Acute Lymphblastic Leukaemia

Question 1

What is ALL?

Answer 1

Malignancy of primitive lymphoid cells

Acute proliferation of one type of lymphocyte, usually B

Question 2

Who is ALL most common in?

Answer 2

Kids under 5 (most common childhood cancer) but can also affect adults

Question 3

What is ALL associated with?

Answer 3

Down syndrome
Philadelphia chromosome

Question 4

What is the pathophysiology of ALL?

Answer 4

t(9:22) translocation -> abnormal BCR-ABL1 gene

Leads to production of abnormal tyrosine kinase which promotes excess cell proliferation

Question 5

How does ALL present?

Answer 5

Pancytopenia associated symptoms- anaemia, neutropenia, thrombocytopenia
Bone pain

Hepatosplenomegaly and lymphadenopathy MORE PROMINENT IN ALL THAN AML

Question 6

Investigations for ALL

Answer 6

FBC and blood film-
Pancytopenia and immature lymphocytic cells
NO Auer rods
Coagulation screen for DIC

for definitive diagnosis- immunophenotyping bone marrow aspirate
Also genetic testing for Philadelphia chromosome translocation

Question 7

How is ALL treated?

Answer 7

Supportive care

3-4 chemotherapy cycles
Stem cell transplants
Targeted therapy eg tyrosine kinase inhibitors

For long term central venous access- Hickman line

Question 8

Complications of ALL

Answer 8

Consequences of pancytopenia symptoms-

Susceptibility to infection due to neutropenia, fatigue and weakness due to anaemia, easy bleeding and bruising due to thrombocytopenia

Question 9

Complications of ALL treatment

Answer 9

Nausea and vomiting
Hair loss
Hepatic/renal dysfunction
Tumour lysis syndrome

Bacterial infection -> treated with broad spectrum antibiotics (particularly gram -ve) when neutropenic fever presents
Also possible to get fungal and protozoal infections