Acute Lymphcytic Leukemia

Question 1

How does ALLL present?

Answer 1

Painless lymphadenoapthy
Hepatosplenomegaly
Testicular infiltration causing painless unilateral enlargement
Features fo pancytopenia
Organ filtration with bone pain
CNS involvement may occur

Question 2

What is a key stain in ALL?

Answer 2

Periodic acid-Schaffer stains for carbohydrate material
Tdt positive
Large immature cells with punched out nuclei

Question 3

What is the NICE guidance for referral?

Answer 3

Immediate specialist referral for any young person with unexplained petechiae or hepatosplenomegaly. They must have urgent FBC within 48 hours for leukaemia if there is pallor, unexplained fever, generalised lymphadenoapthy and brusing

Question 4

What is the treatment of ALL?

Answer 4

CNS prophylactic agents
Combination chemotherapy

Question 5

What indicates poor prognosis in ALL?

Answer 5

Male sex
CNS disease
T-ALL type
WCC that is high
Age over 10 or less than 1

Question 6

What indicates good prognsois?

Answer 6

Female gender
Hyperdiploid blast cells
Low white cell count
Fast response to chemotherapy