AM report 10/26/16: Acute lymphoblastic leukemia

Epidemiology
Peak incidence ages 2-5, most common leukemia in children/teens but can occur in adults! (like our patient)

Timing

Sub-Acute

Signs & Symptoms

-60 % Hepatosplenomegaly
-50 % lymphadenopathy
-33 % musculoskeletal pain (bone pain)
-Symptoms of low hemoglobin/platelet (usually WBC<10k, platelets <1000)- eg: bruising, bleeding.
-Headache
-Can also see unilateral testicular enlargement and mediastinal mass (mimicking NHL)

Workup

Bone marrow biopsy showing >30 % lymphoblasts
-Chem 10, uric acid-HIGH risk of tumor lysis syndrome with ALL
-Flow cytometry- check if it is B cell (eg: CD10/CD19/CD20) or T cell (Cd2, 4,5,7,8), usually Tdt+, MPO- in ALL
-Philadelphia Chromosome (T:9:22)-If positive, associated with worse prognosis

Treatment

Induction-CALBG + tyrosine kinase inhibitor if + Philadelphia Chromosome
-Consolidation
-Maintenance
-CNS prophylaxis

See image below that shows  progenitors for lymphocytes which are from a common lymphoid progenitor while granulocytes, platelets, RBC, and mast cells originate from a common myeloid progenitor.

1280px-Hematopoiesis_simple.svg.png

Image by Mikael Häggström, from original by A. Rad – Image:Hematopoiesis (human) diagram.png by A. Rad, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=7351905

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