acute lymphoid leukemia

Question 1

Acute lymphoblastic leukemia

Answer 1

less common in adults

two main categories
Precursor B cell lymphoblastic leukemia
Precursor T cell lymphoblastic leukemia

Question 2

Diagnosis of ALL

Answer 2

bone marrow aspirate

> 25 percent bone marrow blasts
lymphoid lineage

Question 3

Treatment of ALL

Answer 3

Need to determine whether the cancer is Philadelphia chromosome positive

When treated with chemotherapy alone, patients with Ph+ ALL have a uniformly poor prognosis with few survivors at five years after treatment

Incorporation of a tyrosine kinase inhibitor (TKI) of BCR-ABL1 (imatinib, dasatinib, nilotinib, bosutinib, ponatinib) into the treatment regimen has resulted in superior response rates, thereby allowing more patients to proceed to allo-HCT.

Induction = TKI and chemotherapy

CNS prophylaxis with methotrexate

in Philadelphia negative ALL Combination chemotherapy is the primary treatment modality There is no role for surgery or radiation therapy in the induction phase

no best therapy
hyper CVAD

rituximab if cd20 positive
TKI if bcr/abl positive