Acute Lymphoblastic Leukaemia Flashcards
What is acute lymphoblastic leukaemia?
Acute lymphoblastic leukaemia (ALL) is the most common malignancy affecting children and accounts for 80% of childhood leukaemias. Malignant disorder of the lymphoid progenitor cells. Note there is a second peak at over 50 years.
What types of acute lymphoblastic leukaemia are there?
ALL is classified into B or T lymphoblastic leukaemia.
Common ALL (75%), CD10 present, pre-B phenotype
T-cell ALL (20%)
B-cell ALL (5%)
What are the risk factors for acute lymphoblastic leukaemia?
White > Black
Boys are affected slightly more commonly than girls
The peak incidence is at around 2-5 years of age
Genetic associations included Trisomy 21
How does acute lymphoblastic leukaemia present?
Pancytopenia as a result of bone marrow failure:
• Anaemia: lethargy and pallor (normochromic and normocytic)
• Neutropaenia: frequent or severe infections
• Thrombocytopenia: easy bruising, petechiae
Painless lumps in neck, axilla or groin
Other features
Bone pain (secondary to bone marrow infiltration)
Splenomegaly
Hepatomegaly
Fever is present in up to 50% of new cases (representing infection or constitutional symptom)
CNS and Testicular infiltration is common and will give the corresponding features
What factors would suggest a poor prognosis in ALL?
Age < 2 years or > 10 years WBC > 20 x 109/l at diagnosis T or B cell surface markers Non-Caucasian Male sex
How should suspected acute lymphoblastic leukaemia be investigated?
Bone marrow biopsy
CSF – pleocytosis, raised protein and reduced glucose
FBC
Cytogenetic analysis usually shows mutations
CXR – may be mediastinal mass
How is acute lymphoblastic leukaemia managed?
Induction therapy – 3 drug induction over 4 weeks
Consolidation phase – Cranial irradiation if known CNS involvement and further chemotherapy
Maintenance phase – 2.5 years of daily/weekly/3monthly drugs
