{"id":5337,"date":"2021-05-15T23:53:42","date_gmt":"2021-05-15T21:53:42","guid":{"rendered":"https:\/\/meddists.com\/learn\/clinical\/hematology\/hematological-oncology\/acute-lymphocytic-leukemia-lymphoma-all\/"},"modified":"2022-02-15T11:34:18","modified_gmt":"2022-02-15T09:34:18","slug":"acute-lymphoid-leukemia-lymphoma-all","status":"publish","type":"page","link":"https:\/\/meddists.com\/learn\/clinical\/internal-medicine\/hematology\/oncological-disorders\/acute-leukemias\/acute-lymphoid-leukemia-lymphoma-all\/","title":{"rendered":"Acute lymphoblastic (lymphocytic) leukemia (ALL)"},"content":{"rendered":"<span class=\"block-heading\" id=\"header_1\">\n<h3 class=\"wp-block-heading\" id=\"introduction\" class=\"wp-block-heading\" id=\"introduction\" class=\"title_collection title1\">Introduction<\/h3>\n<\/span><span class=\"block-content\" id=\"contents_1\">\n\n\n<p class=\"wp-block-paragraph\">In healthy individuals, the number of precursor (-blast) cells in the bone marrow stays at a normal range (since cells maturate and new -blast cells are formed).<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>In acute leukemias, precursor cells (-blasts) lose the ability to maturate, and these cells start proliferating and pile up in the bone marrow<\/li><li>This may affect hematopoiesis and cause&nbsp;<strong>cytopenia<\/strong>&nbsp;(cell number decrease in the blood) of other cell lineages (<strong>thrombocytopenia<\/strong>,&nbsp;<strong>anemia<\/strong>,&nbsp;<strong>leukopenia<\/strong>)<ul><li>The patient may present with symptoms that fit one of the cytopenia types (bleeding, hypoxia, or infections)<\/li><\/ul><\/li><li>Precursor cells usually reach the circulation<ul><li>They will seem polymorphic: larger, with and a big, pale nucleolus<\/li><li>This may result in an increased count of the specific cell lineage<\/li><\/ul><\/li><li>Acute leukemias have a sudden onset, they can arise on their own or as a progression of chronic leukemia<\/li><li>Progress quickly, but are curable<\/li><li>Mostly affect younger patients.<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_2\">\n<h3 class=\"wp-block-heading\" id=\"acute-lymphoblastic-leukemia\" class=\"wp-block-heading\" id=\"acute-lymphoblastic-leukemia\" class=\"title_collection title1\">Acute lymphoblastic leukemia<\/h3>\n<\/span><span class=\"block-content\" id=\"contents_2\">\n\n\n<p class=\"wp-block-paragraph\">Acute lymphoblastic leukemia (ALL) is a clonic proliferation of immature lymphocytes in the bone marrow.<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li><strong>Acute <\/strong>= sudden onset, of precursor (blast) cells; <strong>lymphoblastic <\/strong>= of lymphoblasts (TdT positive); leukemia = cancer of the blood and bone marrow.<\/li><li>Most common in young children; can also appear in older adults; the most common pediatric cancer.<\/li><li>Similarly to AML, most cases result from inherited genetic mutations<ul><li>Most common point mutations include NOTCH1, WT1, EZH2<\/li><li>Chromosomal translocations include t(9;22), t(12;21), and 11q23<ul><li>t(12;21) has a&nbsp;good prognosis, mostly seen in children<\/li><li>t(9;22) has a bad prognosis, mostly seen in adults (Philadelphia chromosome; BCR-ABL fusion)<\/li><\/ul><\/li><\/ul><\/li><li>Divided based on the cell lineage: B-ALL (most common), T-ALL (less common; bad prognosis), NK-ALL (rare).<ul><li>B-cell-specific markers: CD19, CD20<\/li><li>T-cell-specific markers: CD2, CD3, CD7<\/li><li>NK-cell-specific markers: CD56<\/li><\/ul><\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_3\">\n<h4 class=\"wp-block-heading\" id=\"classification\" class=\"wp-block-heading\" id=\"classification\" class=\"title_collection title2\">Classification<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_3\">\n\n\n<p class=\"wp-block-paragraph\">French-American-British classification with 3 classes (L1-L3) that has been replaced with 13 major groups defined by WHO, based on the cell type and the major genetic alterations.<\/p>\n\n\n<\/span><span class=\"block-heading\" id=\"header_4\">\n<h4 class=\"wp-block-heading\" id=\"clinical-presentation\" class=\"wp-block-heading\" id=\"clinical-presentation\" class=\"title_collection title2\">Clinical presentation<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_4\">\n\n\n<ul class=\"wp-block-list\"><li>Thrombocytopenia, anemia, and neutropenia resulting in bleeding, anemia, and infections<\/li><li>Tender bones and lymphadenopathy due to organ infiltration<\/li><li>Fever<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_5\">\n<h4 class=\"wp-block-heading\" id=\"diagnosis\" class=\"wp-block-heading\" id=\"diagnosis\" class=\"title_collection title2\">Diagnosis<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_5\">\n\n\n<ul class=\"wp-block-list\"><li>Blood count (showing anemia and thrombocytopenia with varying white cell count)<\/li><li>Blood smear (showing blast cells)<\/li><li>Bone marrow sampling (hypercellular with many blast cells) with immunohistological staining<\/li><li>Flow cytometry (identifying the cell type; B-cells: CD19, CD20; T-cells: CD3, CD2, CD7)<\/li><li>Cytogenic analysis (karyotyping, FISH)<\/li><li>Molecular genetic analysis<\/li><li>MRD (minimal residual disease) using special flow-cytometry techniques for the detection of possible residual tumor cells at the end of treatment.<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_6\">\n<h4 class=\"wp-block-heading\" id=\"treatment\" class=\"wp-block-heading\" id=\"treatment\" class=\"title_collection title2\">Treatment<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_6\">\n\n\n<ul class=\"wp-block-list\"><li><strong>Induction<\/strong>: Vincristine + corticosteroids +- daunorubicin (4-6 weeks)<\/li><li><strong>Consolidation<\/strong>: Cyclophosphamide\/cytarabine\/6-MP\/daunorubicin (6-9 months)<\/li><li><strong>Maintenance<\/strong>: 6-MP\/MTX +-corticosteroids (3 years)<\/li><li><strong>SCT<\/strong><\/li><li><strong>TK inhibitors<\/strong>: imatinib (in BCR-ABL1)<\/li><\/ul>\n<\/span><div id=\"the_titles\" style=\"display:none;\"><h3 class=\"wp-block-heading\" id=\"introduction\" class=\"wp-block-heading\" id=\"introduction\">Introduction<\/h3><h3 class=\"wp-block-heading\" id=\"acute-lymphoblastic-leukemia\" class=\"wp-block-heading\" id=\"acute-lymphoblastic-leukemia\">Acute lymphoblastic leukemia<\/h3><h4 class=\"wp-block-heading\" id=\"classification\" class=\"wp-block-heading\" id=\"classification\">Classification<\/h4><h4 class=\"wp-block-heading\" id=\"clinical-presentation\" class=\"wp-block-heading\" id=\"clinical-presentation\">Clinical presentation<\/h4><h4 class=\"wp-block-heading\" id=\"diagnosis\" class=\"wp-block-heading\" id=\"diagnosis\">Diagnosis<\/h4><h4 class=\"wp-block-heading\" id=\"treatment\" class=\"wp-block-heading\" id=\"treatment\">Treatment<\/h4><\/div>","protected":false},"excerpt":{"rendered":"<p>Introduction In healthy individuals, the number of precursor (-blast) cells in the bone marrow stays at a normal range (since cells maturate and new -blast cells are formed). In acute leukemias, precursor cells (-blasts) lose the ability to maturate, and these cells start proliferating and pile up in the bone marrow This may affect hematopoiesis [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":5472,"menu_order":1,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-5337","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.9 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Acute lymphoblastic (lymphocytic) leukemia (ALL) &#8211; Meddists<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/meddists.com\/learn\/clinical\/internal-medicine\/hematology\/oncological-disorders\/acute-leukemias\/acute-lymphoid-leukemia-lymphoma-all\/\" \/>\n<meta name=\"twitter:label1\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data1\" content=\"2 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/meddists.com\\\/learn\\\/clinical\\\/internal-medicine\\\/hematology\\\/oncological-disorders\\\/acute-leukemias\\\/acute-lymphoid-leukemia-lymphoma-all\\\/\",\"url\":\"https:\\\/\\\/meddists.com\\\/learn\\\/clinical\\\/internal-medicine\\\/hematology\\\/oncological-disorders\\\/acute-leukemias\\\/acute-lymphoid-leukemia-lymphoma-all\\\/\",\"name\":\"Acute lymphoblastic (lymphocytic) leukemia (ALL) &#8211; 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