Acute lymphocytic leukaemia

Last reviewed: 1 Sep 2022
Last updated: 05 Mar 2021

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • lymphadenopathy
  • hepatosplenomegaly
  • pallor, ecchymoses, or petechiae
  • fever
  • fatigue, dizziness, palpitations, and dyspnoea
  • bruising, epistaxis, menorrhagia
More key diagnostic factors

Other diagnostic factors

  • papilloedema, nuchal rigidity, and meningismus
  • focal neurological signs
  • painless unilateral testicular enlargement
  • renal enlargement
  • bone pain
  • abdominal pain
  • mediastinal or abdominal mass
  • pleural effusion
  • skin infiltrations
Other diagnostic factors

Risk factors

  • children less than 5 years of age
  • age in mid to late 30s
  • age in mid 80s
  • genetic factors
  • family history of ALL
  • viruses
  • environmental factors
  • history of malignancy
  • treatment with chemotherapy
  • male sex
  • white population
  • poor maternal diet
More risk factors

Diagnostic investigations

1st investigations to order

  • FBC with differential
  • peripheral blood smear
  • serum electrolytes
  • renal function
  • liver function
  • lactic dehydrogenase
  • coagulation profile
  • bone marrow aspiration and trephine biopsy
  • immunophenotyping (on bone marrow, or peripheral blood if cell count is raised)
  • thiopurine methyltransferase (TPMT) phenotyping
  • nudix hydrolase 15 (NUDT15) phenotyping
  • cytogenetics
  • molecular studies
More 1st investigations to order

Investigations to consider

  • HLA-typing
  • chest x-ray
  • lumbar puncture (LP)
  • pleural tap
  • CT/MRI brain
  • CT
  • minimal residual disease molecular samples
More investigations to consider

Treatment algorithm

ACUTE

newly diagnosed ALL without CNS disease

newly diagnosed ALL with CNS disease

ONGOING

complete remission: standard risk

complete remission: high risk

relapsed or refractory disease

Contributors

Authors

Melissa Ooi, MB BCh, BAO, MRCP(I), FRCPath, PhD

Consultant

Department of Haematology-Oncology

National University Cancer Institute

Singapore

Disclosures

MO declares that she has no competing interests.

Michelle Poon, MBBS, MRCP, FRCPath

Senior Consultant

Department of Haematology-Oncology

National University Cancer Institute

Singapore

Disclosures

None declared.

Esther Chan, MD

Consultant

Department of Haematology-Oncology

National University Cancer Institute

Singapore

Disclosures

EC declares that she has no competing interests.

Chin Hin Ng, MD, MRCP, FRCPath

Consultant

Department of Haematology-Oncology

National University Cancer Institute

Singapore

Disclosures

CHN declares that he has no competing interests.

Acknowledgements

Dr Melissa Ooi, Dr Michelle Poon, Dr Esther Chan, and Dr Chin Hin Ng would like to gratefully acknowledge Dr Arati V. Rao, Dr Matthew Smith, Dr Samer Bleibel, and Dr Robert Leonard, previous contributors to this topic.

Disclosures

AVR, MS, SB, and RL declare that they have no competing interests.

Peer reviewers

Olga Kozyreva, MD

Staff Physician

Department of Hematology and Oncology

New England Medical Center

Tufts University

Boston

MA

Disclosures

OK declares that she has no competing interests.

Shankaranarayanan Paneesha, MD, MRCP, FRCPath

Consultant Haematologist

Department of Haematology and Stem Cell Transplantation

Heartlands Hospital

Birmingham

UK

Disclosures

SP declares that he has no competing interests.

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