ACUTE LYMPHOBLASTIC LEUKEMIA

Prepared by :

Dr Gul Rahman Aleemi

MBBS
Resident Ophthalmologist MS
WBC CELLS
OVERVIEW
TYPES OF LEUKEMIA
 BASIC PRINCIPLES OF
ACUTE LEUKEMIA

• Neoplastic proliferation of blasts; defined as the accumulation of > 20% blasts

in the bone marrow.
1-Blasts usually enter the blood stream, resulting in a high WBC count
(leukostasis) Blasts are large, immature cells, often with punched out nucleoli
2-Leukemic cell infiltration of liver, spleen,painless lymph nodes, and skin
(leukemia cutis) May spread to CNS and testes.
3-Bone pain (tender sternm)
Increased blasts "crowd-out" normal hematopoiesis, resulting in an "acute"
presentation with anemia (fatigue), thrombocytopenia (bleeding), or neutropenia
(infection).
 ACUTE LYMPHOBLASTIC LEUKEMIA

• Neoplastic accumulation of lymphoblasts ( > 20%) in the bone marrow

• Lymphoblasts are characterized by positive nuclear staining for TdT (Terminal
deoxynucleotidyl transferase) a DNA polymerase , absent in myloid cells and
mature lymphoblast
• Most commonly arises in children; associated with Down syndrome (usually
arises after the age of 5 years)
 RISK FACTORS

• Genetic + Environmental
• Antineoplastic agents e.g etoposide
• Radiations
• Benzene
• Hodgkin’s lymphoma
• Multiple myeloma
• Labs hyperureciamia hyperkalemia , hyper phosphatemia
 SUBTYPES

• 1_B-ALL
• is the most common type of ALL.
• Usually characterized by lymphoblasts (TdT + ) that express CD10, CD19, and
CD20. 2. Excellent response to chemotherapy; requires prophylaxis to scrotum
and CSF
• 3. Prognosis is based on cytogenetic abnormalities. i. t(12;21) has a good
prognosis; more commonly seen in children
• ii. t(9;22) has a poor prognosis; more commonly seen in adults (Philadelphia+
ALL)
 SUBTYPES

• 2-T-ALL
is characterized by lymphoblasts (TdT + ) that express markers ranging from
CD2 to CD8 (e.g., CD3, CD4, CD7). The blasts do not express CD10.

• Usually presents in teenagers as a mediastinal (thymic) mass (called acute

lymphoblastic lymphoma because the malignant cells form a mass)
 INVESTIGATIONS

• CBC
• PERIPHERAL BLOOD SMEAR
• BONE MARROW BIOPSY >20 % BLASTS
• CHROMOSOME Analysis
• Flow Cytometry
• stains
 TREATMENT

Chemo treatment for ALL is typically divided into 3 phases:

• Induction, which is short and intensive, usually lasts about a month.
• Consolidation (intensification), which is also intensive, typically lasts for a few
months.
• Maintenance (post-consolidation), which is less intensive, typically lasts for about
2 years.

Most chemo drugs have trouble reaching the area around the brain and spinal cord, so
chemo may need to be injected into the cerebrospinal fluid (CSF) to kill cancer cells in
that area. This is called intrathecal chemo
 MEDICATION

• Vincristine
• Daunorubicin / doxorubicin
• Methotrexate ( intrathecal )
• Cyclophosphamide
• Prednisone
• Dexamethasone

• Tyrosisne kinase inhibitors

• Bone marrow transplantation

Side effects
• nerve injury , cardiac toxicity , bone marrow dysfunction , Tumor LS
 .

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