Hematology and Oncology Book

Approach

Bone Marrow Disorders

Lymphatic Disorders

http://www.fpnotebook.com/

Acute Lymphocytic LeukemiaAka: ALL

Advertisement

  1. History
    1. Success story of Twentieth Century Oncology
    2. Previously ALL was 100% fatal in 3 months
    3. Current Chemotherapy regimens hold >50% cure
  2. Epidemiology
    1. Disease of children
  3. Symptoms
    1. See Acute Leukemia
    2. Distinguishing features from Acute Lymphocytic Leukemia
      1. Gastrointestinal symptoms from hepatoSplenomegaly
      2. Nausea
      3. Abdominal fullness
      4. Early Satiety
  4. Signs
    1. See Acute Leukemia
    2. Distinguishing features from Acute Lymphocytic Leukemia
      1. Hepatomegaly or Splenomegaly (50% to 75%)
      2. Lymphadenopathy
      3. Testicular involvement may occur
      4. Anterior mediastinal mass (T-Cell Variant)
  5. Pathology
    1. Immature Lymphoblasts
      1. Round or convoluted nuclei
      2. Smaller than in Acute Myelogenous Leukemia
      3. Contain deoxynucleotidyl transferase in 90% of cases
        1. Rarely present in Acute Myelogenous Leukemia
      4. Express Common ALL Antigen (CALLA) in 60% of cases
    2. Cell Types
      1. T-Cell Type (20% of cases)
      2. B-Cell Type (5%)
      3. Null Cell Type (15%)
  6. Management
    1. Remission-Induction Chemotherapy
      1. Vincristine
      2. Prednisone
      3. Daunorubicin or L-asparaginase
    2. CNS Prophylaxis (prevents Leukemic Meningitis)
      1. Whole Brain Radiation (18 to 24-Gy)
      2. Intrathecal Methotrexate
    3. Maintenance Chemotherapy for 2-3 years
      1. 6-Mercaptopurine
      2. Methotrexate
  7. Prognosis
    1. Child: Probable cure in >50%
    2. Adult: Long term survival <30%
  8. Complications
    1. See Acute Leukemia
    2. Leukemic Meningitis in relapse
      1. Headache and Nausea
      2. Cranial Nerve palsy
      3. Seizures
      4. Altered Level of Consciousness
    3. General Chemotherapy complications
      1. Lymphocytopenia
      2. Immunodeficiency (predominantly T-Cells)
        1. Pneumocystis carinii Pneumonia
      3. Growth retardation (most attain normal growth)
      4. Sterility (most resolves)
    4. Cyclophosphamide related
      1. Bladder Cancer
    5. Anthracycline (doxorubicin or daunorubicin) related
      1. CardioMyopathy
    6. Cranial radiotherapy related
      1. CNS tumor
      2. Papillary Thyroid Carcinoma
      3. Acute monocytic Leukemia
      4. Cognitive decline
      5. Osteoporosis
      6. Obesity
      7. Periodontal disease
      8. Cataracts

Navigation Tree