Acute Lymphoblastic Leukaemia

Question 1

What is ALL?

Answer 1

Malignancy of lymphoid cells that affect B or T cell lineages

Question 2

What are important associations of ALL?

Answer 2

Ionising radiation, Down’s syndrome

Question 3

What is the commonest cancer of childhood?

Answer 3

ALL

Question 4

How does ALL cause problems?

Answer 4

Arresting maturation, promotes uncontrolled proliferation of immature blast cells, marrow failure, tissue infiltration

Question 5

What are signs and symptoms due to?

Answer 5

Marrow failure and infiltration

Question 6

What signs and symptoms are due to marrow failure and what type of blood cell are they due to?

Answer 6

Anaemia - RBC, Infections - WCC, Bleeding - Platelets

Question 7

What signs and symptoms are due to infiltration?

Answer 7

Hepatomegaly, Splenomegaly, Lymphadenopathy, CNS involvement, SVC obstruction

Question 8

What investigations would you do?

Answer 8

FBC, Blood film, Lumbar puncture, CXR/CT

Question 9

In which test would you find characteristic blast cells?

Answer 9

Blood film

Question 10

What is the purpose of a CXR/CT scan?

Answer 10

To look for lymphadenopathy

Question 11

What is the purpose of a lumbar puncture?

Answer 11

To look for CNS involvement

Question 12

What management would you start?

Answer 12

Blood and platelet transfusions, chemo, steroids, intrathecal drugs, stem cell transplant

Question 13

How would you treat infections?

Answer 13

IV antibiotics

Question 14

What is morphological classification?

Answer 14

Classification based on microscopic appearance

Question 15

What does L1 look like?

Answer 15

Small blasts with scanty cytoplasm

Question 16

What does L2 look like?

Answer 16

Larger blast cells with greater morphological variation and more abundant cytoplasm

Question 17

What does L3 look like?

Answer 17

Blasts with vacuolated basophilic cytoplasm

Question 18

What is immunological classification?

Answer 18

Classification based on surface markers. Separates in precursor B cell, T cell and B cell

Question 19

What is cytogenetic classification?

Answer 19

Classification based on chromosomal analysis

Question 20

What drug would you start to prevent tumour lysis syndrome?

Answer 20

Allopurinol

Question 21

Give an example of an intrathecal drug

Answer 21

Methotrexate