 1-2 yrs…
CNS prophylaxis – important for ALL more risk than AML…done by intrathecal therapy to get therapy into spinal fluid. |
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