T-ALL

Question 1

Clinical Fts of T-ALL

Answer 1

1. Male Teens
2. LAD & HSM
3. Large mediastinal/tissue mass
4. +++ WCC

Question 2

Morphology in T-ALL

Answer 2

Blasts:
* Scanty basophilic agranular cytoplasms
* May resemble mature lymphos
* Hand-mirror forms

Question 3

IMPT of T-ALL

Answer 3

• CD3 (T-cell defining)
• Positive for CD2, 5, 7

Question 4

T-ALL Treatment approach:

Answer 4

I. Multiagent Chemo (VAP)
* Vincristine
* Anthracycline (Doxo/Dauno)
* Pred
II. Dexa
III. Nelarabine
IV. IV MTX and asparginase

No need for prophylactic CNS RT

Question 5

Prognosis of T-ALL

Answer 5

1. MRD Negativity post consolidation = best predictor
2. T-ALL worse prognosis than B-ALL

Question 6

Normal T-cell development:

Answer 6

I. Pro-T
* Dual Neg
* cCD3, CD7 ± CD34

II. Pre-T
* Dual Neg
* “, + CD2

III. Cortical-T
* Dual Pos
* “, + CD1a
* - CD34

IV. Medullary-T
* Single Pos
* “, + sCD3

Question 7

Features of ETP-ALL

Answer 7

• BM and Blood
• LN & HSM = common (mediastinal + CNS = some)
• BCL2 expression

Question 8

Diagnostic criteria of ETP-ALL

Answer 8

1. cCD3+
   2.** CD1a- & CD8-**
2. CD5dim/-
3. >25% blasts have 1+ myeloid markers (CD11b, 13, 33, 65, 117)
4. ” with 1+ SC marker (CD34/HLA-DR)

Note: Near-ETP-ALL: CD5+ of >75% of blasts (but other criteria above are met)