Summary

• Clinical history plus most signs and symptoms are non-specific and reflect bone marrow dysfunction. They include fatigue, dyspnoea, dizziness, bleeding, easy bruising, and recurrent infections.
• Physical examination may reveal pallor, ecchymoses, lymphadenopathy, and hepatosplenomegaly. There may also be evidence of tissue infiltration such as bone pain, testicular enlargement, and cranial nerve symptoms and signs.
• Definitive diagnosis requires bone marrow biopsy. Presence of blast cells in >25% of the bone marrow cells confirms the diagnosis of acute lymphocytic leukaemia (ALL). Initial peripheral blood smear may show leukaemic lymphoblasts.
• Treatment uses multi-agent dose-intense chemotherapy regimens in induction, consolidation, and maintenance phases. Early stem cell transplantation considered in selected patient population.
• Despite the aggressive management methods, less than 30% of adults with ALL can be cured. Long-term adverse effects of treatment include heart failure, sterility, secondary malignancies, and neurotoxicity.