Acute Lymphoblastic Leukaemia

Question 1

COMMS: ALL

Answer 1

• Blood is made up of several components such as RBC which carry oxygen, white blood cells which fight infections and platelets which help the blood clot
• These particular blood cells are made in the bone marrow, a spongy material in the middle of many bones
• In blood cancers, some of these blood cells may excessively be produced and released in the blood stream
• In ALL white cells called lymphoblasts are rapidly produced and released in the blood too early before they have fully become functioning mature cells
• As these blast cells do not work properly this can cause symptoms. You also get a reduced number of the other blood cells being produced as energy resources are being diverted towards cancer growth which also results in symptoms

Question 2

What is the epidemiology of ALL?

Answer 2

• Children - peak age 4yrs (most common type)

- Bimodal in adults - 15-25yrs AND >75yrs

Question 3

What are the symptoms of ALL?

Answer 3

• Anaemia – generally feeling tired, SOB on exercise, weakness
• Bleeding and bruising = thrombocytopaenia
• Infection = leukopaenia
• Bone pain = as a result of bone marrow infiltration

Question 4

What are clinical signs of ALL?

Answer 4

OFTEN NONE

• Pallor
• Fever – due to infection
• Petechiae – purple spots (rupture small vessel)
• Lymphadenopathy – in lymphoblastic leukaemia
• Hepatosplenomegaly – in lymphoblastic leukaemia
• Testicular enlargement
• Cranial nerve palsies – (rare) due to CNS infiltration

Question 5

What are the investigations for ALL?

Answer 5

BLOODS

• Hb = low
• Platelets = low
• WCC = high/normal/low

BLOOD FILM
-High presence of lymphoblast cells

BONE MARROW ASPIRATE
-Followed by cytology + genetic studies to determine lineage and potential mutations

Question 6

What are the treatments for ALL?

Answer 6

SUPPORTIVE

• Treat infections/bleeding
• Reduce anaemia symptoms

CURATIVE

• Remission induction = most tumour destroyed via chemotherapy
• Remission consolidation = if induction fails another treatment (chemo) will be used to destroy tumour
• Maintaining remission = once tumour destroyed, treatment in outpatient setting up to 3 years
• Stem cell transplantation - esp. if destroyed by chemo/radiotherapies

Question 7

What is the prognosis of ALL?

Answer 7

• Cure rates in children high (60-90%)

- Low in adults due to mutations