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Updated: Dec 26 2021

Acute Lymphoblastic Leukemia (ALL)

  • Snapshot
    • A 11-year-old girl with Down syndrome presents with a few weeks of low-grade fever. She is otherwise feeling well, with no signs of infection. Blood-work shows elevated WBCs, low neutrophil count, and anemia. Blood cultures are drawn and come back positive for Pseudomonas.
  • Introduction
    • Acute leukemia of lymphoid precursor cells that occurs in children
    • Crowding of bone marrow leads to bone marrow failure
    • Subtypes
      • B-cell ALL – 85% of all ALL
        • TdT+ (marker of precursor T- or B-cell)
      • T-cell ALL
        • CD2+, CD8+, and CD3+
        • TdT+ (marker of precursor T- or B-cell)
        • commonly presents as mediastinal mass
          • infiltration of thymus
    • Epidemiology
      • < 15 years
      • most common type of cancer and leukemia in children
    • Associated conditions
      • Down syndrome in children > 5 years
        • leukemia in Down syndrome children < 5 years = AML
  • Presentation
    • Symptoms
      • most common symptom is fever
      • acute onset
        • recurrent infections
        • bleeding
        • fatigue
    • Physical exam
      • mediastinal mass from infiltration of thymus
      • hepatosplenomegaly
      • lymphadenopathy
  • Evaluation
    • Peripheral blood smear
      • ↑ lymphoblasts (high nuclei to cytoplasm ratio)
    • CBC reflects bone marrow failure
      • anemia
      • thrombocytopenia
      • ↓ mature WBCs
    • Bone marrow aspiration with cytogenetics
      • ↑ lymphoblasts
      • TdT+, a marker of pre-T and pre-B cells
      • T-cell ALL
        • CD2+
        • CD3+
      • B-cell AML
        • CD10+
        • CD19+
      • negative MPO (myeloperoxidase)
      • t(12:21)
  • Differential Diagnosis
    • AML
    • B-cell lymphoma
    • Non-hodgkin lymphoma
  • Treatment
    • Chemotherapy
    • Prophylaxis to CNS (standard chemotherapy does not penetrate blood-brain barrier)
      • intrathecal chemotherapy
  • Prognosis, Prevention, and Complications
    • Prognosis
      • very responsive to therapy
    • Complications
      • likes to spread to CNS and testes
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