Question 1 of 10

    Acute Lymphoblastic Leukemia (ALL)

    Acute leukemia-ALL[1]

    Acute lymphocytic leukemia (ALL), otherwise referred to as acute lymphoblastic leukemia or acute lymphoid leukemia, is a hematopoietic malignancy that involves the overproduction of cancerous white blood cells in the bone marrow.

    Acute Lymphoblastic Leukemia emerges due to the following process: neoplastic.

    Presentation

    Acute lymphoblastic leukemia is a type of malignancy that most commonly affects children. The cancerous cells can either be found in the bone marrow itself, thus disrupting the process of blood cell production and maturation, or in other extramedullary organs.

    The immature white blood cells that are produced by the diseased bone marrow initially replace the organ; as a result, it fails to produce the rest of the cellular lines, such as erythrocytes and platelets. Due to the pancytopenia that exists, patients can present with a multitude of symptoms. Specifically, a diminished erythrocyte count leads to anemia, pallor, weakness and fatigue, reduced platelets induce hemorrhagic events such as petechiae or active hemorrhage and the immature white blood cells cause an inadequate immune response to any infection. Although the patient is vulnerable to various microorganisms, they rarely exhibit septic phenomena. Many times, patients report a history of skeletal pain, arthritis and limping as the sole symptoms; as a result, diagnosis may be delayed [8]. Hepatosplenomegaly, fever and lymphadenopathy are also frequently observed.

    In addition to the aforementioned symptoms, some types of ALL may lead to the development of masses outside of the borders of the bone marrow. The central nervous system, head and neck are the most common locations for these growths. The infiltration of the central nervous system may lead to papilledema, palsies of the cranial nerves, lethargy or nuchal rigidity; these symptoms rarely constitute the clinical manifestations at the time that ALL is originally diagnosed [9]. Another symptom that may raise suspicion of ALL is testicular edema in male patients that is not accompanied by pain.

    Lastly, stridor is an alarming symptom that should indicate a possible mediastinal mass, which, in turn, may threaten the respiratory function. Corticosteroids should promptly be administered in order to prevent respiratory failure and close monitoring is also considered mandatory.

    Jaw & Teeth
    Bleeding Gums
    • Signs and symptoms may include: excessive sweating fatigue frequent unexplained bleeding, such as nosebleeds or bleeding gums high fever painful joints and/or bones panting several infections over a short period swollen glands (lymph nodes) swollen liver[medicalnewstoday.com]
    • Symptoms include: Bone and joint pain Easy bruising and bleeding (such as bleeding gums, skin bleeding, nosebleeds, abnormal periods) Feeling weak or tired Fever Loss of appetite and weight loss Paleness Pain or feeling of fullness below the ribs Pinpoint[nlm.nih.gov]
    • gums , or other unusual bleeding such as from minor cuts Depending upon where leukemia cells are present, other symptoms may include: A full or swollen belly from leukemia cells in the liver or spleen Enlarged lymph nodes such as in the neck or groin[webmd.com]
    • Symptoms include: pale skin feeling tired and breathless repeated infections over a short space of time unusual and frequent bleeding, such as bleeding gums or nosebleeds high temperature (fever) of 38C (100.4F) or above night sweats bone and joint pain[nhs.uk]
  • more...
  • Liver, Gall & Pancreas
    Hepatomegaly
    • […] pallor bleeding from the gums a fever bruises, purpura, or bleeding within the skin petechiae, which are red or purple spots on the body lymphadenopathy, which is characterized by enlarged lymph nodes in the neck, under the arms, or in the groin region hepatomegaly[healthline.com]
    • Abdominal distention due to hepatomegaly and splenomegaly.[patient.info]
    Hepatosplenomegaly
    • The most frequent signs are lymphadenopathies, hepatosplenomegaly, fever, signs of haemorrhage, and bone pain.[orpha.net]
    • Other presenting signs and symptoms of pediatric ALL include the following: Patients with B-precursor ALL: Bone pain, arthritis, limping; fevers (low or high); neutropenia; fatigue, pallor, petechiae, and bleeding; lymphadenopathy and hepatosplenomegaly[emedicine.medscape.com]
  • more...
  • Entire body system
    Anemia
    • Chemotherapy causing anemia and low platelets often requires transfusions.[chop.edu]
    • Farber wondered whether folic acid would also cure ALL because it too featured immature blood cells and anemia.[hematology.org]
    • Symptoms of anemia are common and include fatigue, dizziness, palpitations, and dyspnea upon even mild exertion.[emedicine.medscape.com]
    • Anemia is a condition when there is a low number of red cells in the blood which can cause fatigue and shortness of breath.[lls.org]
    • Medical Dictionary Medical Definition of acute lymphoblastic leukemia : lymphocytic leukemia that is marked by an abnormal increase in the number of lymphoblasts, that is characterized by rapid onset and progression of symptoms which include fever, anemia[merriam-webster.com]
    Fatigue
    • Symptoms of anemia are common and include fatigue, dizziness, palpitations, and dyspnea upon even mild exertion.[emedicine.medscape.com]
    • Dictionary Medical Definition of acute lymphoblastic leukemia : lymphocytic leukemia that is marked by an abnormal increase in the number of lymphoblasts, that is characterized by rapid onset and progression of symptoms which include fever, anemia, pallor, fatigue[merriam-webster.com]
    • It is the decrease in normal cells that produces many of the symptoms of ALL Fatigue and being pale results from a decreased number of red blood cells, known as anemia Fever due to the disease itself or from infection because there are a decreased number[childrensoncologygroup.org]
    • They include: Fatigue Fever Loss of appetite or weight Night sweats Many symptoms of acute lymphoblastic leukemia are the result of a shortage of normal blood cells.[webmd.com]
    • The decrease in normal cells causes the symptoms of leukemia, which may include: Fatigue and being pale results from a decreased number of red blood cells , known as anemia Fever due to the disease itself or from infection because there are a decreased[curesearch.org]
    Fever
    • Fever is one of the most common symptoms of ALL, and patients with ALL often have fever without any other evidence of infection.[emedicine.medscape.com]
    • The most frequent signs are lymphadenopathies, hepatosplenomegaly, fever, signs of haemorrhage, and bone pain.[orpha.net]
    • Fever — Many children with ALL have fevers that are not related to a specific infection, though sometimes fever at the time of diagnosis can be a sign of infection.[danafarberbostonchildrens.org]
    • You should see your pediatrician if your child has any of the following: Unexplained fever and headaches Enlarged lymph nodes in the neck, arm pits, or groin Pain in the arms, legs, or back Easy bruising and bleeding Tiny red spots in the skin Fatigue[childrensnational.org]
    Lymphadenopathy
    • Some patients present with palpable lymphadenopathy.[emedicine.medscape.com]
    • The most frequent signs are lymphadenopathies, hepatosplenomegaly, fever, signs of haemorrhage, and bone pain.[orpha.net]
    • Other presenting signs and symptoms of pediatric ALL include the following: Patients with B-precursor ALL: Bone pain, arthritis, limping; fevers (low or high); neutropenia; fatigue, pallor, petechiae, and bleeding; lymphadenopathy and hepatosplenomegaly[emedicine.medscape.com]
    • The symptoms of ALL may include: paleness, or pallor bleeding from the gums a fever bruises, purpura, or bleeding within the skin petechiae, which are red or purple spots on the body lymphadenopathy, which is characterized by enlarged lymph nodes in the[healthline.com]
    Malaise
    • Initial presentation is usually generalised fatigue and malaise but usually quickly progresses to bone marrow failure. [ 1 ] Symptoms Fatigue, dizziness and palpitations.[patient.info]
    Pallor
    • Dictionary Medical Definition of acute lymphoblastic leukemia : lymphocytic leukemia that is marked by an abnormal increase in the number of lymphoblasts, that is characterized by rapid onset and progression of symptoms which include fever, anemia, pallor[merriam-webster.com]
    • Patients present with any of the signs and symptoms of marrow failure such as pallor and fatigue caused by anemia, petechiae and ecchymoses caused by thrombocytopenia, and fever related to granulocytopenia.[pathpedia.com]
    • Symptoms include fatigue, pallor, infection, bone pain, and easy bruising and bleeding.[merckmanuals.com]
    • Other presenting signs and symptoms of pediatric ALL include the following: Patients with B-precursor ALL: Bone pain, arthritis, limping; fevers (low or high); neutropenia; fatigue, pallor, petechiae, and bleeding; lymphadenopathy and hepatosplenomegaly[emedicine.medscape.com]
    • The symptoms of ALL may include: paleness, or pallor bleeding from the gums a fever bruises, purpura, or bleeding within the skin petechiae, which are red or purple spots on the body lymphadenopathy, which is characterized by enlarged lymph nodes in the[healthline.com]
    Recurrent Infection
    • Signs and Symptoms All types of leukemia generally have the same symptoms, which include: fatigue and weakness swollen lymph nodes recurrent infections (like bronchitis or tonsillitis) fever easy bruising bone and joint pain abdominal pain (caused by[kidshealth.org]
    • Recurrent infections — Although there may be an unusually high number of white blood cells on your child’s blood count, these white blood cells aren't mature and don’t fight infection.[danafarberbostonchildrens.org]
    • Symptoms and Diagnosis Symptoms of ALL include fatigue, pale skin, recurrent infections, bone pain, bruising, and small red spots under the skin.[umm.edu]
    Weakness
    • Symptoms of ALL include: Weakness or feeling tired Fever Easy bruising or bleeding Bleeding under the skin Shortness of breath Weight loss or loss of appetite Pain in the bones or stomach Pain or a feeling of fullness below the ribs Painless lumps in[nlm.nih.gov]
    • A low number of red blood cells leads to anemia, making the child feel tired or weak .[stbaldricks.org]
    • Symptoms include: Bone and joint pain Easy bruising and bleeding (such as bleeding gums, skin bleeding, nosebleeds, abnormal periods) Feeling weak or tired Fever Loss of appetite and weight loss Paleness Pain or feeling of fullness below the ribs Pinpoint[nlm.nih.gov]
    • Symptoms of ALL include: Fever Easy bruising or bleeding that is hard to stop Flat, dark-red skin spots (petechiae) due to bleeding under the skin Pain in the bones or joints Lumps in the neck, underarm, stomach or groin Weakness, fatigue, paleness or[ochsner.org]
    Weight Loss
    • Both leukemia itself and the treatment can lead to many problems such as bleeding, weight loss, and infections.[nlm.nih.gov]
    • Symptoms of ALL include: Weakness or feeling tired Fever Easy bruising or bleeding Bleeding under the skin Shortness of breath Weight loss or loss of appetite Pain in the bones or stomach Pain or a feeling of fullness below the ribs Painless lumps in[nlm.nih.gov]
    • Possible Complications Both leukemia itself and the treatment can lead to many problems such as bleeding, weight loss, and infections.[mountsinai.org]
    • […] disease itself or from infection because there are a decreased number of healthy white blood cells, known as neutropenia Bruising or bleeding from decreased platelets, known as thrombocytopenia Bone pain, sometimes associated with swelling of the joints Weight[curesearch.org]
  • more...
  • Face, Head & Neck
  • more...
  • neurologic
    Confusion
    • Diagnostic confusion with AML, hairy cell leukemia, and malignant lymphoma is not uncommon.[dana-farber.org]
    Headache
    • You should see your pediatrician if your child has any of the following: Unexplained fever and headaches Enlarged lymph nodes in the neck, arm pits, or groin Pain in the arms, legs, or back Easy bruising and bleeding Tiny red spots in the skin Fatigue[childrensnational.org]
    • If this happens, the patient may have neurological symptoms, such as dizziness, vomiting, blurred vision, fits (seizures), and headaches .[medicalnewstoday.com]
    • […] pinpoint spots under the skin, caused by bleeding) Shortness of breath Weight loss or loss of appetite Pain in the bones or stomach Pain or feeling of fullness below the ribs Painless lumps in the neck, underarm, stomach, or groin Having many infections Headaches[northwell.edu]
    • Depending upon where leukemia cells are present, other symptoms may include: A full or swollen belly from leukemia cells in the liver or spleen Enlarged lymph nodes such as in the neck or groin, under arms, or above the collarbone Bone or joint pain Headache[webmd.com]
    • This can cause a series of neurological symptoms (related to the brain and nervous system), including: headaches seizures (fits) vomiting blurred vision dizziness When to get medical advice If you or your child has some or even all of the symptoms listed[nhs.uk]
  • more...
  • Immune System
    Splenomegaly
    • About 10-20% of ALL patients may present with left upper quadrant fullness and early satiety due to splenomegaly .[emedicine.medscape.com]
    • , purpura, or bleeding within the skin petechiae, which are red or purple spots on the body lymphadenopathy, which is characterized by enlarged lymph nodes in the neck, under the arms, or in the groin region hepatomegaly, or enlargement of the liver splenomegaly[healthline.com]
    • Abdominal distention due to hepatomegaly and splenomegaly.[patient.info]
  • more...
  • Skin
    Night Sweats
    • sweats These symptoms can occur with other conditions.[nlm.nih.gov]
    • He had night sweats and no appetite.[mdanderson.org]
    • A doctor should be contacted when someone has any of the following problems: Weakness or feeling tired Fever or night sweats Easy bruising or bleeding Petechiae (flat, pinpoint spots under the skin, caused by bleeding) Shortness of breath Weight loss[northwell.edu]
    • According to the LLS, common symptoms include: Chills, fever or night sweats Persistent weakness and fatigue Shortness of breath upon exertion Pale skin Pinhead-sized red dots under the skin Unexplained bruises Slow-healing cuts and excess bleeding Joint[livescience.com]
    Petechiae
    • A physical exam may reveal the following: Bruising Enlarged liver , lymph nodes, and spleen Signs of bleeding (petechiae, purpura ) Blood tests may include: Complete blood count (CBC), including white blood cell (WBC) count Platelet count Bone marrow[nlm.nih.gov]
    • Exams and Tests A physical exam may reveal the following: Bruising Enlarged liver , lymph nodes, and spleen Signs of bleeding (petechiae, purpura ) Blood tests may include: Complete blood count (CBC), including white blood cell (WBC) count Platelet count[mountsinai.org]
    • Patients present with any of the signs and symptoms of marrow failure such as pallor and fatigue caused by anemia, petechiae and ecchymoses caused by thrombocytopenia, and fever related to granulocytopenia.[pathpedia.com]
    • Symptoms of ALL include: Fever Easy bruising or bleeding that is hard to stop Flat, dark-red skin spots (petechiae) due to bleeding under the skin Pain in the bones or joints Lumps in the neck, underarm, stomach or groin Weakness, fatigue, paleness or[ochsner.org]
    Purpura
    • A physical exam may reveal the following: Bruising Enlarged liver , lymph nodes, and spleen Signs of bleeding (petechiae, purpura ) Blood tests may include: Complete blood count (CBC), including white blood cell (WBC) count Platelet count Bone marrow[nlm.nih.gov]
    • Exams and Tests A physical exam may reveal the following: Bruising Enlarged liver , lymph nodes, and spleen Signs of bleeding (petechiae, purpura ) Blood tests may include: Complete blood count (CBC), including white blood cell (WBC) count Platelet count[mountsinai.org]
    • […] bleeding gums or nosebleeds high temperature (fever) of 38C (100.4F) or above night sweats bone and joint pain easily bruised skin swollen lymph nodes (glands) abdominal pain – caused by a swollen liver or spleen unexplained weight loss a purple skin rash (purpura[nhs.uk]
    • The symptoms of ALL may include: paleness, or pallor bleeding from the gums a fever bruises, purpura, or bleeding within the skin petechiae, which are red or purple spots on the body lymphadenopathy, which is characterized by enlarged lymph nodes in the[healthline.com]
  • more...
  • respiratoric
    Cough
    • Wheezing, coughing and/or painful breathing requires immediate medical attention.[danafarberbostonchildrens.org]
    • Any wheezing, coughing and/or labored or painful breathing requires immediate medical attention.[chop.edu]
    • These symptoms can include fever, increased risk of infection (especially bacterial infections like pneumonia, due to neutropenia; symptoms of such an infection include shortness of breath, chest pain, cough, vomiting), increased tendency to bleed (due[en.wikipedia.org]
    • Report to the doctor any symptoms of fever, chills, cough, difficulty breathing, rash or changes in skin, and severe diarrhea or vomiting.[umm.edu]
    Dyspnea
    • Symptoms of anemia are common and include fatigue, dizziness, palpitations, and dyspnea upon even mild exertion.[emedicine.medscape.com]
    • Dyspnea (difficulty breathing) — In some cases of ALL, leukemia cells tend to clump together and form a mass in the middle of the chest.[danafarberbostonchildrens.org]
  • more...
  • gastrointestinal
    Loss of Appetite
    • Symptoms of ALL include: Weakness or feeling tired Fever Easy bruising or bleeding Bleeding under the skin Shortness of breath Weight loss or loss of appetite Pain in the bones or stomach Pain or a feeling of fullness below the ribs Painless lumps in[nlm.nih.gov]
    • […] of appetite Enlarged lymph nodes The signs and symptoms of ALL can be the same as more common children’s illnesses and some children are treated for those other illnesses before leukemia is diagnosed.[curesearch.org]
    • Symptoms include: Bone and joint pain Easy bruising and bleeding (such as bleeding gums, skin bleeding, nosebleeds, abnormal periods) Feeling weak or tired Fever Loss of appetite and weight loss Paleness Pain or feeling of fullness below the ribs Pinpoint[nlm.nih.gov]
    Vomiting
    • Understanding Their Role in Cancer Treatment: Current and Future Perspectives Managing Sensory Disruptions During Cancer Treatments Preventing Chemotherapy Induced Nausea and Vomiting For Health Care Professionals: Care Coordination for Older Men Living[cancercare.org]
    • If this happens, the patient may have neurological symptoms, such as dizziness, vomiting, blurred vision, fits (seizures), and headaches .[medicalnewstoday.com]
    • […] cells are present, other symptoms may include: A full or swollen belly from leukemia cells in the liver or spleen Enlarged lymph nodes such as in the neck or groin, under arms, or above the collarbone Bone or joint pain Headache , trouble with balance, vomiting[webmd.com]
    • This can cause a series of neurological symptoms (related to the brain and nervous system), including: headaches seizures (fits) vomiting blurred vision dizziness When to get medical advice If you or your child has some or even all of the symptoms listed[nhs.uk]
    • […] pain, arthritis, limping; fevers (low or high); neutropenia; fatigue, pallor, petechiae, and bleeding; lymphadenopathy and hepatosplenomegaly Patients with mature-B ALL: Extramedullary masses in the abdomen or head/neck; CNS involvement (eg, headache, vomiting[emedicine.medscape.com]
  • more...
  • musculoskeletal
    Bone Pain
    • Infiltration of the marrow by massive numbers of leukemic cells frequently manifests as bone pain.[emedicine.medscape.com]
    • The most frequent signs are lymphadenopathies, hepatosplenomegaly, fever, signs of haemorrhage, and bone pain.[orpha.net]
    • pain, sometimes associated with swelling of the joints The signs and symptoms of ALL can be the same as more common children’s illnesses and many children are treated for those other illnesses before leukemia is diagnosed.[childrensoncologygroup.org]
    • They’ll likely ask about bone pain, which is one of the first symptoms of ALL.[healthline.com]
    • A high number of leukemia cells can cause bone pain and swelling of the joints .[stbaldricks.org]
  • more...
  • cardiovascular
    Chest Pain
    • These symptoms can include fever, increased risk of infection (especially bacterial infections like pneumonia, due to neutropenia; symptoms of such an infection include shortness of breath, chest pain, cough, vomiting), increased tendency to bleed (due[en.wikipedia.org]
    Palpitations
    • Symptoms of anemia are common and include fatigue, dizziness, palpitations, and dyspnea upon even mild exertion.[emedicine.medscape.com]
    • Initial presentation is usually generalised fatigue and malaise but usually quickly progresses to bone marrow failure. [ 1 ] Symptoms Fatigue, dizziness and palpitations.[patient.info]
    Tachycardia
    • […] bacterial infections like pneumonia, due to neutropenia; symptoms of such an infection include shortness of breath, chest pain, cough, vomiting), increased tendency to bleed (due to thrombocytopenia), and signs indicative of anemia, including pallor, tachycardia[en.wikipedia.org]
    • Tachycardia and a flow murmur.[patient.info]
  • more...
  • hematological
    Easy Bruising
    • Symptoms of ALL include: Weakness or feeling tired Fever Easy bruising or bleeding Bleeding under the skin Shortness of breath Weight loss or loss of appetite Pain in the bones or stomach Pain or a feeling of fullness below the ribs Painless lumps in[nlm.nih.gov]
    • You should see your pediatrician if your child has any of the following: Unexplained fever and headaches Enlarged lymph nodes in the neck, arm pits, or groin Pain in the arms, legs, or back Easy bruising and bleeding Tiny red spots in the skin Fatigue[childrensnational.org]
    • Thrombocytopenia is a condition when there is a low number of platelets which can cause bleeding and easy bruising with no apparent cause.[lls.org]
    • Symptoms include: Bone and joint pain Easy bruising and bleeding (such as bleeding gums, skin bleeding, nosebleeds, abnormal periods) Feeling weak or tired Fever Loss of appetite and weight loss Paleness Pain or feeling of fullness below the ribs Pinpoint[nlm.nih.gov]
    • Symptoms of ALL include: Fever Easy bruising or bleeding that is hard to stop Flat, dark-red skin spots (petechiae) due to bleeding under the skin Pain in the bones or joints Lumps in the neck, underarm, stomach or groin Weakness, fatigue, paleness or[ochsner.org]
  • more...
  • Eyes
  • more...
  • Workup

    The first step towards diagnosing acute lymphocytic leukemia includes blood tests. Laboratory tests are expected to reveal anemia and thrombocytopenia, alongside leukocytosis. Lymphoblasts may also be present. A bone marrow biopsy is also required in order for the diagnosis of ALL to be definitive: the bone marrow is aspirated and biopsized, in order to detect an infiltration by precursor cells and to differentiate between a T or B type leukemia.

    Furthermore, imaging modalities can illustrate the extent of the malignancy. Plain radiographs or a computerized tomography scan can be used to eliminate or confirm suspicion that the disease has disseminated to the brain or spinal cord. Finally, a lumbar puncture can also detect cancerous precursor cells within the cerebrospinal fluid.

    As soon as the diagnosis of ALL is established, HLA-typing is promptly carried out [10] [11].

    Pathology

    Biopsy
  • more...
  • Test Results

    Other Test Results
  • more...
  • Laboratory

    Serum
    Lymphocytes Increased
    • Also, as the number of lymphocytes increases in the blood and bone marrow, there is less room for healthy white blood cells, red blood cells, and platelets.[cancer.gov]
  • more...
  • Cerebrospinal Fluid
  • more...
  • Pleura
  • more...
  • HLA Type
  • more...
  • Imaging

    X-ray
    Mediastinal Mass
    • Others, particularly those with T-cell ALL, present with symptoms related to a large mediastinal mass, such as shortness of breath.[emedicine.medscape.com]
    • Imaging studies No other imaging studies other than chest radiography to evaluate for a mediastinal mass are routinely required in pediatric ALL.[emedicine.medscape.com]
    • Seventeen percent of patients demonstrated T-lineage ALL; one quarter of these coexpressed myeloid antigens. [ 3 ] T-lineage ALL was associated with younger age, male sex, presence of a mediastinal mass, higher WBC count and hemoglobin level, longer survival[emedicine.medscape.com]
    • Radiology CXR may show pneumonia, a mediastinal mass or lytic bone lesions.[patient.info]
  • more...
  • Ultrasound
  • more...
  • Treatment

    Acute lymphocytic leukemia is a type of malignancy that may affect various organs and is treated pharmacologically, by administrating chemotherapy.

    Treatment is individualized depending on the type of all. In general, every therapeutic plan centers around three basic treatment stages:

    • Remission-induction phase
    • Intensification phase
    • Continuation therapy, reserved for those patients who exhibit residual disease

    T-cell acute lymphocytic leukemia is treated with the addition of asparaginase and cyclophosphamide and mature B-cell acute leukemia requires a brief but intensive period of chemotherapy with additional methotrexate, cytarabine and cyclophosphamide.

    Prognosis

    Acute lymphocytic leukemia is considered a curable malignancy, with survival rates being exceptionally high during the past years. Although it progresses rapidly and will threaten the life of the patient, if left untreated, proper therapeutic actions are promising and generally effective.

    Specifically, prognosis depends on a number of factors. Pediatric patients exhibit a greater recovery rate in comparison to adult individuals; amongst the adult group, patients that are diagnosed with ALL before the age of 50 also display a better prognosis. Studies have delineated that the remission rate for patients below the age of 30 is 90%, for patients between the ages of 30 and 60 the rate decreases to 80% and reaches its lowest number, 52%, when referring to patients who are older than 60 years of age [7].

    Furthermore, patients who have a white blood cell count greater than 50,000 at the time of diagnosis are expected to respond better to treatment. The extent of the disease, including infiltration of other organs, involvement of the central nervous system etc, also affects prognosis in a negative way.

    The exact subtype of ALL also makes a difference in the prognosis: patients with a T-cell acute lymphocytic leukemia recover at a bigger rate, compared to individuals with B-cell ALL. Additionally, individuals whose cancer evinces complete remission during the first 5 weeks since the initiation of treatment are seen in a more positive light, in contradistinction to patients whose remission requires longer periods of time or is never achieved.

    Complications

    Acute Leukemia
    • leukemia without major o.r. procedure with mcc 835 Acute leukemia without major o.r. procedure with cc 836 Acute leukemia without major o.r. procedure without cc/mcc 837 Chemotherapy with acute leukemia as sdx or with high dose chemotherapy agent with[icd10data.com]
    • A frequency of 20% blasts is required to confirm a diagnosis of acute leukemia.[casesjournal.biomedcentral.com]
    • Acute leukemia: In acute leukemia, the bone marrow cells cannot mature properly.[cancer.org]
    • leukemia lymphocytic , acute leukemia lymphoid , acute leukemia lymphoblastic , acute lymphoid leukemia , lymphoblastic leukaemia , lymphoblastic leukemia , Leukaemias acute lymphocytic , Leukemia, Acute Lymphocytic , Acute Lymphocytic Leukemia , [M][fpnotebook.com]
    • Ethnicity: Caucasians are more likely to develop acute leukemia than African-Americans, Asians, or Hispanics.[en.wikipedia.org]
    Edema
    • […] or loss of appetite Excessive and unexplained bruising Bone pain, joint pain (caused by the spread of "blast" cells to the surface of the bone or into the joint from the marrow cavity) Breathlessness Enlarged lymph nodes, liver and/or spleen Pitting edema[en.wikipedia.org]
    Hyperuricemia
    • Patients with a high tumor burden, particularly those with severe hyperuricemia, can present in renal failure.[emedicine.medscape.com]
    Infection
    • As a result, these individuals are at an increased risk of infection.[emedicine.medscape.com]
    • B cells particularly help prevent germs from infecting the body while T cells destroy the infected cells.[cancercenter.com]
    • Infection Prevention Both chemotherapy and transplantation increase the risk for infection.[umm.edu]
    • A low number of white blood cells that fight infection cause the child to get fevers or infections that are hard to treat.[stbaldricks.org]
    Leukocytosis
    • It also allows your doctor to test for dysplasia, which is an abnormal development of immature cells, in the presence of leukocytosis, or increased white blood cells.[healthline.com]
    • A peripheral blood specimen ( A ) showed marked leukocytosis (WBC count, 136 K/mL) with hypereosinophilia (Giemsa, 500).[ajcp.oxfordjournals.org]
    • Leukaemia is unlikely in the presence of a normal FBC but the FBC will not always be abnormal in all cases of ALL, as some patients may not yet have marrow suppression. [ 11 ] If the blood count is abnormal, a blood film is essential to help decide whether leukocytosis[patient.info]
    • Baseline leukocytosis and gender were associated with a shorter overall survival.[haematologica.org]
    Leukostasis
    • Although patients may present with symptoms of leukostasis (eg, respiratory distress, altered mental status) because of the presence of large numbers of lymphoblasts in the peripheral circulation, leukostasis is much less common in people with ALL than[emedicine.medscape.com]
    Thrombocytopenia
    • Bleeding can be the result of thrombocytopenia due to marrow replacement.[emedicine.medscape.com]
    • […] lymphoblastic leukemia : lymphocytic leukemia that is marked by an abnormal increase in the number of lymphoblasts, that is characterized by rapid onset and progression of symptoms which include fever, anemia, pallor, fatigue, appetite loss, bleeding, thrombocytopenia[merriam-webster.com]
    • […] a decreased number of red blood cells, known as anemia Fever due to the disease itself or from infection because there are a decreased number of healthy white blood cells, known as neutropenia Bruising or bleeding from decreased platelets, known as thrombocytopenia[childrensoncologygroup.org]
    • […] a decreased number of red blood cells , known as anemia Fever due to the disease itself or from infection because there are a decreased number of healthy white blood cells, known as neutropenia Bruising or bleeding from decreased platelets, known as thrombocytopenia[curesearch.org]
    • Patients present with any of the signs and symptoms of marrow failure such as pallor and fatigue caused by anemia, petechiae and ecchymoses caused by thrombocytopenia, and fever related to granulocytopenia.[pathpedia.com]
  • more...
  • Etiology

    The exact etiologic mechanisms that underlie ALL have yet to be firmly established. There have been, however, observations that lead to the illustration of various factors that are believed to play a role in the causes.

    A genetic background has been proposed, especially due to the 25% possibility of a monozygotic twin to develop the disease, once its sibling is diagnosed with it. ALL has been linked to various other pathologies, such as trisomy 21, Bloom syndrome, Klinefelter syndrome and others [1] [2] [3]. Furthermore, the exposure to radiation or energy from a nuclear explosion, the use of tobacco products and hair dyes, as well as jobs related to electricity are all believed to contribute to the onset of acute lymphocytic leukemia [4].

    It is also believed that viruses can lead to the development of such a malignancy, even though this hypothesis has not been substantiated scientifically. Various polymorphisms in the metabolism of folate is another potential etiologic factor [5].

    Epidemiology

    Although ALL can be diagnosed in patients of all ages, children between the age of 0 to 14 are the ones most commonly affected by it. In fact, this type of cancer has been estimated to display a yearly incidence of approximately 4 cases per 100,000 children in the aforementioned age group [6]. This particular incidence is considered to be an average worldwide estimation.

    The disease exhibits a predilection for Caucasian male individuals and its frequency peak is between 2 and 5 years old.

    Sex distribution
    Age distribution

    Pathophysiology

    Acute lymphocytic leukemia is a malignancy of the hematopoietic system, namely the bone marrow and, subsequently, of the blood. The bone marrow is a vital organ responsible for the production and maturation of all the lines of the blood's components: erythrocytes, white blood cells and platelets.

    The bone marrow produces all three types of cells; after a differentiation process is completed within the organ, it releases mature cells in the circulation. In the case of ALL normal white blood cells fail to differentiate properly and immature precursor cells are released into the circulation. This developmental arrest in the life cycle of leukocytes implies that the immune system does not possess cells that are mature enough to fight infection and the patient is therefore severely immunocompromised. Furthermore, the precursor cells known as lymphoblasts infiltrate the bone marrow to such a degree that they replace the organ's elements and, as a result, it is incapable of producing red cells and platelets as well.

    Prevention

    The exact etiologic factors that underlie acute lymphocytic leukemia have not yet been clarified; it is therefore not possible to provide any strategic plan concerning its avoidance.

    Summary

    Acute lymphocytic leukemia (ALL) is a malignancy of the bone marrow. It affects the leukocytes, which are produced from the precursor cells, but fail to differentiate into mature white cells, because of an early arrest in their development.

    The malignancy is defined as acute, due to the fact that it progresses quickly and, if left without the administration of the proper chemotherapeutic agents, it may threaten the life of the patient. Children are more commonly affected by this type of cancer than adults: a young age is amongst the positive prognostic factors with regard to the efficacy of the treatment.

    The causes of acute lymphocytic leukemia are still not definitively established, although a certain genetic substrate has been proposed. Other factors that potentially contribute to the onset of the disease include exposure to chemicals, smoking and folate metabolism disruption.

    ALL is diagnosed via a complete blood count and a bone marrow biopsy to definitively confirm the diagnosis. A plain radiograph or magnetic resonance imaging scan can be used to detect sites of potential dissemination, which are usually found in the brain or spinal cord. It is treated with chemotherapy and prognosis is generally positive.

    Patient Information

    Acute lymphocytic leukemia (ALL) is a type of cancer that affects the bone marrow, and, subsequently, the blood. It can occur at any age, but children are most commonly affected by it.

    The bone marrow is a vital organ, that is responsible for the production and maturation of all of the cellular components of the blood: red blood cells, white blood cells and platelets. In cases of ALL, the white blood cells do not develop properly and experience a very early arrest in their maturation process. As a result, they are released into the circulation at an earlier developmental stage and are too immature to fight infections and diseases. Moreover, these immature cells, called lymphoblasts, progressively replace the material that the bone marrow is made of and lead to a decreased production of red blood cells and platelets as well.

    Patients with ALL present with a variety of symptoms. Decreased concentrations of red blood cells lead to anemia, fatigue and weakness; less platelets imply a tendency towards hemorrhaging and the presence of immature white blood cells leads to the inability of the organism to protect itself against infections.

    Acute lymphocytic leukemia is diagnosed with a complete blood count and a bone marrow biopsy. Radiologic evaluation is necessary to find out whether the malignant cells have infiltrated the brain or spinal cord. The condition is treated with chemotherapy.

    Self-assessment

    Ask Question


    5000 Characters left Format the text using: # Heading, **bold**, _italic_. HTML code is not allowed.

    References

    1. De Keersmaecker K, Marynen P, Cools J. Genetic insights in the pathogenesis of T-cell acute lymphoblastic leukemia. Haematologica. 2005; 90:1116-1127.
    2. Machatschek JN, Schrauder A, Helm F, et al. Acute lymphoblastic leukemia and Klinefelter syndrome in children: two cases and review of the literature. Pediatr Hematol Oncol. 2004; 21:621-626.
    3. Greaves MF, Maia AT, Wiemels JL, et al. Leukemia in twins: lessons in natural history. Blood. 2003; 102:2321-2333.
    4. Snyder DS, Stein AS, O'Donnell MR, et al. Philadelphia chromosome-positive acute lymphoblastic leukemia secondary to chemoradiotherapy for Ewing sarcoma. Report of two cases and concise review of the literature. Am J Hematol. 2005; 78:74-78.
    5. Koppen IJ, Hermans FJ, Kaspers GJ. Folate related gene polymorphisms and susceptibility to develop childhood acute lymphoblastic leukaemia. Br J Haematol. 2010; 148:3-14.
    6. Ribera JM, Oriol A. Acute lymphoblastic leukemia in adolescents and young adults. Hematol Oncol Clin North Am. 2009 Oct; 23(5):1033-42, vi. 
    7. Larson RA. Acute lymphoblastic leukemia: older patients and newer drugs. Hematology Am Soc Hematol Educ Program. 2005; 131-136.
    8. Muwakkit S, Al-Aridi C, Samra A, et al. Implementation of an intensive risk-stratified treatment protocol for children and adolescents with acute lymphoblastic leukemia in Lebanon. Am J Hematol. 2012 Jul; 87(7):678-83.
    9. Pui CH, Robison LL, Look AT. Acute lymphoblastic leukaemia. Lancet. 2008 Mar 22; 371(9617):1030-43.
    10. Hoelzer D, Gökbuget N, Ottmann O, et al. Acute lymphoblastic leukemia. Hematology Am Soc Hematol Educ Program. 2002:162-192.
    11. Jabbour EJ, Faderl S, Kantarjian HM. Adult acute lymphoblastic leukemia. Mayo Clin Proc. 2005; 80:1517-1527.

    • Morphology using in situ hybridization: an analysis of suspicious cells in bone marrow specimens of two patients completing therapy for acute lymphoblastic leukemia - J Anastasi, JW Vardiman, R Rudinsky - , 1991 - bloodjournal.hematologylibrary.org
    • A five-drug remission induction regimen with intensive consolidation for adults with acute lymphoblastic leukemia: cancer and leukemia group B study 8811 - RA Larson, RK Dodge, CP Burns, EJ Lee - , 1995 - bloodjournal.hematologylibrary.org


    Media References

    1. Acute leukemia-ALL, CC BY-SA 3.0

    Languages

    Self-assessment