Acute Lymphoblastic Leukaemia

Question 1

What is acute lymphoblastic leukaemia?

Answer 1

malignancy of BM + blood characterised by the proliferation of lymphoblasts (primitive lymphoid cells)
fail to develop into mature T or B cells

Question 2

Describe the pathophysiology of ALL

Answer 2

Lymphoblasts undergo malignancy transformation + proliferation
This leads to the replacement of normal marrow elements, leading to BM failure + infiltration into other tissues

Question 3

List 3 environmental risk factors for ALL

Answer 3

Radiation
Cigarette smoking
Exposure to chemicals

Question 4

List 4 genetic risk factors for ALL

Answer 4

Down’s syndrome
Neurofibromatosis type 1
Fanconi’s anaemia
Xeroderma pigmentosum

Question 5

Describe the epidemiology of ALL

Answer 5

MOST COMMON malignancy of CHILDHOOD
Peak incidence: 2-5 yrs old
(2nd peak in elderly)
Annual UK incidence: 1/70,000

Question 6

List 3 categories of symptoms arising in ALL from bone marrow failure

Answer 6

Anaemia (fatigue, dyspnoea)
Bleeding (spontaneous bruising, bleeding gums, menorrhagia)
Opportunistic infections

Question 7

List 4 symptoms arising in ALL from organ infiltration

Answer 7

Tender bones
Lymphadenopathy
Mediastinal compression
Meningeal involvement (headache, visual disturbances, nausea)

Question 8

List 4 signs of bone marrow failure in ALL

Answer 8

Pallor
Bruising
Bleeding
Infection + Fever

Question 9

List 7 signs of organ infiltration in ALL

Answer 9

Lymphadenopathy 
Hepatosplenomegaly 
CN palsies  
Retinal haemorrhage  
Papilloedema on fundoscopy  
Leukaemic infiltration of the anterior chamber of the eye  
Testicular swelling

Question 10

What bloods are investigated in ALL?

Answer 10

FBC: normochromic normocytic anaemia, low platelets, variable WCC 
High uric acid  
High LDH 
High calcium due to bony infiltration  
Clotting screen: identify DIC

Question 11

What is seen on blood film in ALL?

Answer 11

Abundant lymphoblasts

Question 12

What may be seen on CXR and bone radiographs in ALL?

Answer 12

CXR: mediastinal lymphadenopathy, lytic bone lesions
Bone: mottled appearance with punched out lesions due to leukaemic infiltration

Question 13

What is the diagnostic test for ALL?

Answer 13

Bone Marrow Aspiration + Trephine Biopsy

Hypercellular with > 20% lymphoblasts

Question 14

What investigations may be performed on aspirate in ALL?

Answer 14

Immunophenotyping: identify specific lineage
Cytogenetic: for prognosis
Cytochemistry

Question 15

Why perform an LP in ALL?

Answer 15

check for CNS involvement