Hematology and Oncology Book

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Acute Lymphocytic Leukemia

Aka: Acute Lymphocytic Leukemia, ALL
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  1. History
    1. Success story of Twentieth Century Oncology
    2. Previously ALL was 100% fatal in 3 months
    3. Current Chemotherapy regimens hold >50% cure
  2. Epidemiology
    1. Disease of children
  3. Symptoms
    1. See Acute Leukemia
    2. Distinguishing features from Acute Lymphocytic Leukemia
      1. Gastrointestinal symptoms from hepatosplenomegaly
      2. Nausea
      3. Abdominal fullness
      4. Early Satiety
  4. Signs
    1. See Acute Leukemia
    2. Distinguishing features from Acute Lymphocytic Leukemia
      1. Hepatomegaly or Splenomegaly (50% to 75%)
      2. Lymphadenopathy
      3. Testicular involvement may occur
      4. Anterior mediastinal mass (T-Cell Variant)
  5. Pathology
    1. Immature Lymphoblasts
      1. Round or convoluted nuclei
      2. Smaller than in Acute Myelogenous Leukemia
      3. Contain deoxynucleotidyl transferase in 90% of cases
        1. Rarely present in Acute Myelogenous Leukemia
      4. Express Common ALL Antigen (CALLA) in 60% of cases
    2. Cell Types
      1. T-Cell Type (20% of cases)
      2. B-Cell Type (5%)
      3. Null Cell Type (15%)
  6. Management
    1. Remission-Induction Chemotherapy
      1. Vincristine
      2. Prednisone
      3. Daunorubicin or L-asparaginase
    2. CNS Prophylaxis (prevents Leukemic Meningitis)
      1. Whole Brain Radiation (18 to 24-Gy)
      2. Intrathecal Methotrexate
    3. Maintenance Chemotherapy for 2-3 years
      1. 6-Mercaptopurine
      2. Methotrexate
  7. Prognosis
    1. Child: Probable cure in >50%
    2. Adult: Long term survival <30%
  8. Complications
    1. See Acute Leukemia
    2. Leukemic Meningitis in relapse
      1. Headache and Nausea
      2. Cranial Nerve palsy
      3. Seizures
      4. Altered Level of Consciousness
    3. General Chemotherapy complications
      1. Lymphocytopenia
      2. Immunodeficiency (predominantly T-Cells)
        1. Pneumocystis carinii Pneumonia
      3. Growth retardation (most attain normal growth)
      4. Sterility (most resolves)
    4. Cyclophosphamide related
      1. Bladder Cancer
    5. Anthracycline (doxorubicin or daunorubicin) related
      1. Cardiomyopathy
    6. Cranial radiotherapy related
      1. CNS tumor
      2. Papillary Thyroid Carcinoma
      3. Acute monocytic Leukemia
      4. Cognitive decline
      5. Osteoporosis
      6. Obesity
      7. Periodontal Disease
      8. Cataracts

Acute lymphocytic leukemia (C0023449)

Definition (NCI) Leukemia with an acute onset, characterized by the presence of lymphoblasts in the bone marrow and the peripheral blood. It includes the acute B lymphoblastic leukemia and acute T lymphoblastic leukemia.
Definition (MEDLINEPLUS)

Leukemia is cancer of the white blood cells. White blood cells help your body fight infection. Your blood cells form in your bone marrow. In leukemia, however, the bone marrow produces abnormal white blood cells. These cells crowd out the healthy blood cells, making it hard for blood to do its work. In acute lymphocytic leukemia (ALL), there are too many of specific types of white blood cells called lymphocytes or lymphoblasts.

Possible risk factors for ALL include being male, being white, being older than 70, previous chemotherapy treatment, or exposure to radiation.

Symptoms of ALL include:

  • Weakness or feeling tired
  • Fever
  • Easy bruising or bleeding
  • Bleeding under the skin
  • Shortness of breath
  • Weight loss or loss of appetite
  • Pain in the bones or stomach
  • Pain or a feeling of fullness below the ribs
  • Painless lumps in the neck, underarm, stomach, or groin

Tests that examine the blood and bone marrow diagnose ALL. Treatments include chemotherapy, radiation therapy, stem cell transplants, and targeted immune therapy. Once the leukemia is in remission, you need additional treatment to make sure that it does not come back.

NIH: National Cancer Institute
Definition (NCI) An aggressive (fast-growing) type of leukemia (blood cancer) in which too many lymphoblasts (immature white blood cells) are found in the blood and bone marrow.
Definition (CSP) acute leukemia in which lymphoblasts and their progenitor cells predominate; the most common childhood cancer and accounts for 20 percent of adult acute leukemia; common ALL antigen (CALLA) expressed in most cases.
Concepts Neoplastic Process (T191)
ICD9 204.0
ICD10 C91.0, C91.00, M9821/3
SnomedCT 90151006, 91857003, 154588002, 190034000, 128822004
English Lymphoid leukemia, acute, ACUTE LYMPHOBLASTIC LEUKEMIA, ACUTE LYMPHOCYTIC LEUKEMIA, LEUKEMIA LYMPHOBLASTIC ACUTE, LEUKEMIA, LYMPHOBLASTIC, ACUTE, LEUKEMIA, LYMPHOCYTIC, ACUTE, ALL - Acute lymphobl leukaemia, ALL - Acute lymphobl leukemia, LEUKEMIA ACUTE LYMPHOBLASTIC, ALL, acute lymphoblastic leukemia, [M]Acute lymphoid leukaemia, [M]Acute lymphoid leukemia, Acute lymphocytic leukemia, acute lymphatic leukemia, acute lymphogenous leukemia, ALL (acute lymphocytic leukemia), acute lymphocytic leukemia (diagnosis), acute lymphocytic leukemia, Acute lymphoblastic leukemia (morphologic abnormality), Acute lymphoid leukaemia, disease, Acute lymphoid leukemia, disease, Acute lymphoblastic leukaemia -RETIRED-, [M]Acute lymphoid leukaemia (disorder), Lymphoid leukaemia, acute, Leukemia lymphoblastic acute, [M]Acute lymphoid leukemia (morphologic abnormality), Acute Lymphocytic Leukemia, Acute Lymphoblastic Leukemia, Acute Lymphogenous Leukemia, Precursor Lymphoblastic Leukemia, Acute Lymphocytic Leukemias, acute lymphocytic leukemia (ALL), Acute lymphoblastic leukemia [ALL], Acute lymphoblastic leukaemia NOS, Acute lymphoblastic leukemia NOS, Leukaemia;acute lymphocytic, acute lymphatic leukaemia, leukemia lymphoblastic, leukemia acute lymphoblastic, acute lymphoblastic leukaemia, acute lymphoblastic leukemias, leukemia - acute lymphoblastic, lymphocytic leukemia acute, acute leukaemia lymphoblastic, acute leukemia lymphocytic, acute leukemia lymphoid, acute leukemia lymphoblastic, acute lymphoid leukemia, lymphoblastic leukaemia, lymphoblastic leukemia, Leukemia, Acute Lymphoblastic, Leukemia, Acute Lymphocytic, Leukaemias acute lymphocytic, Leukaemia lymphoblastic acute, Acute lymphoid leukemia, Acute lymphatic leukemia, Lymphoblastic leukemia, ALL - Acute lymphoblastic leukaemia, ALL - Acute lymphoblastic leukemia, Acute lymphoblastic leukaemia, Acute lymphoblastic leukemia, Acute lymphoid leukaemia, Acute lymphatic leukaemia, Acute lymphocytic leukaemia, Acute lymphoblastic leukaemia-lymphoma, Acute lymphoblastic leukemia-lymphoma, Acute lymphoid leukemia, disease (disorder), Lymphoblastic leukaemia, leukemia, acute lymphocytic, leukemia; lymphatic, acute, lymphatic; leukemia, acute, Acute lymphoblastic leukemia, NOS, Lymphoblastic leukemia, NOS, Acute lymphoblastic leukemia -RETIRED-, Lymphoblastic Leukemia, Acute Lymphocytic Leukaemia, Acute Lymphoid Leukemia, Precursor Cell Lymphoblastic Leukemia, ALL - Acute Lymphocytic Leukemia, Leukemias acute lymphocytic, Leukemia;acute lymphocytic, acute lymphocytic leukaemia
Spanish leucemia linfoide aguda, enfermedad, Leucemia linfática aguda, Leucemia linfoide aguda, Leucemia linfoblástica aguda, [M]Acute lymphoid leukemia, [M]Acute lymphoid leukaemia, [M] leucemia linfoide aguda, [M] leucemia linfoide aguda (anomalía morfológica), leucemia linfoide aguda, enfermedad (trastorno), leucemia linfoide aguda, Leucemia aguda linfocítica, Leucemia linfocítica aguda
Italian Leucemia linfocitica acuta, Leucemie linfocitiche acute, Leucemia linfoblastica acuta, Leucemia linfatica acuta, ALL, Leucemia linfoide, acuta, Leucemia linfoide acuta
Dutch lymfoïde leukemie, acuut, acute lymfatische leukemie, acute lymfoblastische leukemie, acute lymfoïde leukemie, lymfoblastische leukemie acuut, ALL, leukemie; lymfatisch, acuut, lymfatisch; leukemie, acuut, Acute lymfoblastenleukemie, acute lymfocytaire leukemie, lymfocytische leukemieën acuut
French Leucémie lymphatique aiguë, Leucémie lymphoblastique aiguë, Leucémie lymphoïde aiguë, LLA, Leucémie lymphoïde, aiguë, Leucémie lymphocytaire aiguë, Leucémie aiguë lymphoblastique, Leucémies lymphocytaires aiguës
German akute lymphoblastische Leukaemie, akute Lymphoblastenleukaemie, ALL, akute lymphoide Leukaemie, lymphoide Leukaemie, akut, akute lymphablastische Leukaemie, Leukaemie lymphoblastisch akut, Akute lymphoblastische Leukaemie, Leukaemien akut lymphozytaer, akute lymphatische Leukaemie
Portuguese Leucemia linfóide aguda, Leucemia linfática aguda, Leucemia linfoblástica aguda, Leucemia linfocítica aguda, Leucemias linfocítica aguda
Japanese 急性リンパ球性白血病, 急性リンパ性白血病, 急性リンパ芽球性白血病, ＡＬＬ, ALL, ｷｭｳｾｲﾘﾝﾊﾟｷｭｳｾｲﾊｯｹﾂﾋﾞｮｳ, ｷｭｳｾｲﾘﾝﾊﾟｾｲﾊｯｹﾂﾋﾞｮｳ, ｷｭｳｾｲﾘﾝﾊﾟｶﾞｷｭｳｾｲﾊｯｹﾂﾋﾞｮｳ
Czech Akutní lymfatická leukemie, Akutní lymfoblastické leukemie, Akutní lymfoidní leukemie, Akutní lymfocytická leukemie, Akutní lymfoblastická leukemie, ALL
Korean 급성 림프모구성 백혈병
Hungarian Heveny lymphoblastos leukemia, Heveny lymphoid fehérvérűség, Acut lymphatikus leukaemia, Acut lymphatikus leukemia, Acut lymphoblastos leukemia, ALL, Acut lymphoblastos leukaemia, Lymphoid fehérvérűség, heveny, Acut lymphocytás leukemia, Leukemiák, acut lymphocytás, Fehérvérűség limfoblasztos heveny, Lymphoid fehérvérűség, acut, Acut lymphocytás leukaemia, Acut lymphoid leukaemia
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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