Acute Lymphoid Leukemia
- Malignant disease of the marrow in which early lymphoid precursors proliferate and replace the normal hematopoietic cells.
- Clonal diseases.
- Reduces other blood cell formation
Malignancy in children and adults is characterized by the monoclonal proliferation and accumulation of immature lymphoid cells in the bone marrow, blood, lymph nodes, and other organs including the spleen, liver, and CNS.
Epidemiology of ALL
- Commonest in the age 2-10 years
- Peak at 3-4 years.
- Incidence decreases with age, and a secondary rise after 40 years.
- In children - most common malignant disease.
- 85% of childhood leukemia.
Medical History
- Family history of Acute lymphoid leukemia
- Down syndrome
- Adverse effects of radiation therapy
- Delayed early childhood exposure to common infections
Indications
- Lymphadenopathy - Acute
- Fatigue
- Lack of energy
- Fever
- Asthenia
- Infectious disease
- Lightheadedness
- Asymptomatic
- Hepatosplenomegaly
- Abdominal mass
- Nausea and vomiting - Acute
- Bleeding
- Pallor
- Petechiae
- Ecchymosis
- Arthralgia
- Bone pain
- Dyspnea on exertion
- Stridor
- Wheezing
- Headache
- Nuchal rigidity
- Optic disc edema
- Diplopia
- Disorder of eye movements
- Facial nerve sensory disorder
- Weakness of face muscles
- Numbness of face
- Testicular mass
Tests
Acute Lymphoblastic Leukemia
- Complete blood count with white cell differential, manual: Leukocytosis is found in over 50%, neutropenia in 25%, thrombocytopenia in over 75%, and anemia in more than 80% of patients at the time of diagnosis.
Suspected and known Acute Lymphoblastic Leukemia
- Bone marrow examination: Greater than 25% lymphoblasts in bone marrow as diagnostic of ALL; the further definition is by morphology, cytochemistry, immunophenotype, and genetics.
Suspected and known Acute Lymphoblastic Leukemia
- Lumbar puncture: Evaluation of cerebrospinal fluid is necessary to detect CNS involvement in acute leukemia; caution is taken to avoid a traumatic lumbar puncture.
Initial evaluation of suspected and known Acute Lymphoblastic Leukemia
- Electrolytes measurement, serum
- Hepatic function panel
- Measurement of renal function
Differential Diagnosis
- Acute myeloid leukemia - Acute
- Secondary malignant neoplasm of bone marrow
- Non-Hodgkin's lymphoma
- Hodgkin's disease
- Chronic myeloid leukemia - Acute
- Hairy cell leukemia
- Multiple myeloma
- Compound leukemias
- Juvenile rheumatoid arthritis
- Infectious mononucleosis - Acute
- Pertussis - Acute
- Rheumatic fever - Acute
- Autoimmune disease
- Aplastic anemia - Acute
- Myelodysplastic syndrome - Chronic
- Myelofibrosis
- Iron deficiency anemia - Chronic
- Idiopathic thrombocytopenic purpura - Acute
- Osteomyelitis - Acute
Treatment
Procedural Therapy
High-risk Acute Lymphoblastic Leukemia
- Hemopoietic stem cell transplant: Stem cell transplantation following first remission is beneficial in children and adults with high-risk ALL and also in refractory or relapsed disease.
CNS-directed treatment of Acute Lymphoblastic Leukemia
Radiation therapy: Cranial radiation is used for CNS-directed therapy but may be largely replaced by improved chemotherapy regimens because of the long-term CNS effects of radiation.
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Disease