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    1. Acute lymphoblastic leukemia (ALL) is a cancer of the blood and bone marrow that is the most common childhood malignancy, making up about 1/3 of all pediatric cancers. 2. ALL is classified based on morphology and immunological markers into subtypes including ALL-L1, ALL-L2, ALL-L3, precursor B-ALL, and T-ALL. 3. Diagnosis involves clinical features of bone marrow failure and organ infiltration as well as laboratory tests including complete blood count, blood chemistry, lumbar puncture, imaging, immunophenotyping, and cytogenetic analysis.

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    1. Acute lymphoblastic leukemia (ALL) is a cancer of the blood and bone marrow that is the most common childhood malignancy, making up about 1/3 of all pediatric cancers. 2. ALL is classified based on morphology and immunological markers into subtypes including ALL-L1, ALL-L2, ALL-L3, precursor B-ALL, and T-ALL. 3. Diagnosis involves clinical features of bone marrow failure and organ infiltration as well as laboratory tests including complete blood count, blood chemistry, lumbar puncture, imaging, immunophenotyping, and cytogenetic analysis.

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    1. Acute lymphoblastic leukemia (ALL) is a cancer of the blood and bone marrow that is the most common childhood malignancy, making up about 1/3 of all pediatric cancers. 2. ALL is classified based on morphology and immunological markers into subtypes including ALL-L1, ALL-L2, ALL-L3, precursor B-ALL, and T-ALL. 3. Diagnosis involves clinical features of bone marrow failure and organ infiltration as well as laboratory tests including complete blood count, blood chemistry, lumbar puncture, imaging, immunophenotyping, and cytogenetic analysis.

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    MEDICAL LECTURE

    ACUTE LYMPHOBLASTIC LEUKEMIA


    SUSANTO NUGROHO

    Haematology-Oncology Division Department of Child Health Faculty of Medicine University of Brawijaya/Dr. Saiful Anwar Hospital Malang

    INTRODUCTION
    ALL is a cancer of the blood & bone marrow (spongy tissue in the centre of bone) Acute leukemia is the most common childhood malignancy : 1/3 of all pediatric cancers & about 75% is ALL The peak incidence : occurs between 3 4 yrs old; more common in boys than girls

    RISK FACTORS
    1. GENETIC FACTORS - may predispose children to develop leukemia - germline chromosomal abnormalities have been associated with childhood leukemia 2. ENVIRONMENTAL FACTORS exposure to pesticides/herbicides, maternal use of alcohol, chemical contamination, radiation, etc

    CLASSIFICATION
    Based on morphology FAB (The FrenchAmerican-British) group subclassified ALL into 3 subtypes : a. ALL-L1 : uniform, small blast cell with scanty cytoplasm b. ALL-L2 : larger with more prominent last cell nucleoli cytoplasm, more heterogenity c. ALL-L3 : large with prominent nucleoli, strongly basophilic cytoplasm & cytoplasmic vacuoles

    CLASSIFICATION..
    Classification of ALL based on immunological markers : a. Precursor B-ALL b. T-ALL c. B-ALL

    DIAGNOSIS
    A. CLINICAL FEATURES Clinical features are secondary Bone marrow failure : - Anemia : pallor, lethargy, dyspnoea - Neutropenia : fever, malaise, feature infections - Thrombocytopenia : spontaneous bruises, purpura & gum bleeding Organ infiltration : tender bones, lymphadenopathy, hepatomegaly, splenomegaly, meningeal syndrome

    DIAGNOSIS..
    B. LAB & OTHER EXAMINATIONS 1. Basic laboratory tests - Complete blood count (CBC) : pancytopenia, blast cell (+) - Blood chemistry studies : K, P, Ca, uric acid, LDH - Coagulation studies : PT, aPTT, fibrinogen level, D-dimer 2. Lumbar puncture/LCS : blast cell (+) 3. X-ray : lytic bone lession, mediastinal mass

    DIAGNOSIS..
    4. BM aspiration or biopsy 5. Immunophenotyping : complete morphologic, immunologic and genetic examination 6. Cytogenetic & molecular diagnosis : chromosome analyses

    TREATMENT
    A. General supportive therapy Central venous catheter to give chemotherapy, blood product, antibiotics, i.v. feeding Prevention of vomiting Blood component transfusion Prevention of TLS : allopurinol, hidration, alkalization Prophylaxis & treatment of infections

    TREATMENT..
    B. Chemotherapy To plan protocol risk group : Standard risk : 1-9 yrs, WBC < 50,000 High risk : < 1 yr or > 9 yrs, WBC > 50,000 Indonesia Protocol-ALL 2006 : Induction phase Consolidation phase Reinduction phase Maintenance phase

    PROGNOSIS
    Prognosis (chance of recovery) from childhood ALL is usually very good. Succesfully of treatment & prognosis depend on : - Age & WBC at diagnosis - Response to initial treatment - Origin of leukemia cells (B or T-cell) - Certain changes in the chromosome of the lymphocytes - CNS involvement

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