Acute Lymphoblastic Leukemia Dr. Krafts 5/9/14

Question 1

Acute Lymphoblastic Leukemia things you must know

Answer 1

• Malignant proliferation of lymphoid blasts in blood, bone marrow
• Classified by immunophenotype (B vs. T)
• More common in children (assume ALL until proven otherwise***)
• Prognosis often good! (bad in adults)

Question 2

ALL classification by immunophenotype

Answer 2

T-lymphoblastic leukemia (worse prognosis)

• TdT (enzyme present only in lymphoblasts)(confirm dealing w/ lymphoblastic process)
• T-cell Ag

B-lymphoblastic leukemia (better prognosis)

• TdT
• B-cell Ag

Question 3

T-lymphoblastic leukemia things you must know

Answer 3

• = T-lymphoblastic lymphoma
• Teenage male with mediastinal -mass***
• WBC usually increased
• Bad prognosis

Question 4

B-lymphoblastic leukemia things you must know

Answer 4

• = B-cell lymphoblastic lymphoma
• Several sub- and sub-subtypes
• TdT +
• Rarely, Ph + ! (philadelphia chromosome, seen normally in CML (t9:22 bad prognosis tyrosine kinase)***

Question 5

Tx and prognosis of ALL

Answer 5

Prognosis

• Immunophenotype (T is bad)
• Age (1-10 good) Children***
• WBC (<10,000 good)
• Cytogenetics (hyperdiploidy good!)(more than 1 set of chromosomes in tumor cells)

Treatment
Chemo ± bone marrow transplant
Many children are cured!