Hematology and Oncology Book

Approach

Bone Marrow Disorders

Lymphatic Disorders

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Acute Lymphocytic LeukemiaAka: ALL

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  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

Acute lymphocytic leukemia (C0023449)

Definition (CSP)acute leukemia in which lymphoblasts and their progenitor cells predominate; the most common childhood cancer and accounts for 20 percent of adult acute leukemia; common ALL antigen (CALLA) expressed in most cases.
Definition (NCI)A quickly progressing disease in which too many immature white blood cells called lymphoblasts are found in the blood and bone marrow.
Definition (NCI)Leukemia with an acute onset, characterized by the presence of lymphoblasts in the bone marrow and the peripheral blood. It includes the precursor B lymphoblastic leukemia and precursor T lymphoblastic leukemia.
ConceptsNeoplastic Process (T191)
ICD9204.0
EnglishAcute lymphatic leukaemia, Acute lymphatic leukemia, Acute lymphoblastic leukaemia, Acute lymphoblastic leukaemia-lymphoma, ACUTE LYMPHOBLASTIC LEUKEMIA, Acute lymphoblastic leukemia-lymphoma, Acute lymphocytic leukaemia, acute lymphocytic leukemia, Acute Lymphocytic Leukemias, Acute Lymphogenous Leukemia, Acute lymphoid leukaemia, Acute lymphoid leukemia, ALL, ALL - Acute lymphoblastic leukaemia, ALL - Acute lymphoblastic leukemia, ALL - Acute Lymphocytic Leukemia, LEUKEMIA ACUTE LYMPHOBLASTIC, LEUKEMIA LYMPHOBLASTIC ACUTE, Lymphoblastic Leukemia, Precursor cell lymphoblastic leukaemia, Precursor cell lymphoblastic leukemia, Precursor Lymphoblastic Leukemia
Spanishleucemia linfoblastica de celulas precursoras, leucemia linfoide aguda
Parent ConceptsLymphoblastic Leukemia (C0023448), Acute leukemia (C0085669), Malignant Neoplasms (C0006826), Leukocyte Abnormalities, General and NEC (C0549532), Precursor Lymphoblastic Lymphoma/Leukemia (C1335469), Acute lymphoblastic leukemia - category (C1531702), Duplicate concept (C1274013)
SourcesCOSTAR, CSP, CST, DXP, ICD9CM, MTH, NCI, NDFRT, OMIM, PDQ, QMR, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)



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